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08/18/2014

The raging Ebola epidemic in West Africa—will the key lessons be learned?

by Arthur Caplan, Ph.D.

Ebola, according to the World Health Organization (WHO) is out of control in West Africa.  The disease, which is transmitted by contact with contaminated blood or body fluids, or by close contact with a dead body infected with the virus, has killed more than 1100 people in Guinea, Sierra Leone, Liberia, and Nigeria.  The number of dead is most likely higher since people were dying in rural villages without being counted. At least another 1000 persons are infected.  The world faces the worst outbreak of this horrific disease since 280 people died when the Ebola first appeared in humans near the Ebola river in the Democratic Republic of the Congo in 1976.  The overriding ethical question Ebola raises is how did this epidemic get out of control?

According to both Medecins Sans Frontiers (MSF), one of the leading not-for-profit non-governmental medical aid organizations in the world, and a young worker who recently visited me after coming off the front lines fighting the Ebola outbreak, this tragedy should not have occurred.  Worse, arguing about topics such as who should get the miniscule supply of experimental drugs available to treat victims or vaccines to prevent the future spread of Ebola obscures the lessons that need to be learned to contain this outbreak and prevent future ones.

The young public health worker told me that the initial response to the outbreak in Guinea was simply pathetic.  International agencies and organizations, afraid of offending local officials and governments who were in denial or slow to respond, said almost nothing about the initial inadequate local response.  Neither, despite all the coverage of Ebola, have the media.  The worker was particularly bitter about the lack of cooperation and help provided by the UN, Red Cross and other resources in locations near the original outbreak sites.  In the early days of the epidemic when there might have been a chance of bottling Ebola up “no one came to help” her and the few others who were there trying their best to respond.

In Guinea, Liberia, and Sierra Leone, the story was the same. Local governments did not want to admit there was an Ebola problem.  Local officials were terrified of the disease and would not come near outbreak areas to see what was going on or what was needed.  Even as the outbreak spread, international agencies talked a lot but deployed very little on the ground help.

In March 2014, an outbreak of Ebola hemorrhagic fever started in forested areas of southeastern Guinea. As of March 25th 86 suspected cases including 60 deaths had been reported to nearly universal world indifference. The outbreak subsequently spread to Sierra Leone, Liberia and Nigeria.  Still there was little attention paid.  It was not until August 1st that the WHO and the governments of Sierra Leone, Guinea and Liberia launched a joint $100 million response plan as part of an intensified international campaign to bring the outbreak under control.  By August 8th WHO declared the Ebola outbreak in West Africa a Public Health Emergency of International Concern.

Funding for a response to the initial Ebola outbreak did begin to flow in April and May to international relief organizations, but the money did not fuel on the ground action.  UN agencies organized multi-national meetings and released statements, but few additional staff were actually deployed and on the ground in affected areas in April and May according to my source.

At the start of the outbreak traditional cultural practices of touching the body of a person who has died fueled the epidemic.  With intensive health education, those practices could have been changed but, again according to what my source saw, no resources were available to try to change risky behavior.

MSF echoes her complaints.  In a recent July 2014 report telling titled “Where is everyone?” on the state of humanitarian aid MSF observes, “Humanitarian agencies have adopted a stance on security which is risk-averse and which led, in more than a few cases, to populations being without emergency assistance when they most needed it.”

MSF basically says that recent catastrophes in Africa and elsewhere show that despite huge sums of money being spent by governments and philanthropists the world does not have an effective strategy or system for responding to public health emergencies.  The Ebola epidemic sadly provides further evidence that this is so.

How bad are the consequences of the epidemic?  The disease is taking a bigger toll than just hundreds of dead.  The long-term consequences of this outbreak will be devastating to a region that has already faced brutal civil wars and crushing poverty. The population of doctors and nurses has been decimated in countries already struggling with too few trained health workers. Development projects such as road construction which would help farmers get produce to markets have been stopped because of the outbreak.  Food shortages are likely.

The world is not indifferent to the plight of poor people ravaged by disease and tragedies.  Huge sums of money go to build resources that are meant to provide a capability to respond quickly to diseases like Ebola.  But there is little accountability and a good deal of back-scratching in evaluating the international aid scene.  It is time to take a long, hard and public look at how the morally commendable drive to give money to do good for those in desperate need is apparently not doing well for them.

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