Ebola: A Case of Lagging and Misguided International Response

As of October 1, 2014 the West African Ebola Outbreak has infected 7,470 people and claimed 3,431 lives in Guinea, Liberia and Sierra Leone. The virus has been further spread by travelers to Nigeria (20 cases, 8 fatalities), Senegal and the United States (1 case each), further escalating the fear surrounding this outbreak that Margaret Chan, the Director-General of the WHO, says is “the largest, most complex and most severe we’ve ever seen and is racing ahead of control efforts”. The WHO believes that the outbreak can be contained in 6-9 months, but only if a “massive global response” is implemented. Unfortunately, the outbreak continues to spiral out of control. Moreover, the slow international response over the past few months is responsible for the doubling  of  the number of infected people every 15-20 days in Liberia and every 30-40 days in Sierra Leone and Guinea. At the current rate, the CDC estimates that there will be approximately 550,000 cases in Liberia and Sierra Leone but figures could reach as high as 1.4 million cases. 70 percent of patients must be placed into Ebola Treatment Units or appropriate community settings with reduced transmission risks and proper burial practices in order to halt the epidemic, a task that will only grow more difficult and require more beds, staff, and supplies the longer the current situation is allowed to continue.

The governments of the three most heavily affected countries have implemented measures to contain the epidemic such as instituting restrictions on public and mass gatherings, closing of borders and some entry and exit points, instituting screening at open travel points, closing down  school systems and using the police and military to enforce prevention and control measures. Sierra Leone instituted a three day mass quarantine while 7,000 teams of health workers went door to door to locate Ebola patients, spread awareness, and properly dispose of dead bodies.  International teams of public health specialists and doctors have been sent to the affected nations to try and assuage the situation. However, the already fragile health systems and the limited amount of aid provided by small private organizations cannot nearly meet what is needed. In order to have a chance at putting up an effective response the amount of aid must increase so that it can make up for the severe shortage of manpower, equipment and supplies.

Nigeria’s response and apparently successful containment of Ebola after it appeared and began to spread shows the impact that rapid and effective response can have. After the first patient was identified as having Ebola, he was isolated, possible contacts were quickly identified, and an emergency operations center was formed. Eventually, the nearly 900 possible contacts were identified and monitored, foreign physicians with experience treating Ebola were called in, and an outreach program reached approximately 26,000 households who were near infected people and might have had contact with Ebola patients. The Nigerian government’s efforts contained the outbreak at only 20 people and 9 fatalities, a much smaller impact than the devastation currently being experienced elsewhere. Unfortunately, such an effective response in Liberia, Sierra Leone or Guinea would have required a large amount of outside support as Nigeria represents a wealthier African nation, has a better developed health system and was already aware of the threat due to the existing outbreak in other countries. The continuously worsening status of the outbreak will only increase the amount of  aid necessary to fill in the growing gaps in these three countries health systems.

International organizations such as Medicins Sans Frontieres and the Red Cross were some of the first to respond, sending thousands of personnel to provide medical treatment and logistical support while other organizations such as AmeriCares are collecting funds and sending hundreds of tons of equipment to send in support. So far, the British government has pledged to build a 700 bed hospital, Cuba has sent 165 health professionals and is training 296 more, China has sent 59 medical workers and the United States have promised more than 3,000 troops, training of 500 volunteers every week, and have already built 3 labs to confirm suspected Ebola cases and treatment centers to relieve some of the strain on the health system.

Unfortunately, that is still not enough. “We’ve raised a tenth of donations we received following the typhoon in the Philippines” said Kevin Allan, the senior vice president at AmeriCares. The Ebola outbreak is not as visual as other past emergencies, slowly developing over time rather than in a single dramatic incident, and an outbreak that has largely been confined to Africa making it an unlikely target for large amounts of donations. Logistics issues have also severely hampered the infrastructure development currently underway, delaying any utility from the construction. Even if all of the construction was completed they would still be ineffective as there is a massive need for human resources. Finding volunteers to man the new facilities is difficult due to the fear and danger surrounding Ebola, as exemplified by the 216 medical workers that have already died from Ebola and the many more that have been attacked while trying to help. Israel has even refused to send medical workers or set up field hospitals due to fear of infection.

Most of the action the international community has taken in response to the outbreak has been focused on detection and prevention of Ebola within their own borders, such as requiring screening for incoming passengers on flights and requiring all health workers returning from Ebola infected countries to be quarantined for 21 days. Saudi Arabia banned visas from Liberia, Guinea and Sierra Leone, deployed hundreds of health officials and 22,000 doctors, created 24 isolation units, and requires all incoming planes to be sprayed down twice as they prepared for the large influx of African pilgrims participating in the hajj. Air France, British Airways, Air Côte d’Ivoire, Nigeria’s Arik Air, Togo’s ASKY Airlines, British Airways, Emirates Airlines and Kenya Airways have suspended all flights from affected areas while many nations have closed their borders or instituted varying levels of travel restrictions despite warnings from experts not to do so. Restricting travel in and out of affected countries severely hampers delivery of medical staff and supplies, damages economic activity, and stops medical personnel who travel there to help from leaving to receive treatment if they are infected, all while doing nothing to stop the virus’ spread. Both the WHO and CDC assert that screening passengers and only disallowing infected passengers adequately protects the public, as patients are not contagious until after they are symptomatic and the virus can only be transmitted through direct contact with an infected person’s bodily fluids.