This article is more than 5 years old. Information may no longer be current.
The Ebola epidemic: A costly and preventable global health security and humanitarian crisis
Click Here to Manage Email Alerts
The unprecedented ongoing Ebola crisis provides a vivid reminder of the cost of complacency, of the critical importance of strengthening health care and public health systems around the world, and a tragic example of the consequences of failure of national governments and international organizations to address these issues.
Ebola virus disease, previously known as Ebola hemorrhagic fever, is a zoonosis originating in wildlife. The current outbreak, which began in late 2013 in Guinea, is occurring in three West African countries that have recently suffered from prolonged civil strife and which have not experienced Ebola outbreaks in the past. The outbreaks — first in Guinea, followed by Sierra Leone and Liberia — began in remote rural settings with extremely limited health care and public health system capacity near porous national borders. As a result of delays in recognition, reporting, response, and public health prevention message dissemination, the virus (a new clade of Zaire ebolavirus) spread to large urban slums in the three national capitals where it was rapidly amplified with disastrous consequences for patients, health care workers, family members and local communities. The largest Ebola outbreak in history by several orders of magnitude has now spread to other African countries (Senegal, Nigeria and Mali, so far), Europe and the United States with more dissemination likely to occur, resulting in widespread fear, stigmatization of affected persons, family members and population groups, and distrust of local authorities and international response teams.
In recognition of the severity of the problem and the risk for further international spread, WHO declared the epidemic a Public Health Emergency of International Concern, marking the first time WHO has done this for an Ebola outbreak. The UN Security Council subsequently passed a resolution co-sponsored by more than 130 countries creating a UN Mission for Ebola Emergency Response based in Ghana. President Barack Obama convened a Cabinet meeting to discuss the crisis, defined a role for the US military in construction of and logistical support for much-needed health care facilities in Liberia, called on other countries to provide more assistance to control the epidemic at its source, and appointed an Ebola Response Coordinator (“czar”) to coordinate the US government response. These actions are encouraging, but delays in escalating the international response are evident as the impact of the epidemic on national economies and food security has become apparent and the risk for local and international spread increases.
James M. Hughes
Closer to home, clinical experience in specialized containment units in caring for US health care workers infected abroad has begun to provide vital information on the natural history and complications of the disease. It has shown that with intensive supportive care, seriously ill patients can survive, while at the same time highlighting the infection risk to health care workers and illustrating the many logistical challenges involved in the care of these patients. In the first US community hospital to care for an imported case in a traveler, the infection spread to two health care workers, indicating the need to strengthen local preparedness and infection control supervision and training with particular emphasis on proper procedures for donning and doffing personal protective equipment. This experience has raised doubt about the ability of many US hospitals to provide care safely for patients with Ebola virus disease and has stimulated local and regional preparedness planning activities. Efforts have intensified to develop Ebola countermeasures, but it will be sometime before safe, effective drugs or vaccines are available in sufficient quantities to meet the need in epidemic countries.
Traditional public health measures (prompt patient isolation and reporting, aggressive contact tracing, evidence-based humane quarantine of individuals at risk for infection accompanied by logistical and salary support for them, effective implementation of appropriate infection control precautions, and public education programs) were effective in controlling and eventually ending the international severe acute respiratory syndrome (SARS) epidemic in 2003 and in controlling recent Ebola transmission in Nigeria and Senegal. These same measures, if aggressively implemented, are likely to be effective in decreasing transmission while efforts to develop countermeasures continue.
For now, it is critical to think globally but act locally. For many years, alert health care providers have played central roles in the recognition of new or newly introduced diseases. Health care providers are on the front lines for early detection of patients with possible Ebola virus infection. Travel and contact histories are critical in ensuring prompt isolation of patients with possible infection and timely notification of public health authorities while diagnostic tests are being performed. The CDC, professional societies, and journal editors also have a crucial role to play in informing front-line providers in a timely way of current and evolving information on clinical features and management of infected patients; on evolving guidance for educating their colleagues, co-workers and the public about the disease; and on the inevitable unexpected events that are likely to occur.
Looking ahead, the current crisis provides some important, unprecedented opportunities to learn more about the transmission, pathogenesis, natural history, optimal management, and effective infection control procedures and practices and should provide the opportunity to assess the efficacy of new therapeutic approaches and vaccine strategies. There is also an opportunity for ongoing reflection on lessons being learned from this crisis and previous emerging infection epidemics resulting from cross-species transmission, such as hantavirus pulmonary syndrome, West Nile virus infection, SARS, avian and pandemic influenza, and MERS. These and other recent examples reinforce the urgency of strengthening health care and public health systems around the world and increasing the required collaboration among the multiple disciplines focused on diseases that arise at the human-animal-ecosystem interface as emphasized by the One Health approach. It is important to realize that emerging microbes may be viewed as probes that will continue to highlight inequities, health care and public health system deficiencies, and risky human behaviors.
As the staggering human and economic costs of the current outbreak escalate, it is sobering to consider that the West African urban outbreaks and the international spread were preventable had there been sufficient political will to make modest investments in strengthening early detection and rapid response capabilities in the context of efforts to invigorate health care and public health systems in a sustainable way.
For more information:
James M. Hughes, MD, is a past president of the Infectious Diseases Society of America, professor of medicine and public health at Emory University, and an Infectious Disease News Editorial Board member. Hughes also served as director of the National Center for Infectious Diseases at the CDC.
Disclosure: Hughes is a past president of the IDSA.