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Ebola: The Mounting Cost of Inaction

By  Tanya Anderson

On December 6,  2013, the 2-year-old boy suspected to be “Patient Zero” in what is currently the world’s largest Ebola outbreak, was buried in a border town in Guinea. The toddler would be the index case for the West African Ebola outbreak, and his funeral the point source for person-to-person infection with EBOV–the species of ebolavirus known to be the most common cause of outbreaks—and boasting fatality rates of over 50 percent. For three months, the disease quietly traversed Guinea before making its way across the neighboring border with Sierra Leone, and by the fifth month Liberia was also in the throes of intense and active transmission. 

As of August 31, 2014, the official death toll has exceeded 1,800, with all predictive models pointing to exponential increase–as many as 20,000 more cases by October–and no end before 2015. For the first time since Ebola was discovered in 1976, the disease migrated out of Central Africa into a novel population that was unprepared for surveillance or control. While the disease remained unidentified, it reached urban centers, including the capital cities of Freetown and Monrovia, where transmission continues unabated. Doctors Without Borders (MSF) and the World Health Organization, have both sounded the alarm: they are understaffed and outmatched by the gravity of the virus. 

The West African Ebola outbreak demonstrates what can happen when globalization—marked by increased urbanization, mobility, and connectivity—outpaces sanitation and development. Connectivity has meant that the world bears witness as people, cities, countries, and whole continental regions are brought to their knees. 

The Centers for Disease Control, responding to concerns about Ebola traveling to the United States, has issued an announcement that “the West African Ebola outbreak does not pose a significant risk [to the United States]." Despite reassurances that our medical system and infrastructure would be able to easily handle and diffuse Ebola, a poll conducted in August by the Harvard School of Public Health, finds that 40 percent of Americans are worried about an outbreak on American soil.  

Has globalization had the net-effect of exporting and circulating this fear because we recognize shared humanity in the face of aggressively transmittable and incurable disease, or could the disconnect between individual fear and an insistence for action be a result imagery that closely mirrors much of what we’ve seen in the last 20 years of commercial media? Is there something in all of this that feels surreal–eerily familiar to storylines in The Hot Zone, Outbreak, and Contagion, of exotic and mythologized pathogens that turn into global pandemics? Have we become inured to action, despite the terror we feel in observing, because we’ve been primed to believe that it will all be over in short order?

Disease Trajectory and Potential Impact

The West African Ebola outbreak has a strong foothold in the region for reasons that transcend geography, namely, a lack of resources, healthcare and sanitation infrastructure, a dearth of medical professionals, and cultural forces such as funerary rituals and a growing mistrust of those responsible for relief efforts. 

This has led to the exponential spread of the virus, particularly in Liberia, where the most recent reports indicate a doubling in the number of new cases. Fear of stigma and death has run rampant within affected countries, driving infected patients underground where they continue to infect those around them, and contributing to underreporting, also referred to as an “invisible caseload.” The situation remains. As of September 8, Liberia reported over 2,000 cases and over 1,000 dead–including 152 infected health care workers, 79 of which have died. In cases where patients are brought to hospitals and treatment facilities, they often find that they are at capacity, and the sick are either left to die outside their walls or return home.

Ebola disease models, which can take into consideration observed rates of growth and characteristics of the pathogen, geography, demographics, as well as control efforts, indicate that the impact of Ebola is highly dependent on control methods deployed–and the timing of those efforts. While predictive models are less accurate in their long term projections, they should serve as an ominous warning–with the difference between an improvement in control methods versus maintaining the current levels of intervention at over 45,000 people by mid-October. 

The economic effect of the West African Ebola outbreak has already started to emerge and is effecting more than just the countries experiencing high-levels of transmission: borders are tight, if not completely closed–impeding trade, tourism, and travel. The International Monetary Fund had originally forecasted that growth in sub-Saharan Africa would be around 5.4 percent in 2014, but the IMF is predicting that the outbreak has already slowed Guinea’s growth by a point, 3.5 percent. Sierra Leone, recently the picture of African ascent from destitution, was predicted to grow by almost 14 percent, but as an economy in which agriculture accounts for percent, the decrease in productivity and a decline in exports will result in significant damage to the country’s economic stability. Liberia, the hardest hit of the three countries, is also dependent on agriculture for a significant portion of its GDP and may have already sustained enough economic damage to again destabilize the country for years to come. Extending the outbreak another six or nine months may have devastating effects on food supply and prices across the continent. 

A Call to Action

Despite the potential for unequivocal humanitarian crisis and the economic devastation to the affected countries, the United States has committed $75 million towards the effort—$25 million more than the Gates Foundation, and less than half of that of the European Union. Liberia, a country the United States shares a storied history and close relationship with, pleaded for American intervention. In a letter to President Obama, the President of Liberia, Ellen Johnson Sirleaf wrote, “at this rate, we will never break the transmission chain, and the virus will overwhelm us.” The U.S. responded with a promise of a 25-bed military hospital in the capital of Monrovia. 

Unlike the events of the Arab Spring, which unfolded a world away, there is no celebration in this uprising, no rationalizing about how immediate destabilization could result in long-term gain. The current West African Ebola outbreak presents a unique opportunity for interventionist humanitarian action, where an immediate call to arms can diffuse a cruel force of nature, essentially stopping and quelling a tsunami before landfall. As President Obama travels to the CDC to be briefed on the outbreak, it would be wise of him to fully consider the costs of continued inaction. 

 

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Tanya Anderson is a medical scientist currently serving as a Fellow with the Global Development Institute. Anderson is a native of the Democratic Republic of Congo. Her twitter handle is @mstanyaanderson

[Photo courtesy CommonDreams.org]

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