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Health infrastructure’s hand in Ebola outbreak

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By James McKeon and Allen Moore: 

The worst Ebola outbreak in history continues to rage in Guinea, Liberia, and Sierra Leone, painfully reminding the global community that deadly diseases are not constrained by political boundaries and can spread virtually anywhere. These countries, in particular, because of their relatively low rates of HIV, have not received the support that other African nations have received over the years – hefty investments in public health infrastructure through trained workers, clinics, laboratories, medicines, and education. As such, public health scourges have settled in the most vulnerable areas, yet radiate insecurity locally, regionally, and even internationally. In an era when official resources to address global public health challenges are demonstrably finite, this recent outbreak is a case study of the need to invest more resources for international disease prevention and monitoring, to think more creatively to spread limited resources more efficiently, and how to better leverage intersecting interests to promote global health security.

The recent Ebola outbreak began in February 2014 in Guinea, soon spreading to Liberia and Sierra Leone. On July 20, Patrick Sawyer, a consultant to the Liberian Finance Ministry who lived in the United States, collapsed from the disease just after his plane landed in Lagos, Nigeria. His collapse and subsequent death five days later triggered fears that the disease could have stricken other passengers on the flight, potentially spreading it into the Nigerian capital and other countries across the globe. As of late July, the World Health Organization had recorded over 670 fatalities from the disease. The health sector, at all levels, is frantically responding to the outbreak by deploying medical experts and technical resources to the region to help contain a disease that can have a mortality rate of 90%.

There is no known treatment or preventive vaccine for Ebola. Often described as one of the deadliest known diseases in the world, its health effects are gruesome for those infected. The National Institutes of Health notes that symptoms include acute dysentery and bleeding from the ears and nose, along with other hemorrhaging. The disease is transmitted to human beings through infected animals and their feces, likely a certain kind of “fruit bat,” and can spread from person to person through physical contact or infected instruments at a hospital. In Guinea, the initial fatalities were mistaken for malaria and the families and friends of the victims unknowingly spread the disease by handling infected bodies.

The international community is treating the outbreak with great urgency, but the spread of the disease is proving very difficult to control. Could Ebola appear in more neighboring countries in the near future? Could it spread to other continents? The early response to the outbreak has resulted in fearful reaction by neighboring countries. For example, the Ivory Coast recently prevented repatriation of 400 of its own citizens from Liberia, a decision that has been criticized as illegal under international law. Any further spread of the disease could easily trigger more panic from authorities.  

What about bioterrorism? Could Ebola be used as a terrorist agent? Dr. Nancy Weissbach, an infectious disease physician based in Pennsylvania, recognizes that a further spread is possible but is skeptical of the role of Ebola as a bioterrorist agent. “A bioterror attack is meant to have maximum exposure to the most people in as little time as possible before anyone can get a handle on it,” she says. “Ebola just does not work that way.” Dr. Weissbach notes that since Ebola is not transmitted through air or water, it is a very poor candidate for bio-terrorism. Her bigger concerns include severe acute respiratory syndrome (SARS), anthrax, and other diseases that are comparatively easier to spread. However, she is hesitant to completely rule out Ebola as a bioterror threat.

The United States has only seen Ebola in quarantined lab facilities in Virginia, Pennsylvania, and Texas. Wealthier countries with a well-established health infrastructure can usually identify and isolate cases of exotic diseases relatively quickly. Furthermore, advanced communications capabilities permit authorities to inform the public about the presence of toxic agents, how to identify them, what to do if they are observed, and how to prevent exposure.

It is noteworthy that none of the first three countries where Ebola has appeared has an HIV infection rate above 1.6%. That means that none of the three has received the huge investments in public health infrastructure common in recent years to African countries with much higher HIV infection rates. Those investments mean trained workers, clinics, modern laboratory capabilities, medicines, public education, etc. The lack of educational resources has proven to be one of the most difficult challenges for international health responders who are struggling with certain sections of the population who believe the Ebola outbreak is either a hoax or inflicted by foreign doctors. Nonetheless, the lack of overall investment represents the menu of capabilities that all countries need to identify and respond to the outbreak of diseases like Ebola, or the next virus that migrates from the animal species to man, or…a bio-terrorism attack.

As political and health leaders bring forth all available resources to get control of the recent Ebola outbreak, they would do well to consider the benefits of systematically improving the health infrastructure – through investments that have already been given to countries with higher HIV infection rates– in all developing countries. Where resources are insufficient, identifying partnerships between the public health community, the national security establishment, and private industry can help fill critical gaps, build upon common interests, and promote sustainability of effort. 

Photo credit: EU Humanitarian Aid and Civil Protection via flickr

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