This most recent outbreak of the viral disease named after a Congolese river, Ebola, has captured the imagination here in the west as no disease has since Yellow Fever. This is due partially to the influence of modern media, and the ignorance of the average person. Ebola is easily contained using epidemiological methods that are at least 100 years old. Those methods include isolation, confining the population of exposed to persons, thus halting the spread of the disease. Add to this the failure of needed infrastructure in third world nations and you have conditions that are ripe for disease. The conditions are well-known: lack of running water, lack of sanitation, poor or nonexistent healthcare treatment facilities, lack of food and starvation, and a lack of healthcare education. The number of physicians in affected areas was between one and four per 100,000 people before the onset of the 2015 Ebola outbreak. Before this latest Ebola outbreak, the world had seen several other Ebola epidemics. Zaire and the Congo had experienced Ebola in the past.
In 2000 and 2001, Uganda suffered an outbreak of Ebola, followed by outbreaks in 2002 in the Republic of Congo and Gabon. Another epidemic of Ebola struck in the Republican Congo in 2003, and again in 2004. The Democratic Republic of Congo would suffer Ebola outbreaks in 2012, and again in 2014. Many ask why the area of sub-Saharan Africa experiences so many epidemics of this highly fatal infectious disease? This is a complicated answer, and although the disease may have originated on the dark continent, the continued reemergence Ebola is largely influenced by the west.
Global public health leaders and policy makers don’t often agree with frontline workers, for example, Doctors Without Borders, concerning what they saw on the front lines. Politics, not health drives policy makers. When you combine this with the cultural divide, particularly the local believe systems concerning sickness and death, the influence of various churches who chose to capitalize on the outbreak, you have a system that is failing on multiple levels. From the disinterest of the Congolese politicians to the Church leaders who talk about sin as the cause of the outbreak rather than a virus, to the lack of Health facilities, the next outbreak of Ebola is not a question of if, but of when.
What exactly is Ebola?
If asked, the average person will state that Ebola is a disease. Asked further and they will shrug their shoulders. Science education in the US is abysmal at best. Ebola is a filovirus. While the means of infection are still not stablished, it is believed that the virus invades the host’s cells by a cholesterol transporter protein, the host-encoded Niemann–Pick C1 (NPC1), which appears to be essential for entry of Ebola virus into the host cell and for its replication. Viruses do not replicate through any type of cell division; rather, they use a combination of host- and virally encoded enzymes, alongside host cell structures, to produce multiple copies of themselves. These then self-assemble into viral macromolecular structures in the host cells. Ebola is also described as a zoonotic. A zoonotic must have an intermediary host or reservoir (an intermediary host). The end hosts are humans and great apes, infected through contact or with the reservoir animals or through infected humans or apes.
Ebola virus outbreaks have tended to occur when temperatures are lower, and humidity is higher than is usual for Africa. It is one of four known hemorrhagic viruses to cause disease in humans. It has the highest case-fatality rate averaging 83 percent since the first outbreaks in 1976, although fatality rates up to 90 percent have been recorded in the 2002–03 outbreak in the DRC and Zaire. The first outbreak occurred on 26 August 1976 in Yambuku.
The first recorded case was a 44‑year-old schoolteacher. The symptoms at first resembled malaria, and subsequent patients received quinine. By the time it was established that this was a new viral disease, transmission to other patients had already occurred, probably due to reuse of unsterilized needles and close personal contact, body fluids and places where the person has touched. Even after a person recovers from the acute phase of the disease, Ebola virus survives for months in certain organs such as the eyes and testes. It should be asked, how many of those in the west even know, much less cared about the emergence of this new, lethal disease?
The most recent Ebola outbreak started in early 2014, and would reach epidemic proportions, killing thousands of people. The toll has been especially serious in three countries: Guinea, Liberia, and Sierra Leone. A few cases have also been reported in countries outside of West Africa, all related to international travelers who were exposed in the most affected regions and later showed symptoms of Ebola fever after reaching their destinations.
The question, of course, is why, if the great public health agencies of the world, the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) knew about the periodic outbreaks of this often fatal disease, why has it failed to prevent these outbreaks?
As stated previously, this is a complicated question, one that starts not with the virus, but thousands of miles away. in the west. According to investigative journalist Sean Kelly, the leader of Zaire, a democratically elected President named Patrice Lumumba was unwilling to cooperate with Western governments, or perhaps more accurately, unwilling to allow Western governments to exploit the resources of his country. Enter the CIA.
Pillaging and Looting
According to Kelly, the CIA found a willing puppet in the Army Sgt. By the name of Mobuto. Working with Belgian nationalists, CIA help stage coup d’état. The democratically elected president Lumumba was executed, and now Col. Mobutu assumed the role of army Chief of Staff, before seizing power in another CIA-backed coup in 1965. As part of his program of “national authenticity,” Mobutu changed the Congo’s name to Zaire in 1971, and his own name to Mobutu Sese Seko. Mobutu received unwavering support for the CIA, and backed by the military strength of apartheid South Africa, he became a billionaire while his people starved. Despite the fact the country has vast mineral resources, in 1992 the Washington Post reported that “the cost of food is out of reach of most Zairians, so many eat just one meal a day.” U.S. policy was the direct involvement in the assignation of a foreign leader, one who oppressed his own people, murdered tens of thousands. But aside from being a tragic story of American political manipulation, how is this related to the Ebola outbreak of 2014?
During previous outbreaks of Ebola, Western public health organizations pumped tens of millions of dollars into Zaire in the form of hospital clinics, training for health workers, and diagnostic equipment. Yet when aid workers arrived in Zaire to combat this most recent outbreak, they were unprepared with what awaited them.
The hospital clinic, established and equipped with the latest, by 1980’s science, had been completely looted first by Mobutu’s soldiers and sold off to line the pockets of the politicians. Even the ambulance and sideband radio, the villagers’ only means of communication with the outside world, had been taken. Any treatment could only be rendered by day, as even the overhead lights had been taken, along with the generators, and any sanitary equipment like gowns or latex gloves. All taken soon after they arrived and sold off to line Mobutu’s pockets.
The West has largely ignored the unfolding epidemics, even as the one international responder, Doctors Without Borders, appealed for aid, all the while repeatedly warning that the virus was spreading out of control. The WHO, with its almost non-existent epidemic-response department slashed by years of budget cuts, monitoring the epidemic’s growth, but could take no real action. As the leading physicians in charge of combating Ebola in those African nations succumbed to the virus, global action remained imperceptible.
The West didn’t comprehend it in 2014, doesn’t get it in 2016, And probably never will. Governments universally slash budgets for public health. The CDC continually contents with hiring freezes and budget cuts. Meanwhile the epidemic continues. Epidemiologist use the term “R-naught” or RO to Measure the potential contagion of a disease; an RO of 1 means that each infected person is statistically likely to infect only one other. If the disease has an RO of less than one, the epidemic will die out as the number of infected is always decreasing. If the RO is great than 1, then the disease will spread, expanding into an epidemic. Christian Althaus, from the University of Bern in Switzerland, had calculated the RO for the current Ebola epidemic at outbreak in Guinea at RO = 1.5; each person infected, passed on the infection to one and a half other people. This is considered a moderate rate of epidemic growth. By early July 2014, the RO in Sierra Leone was a 2.53; the epidemic was more than doubling in size with each round of transmission. Liberia’s then-small rural outbreak was approaching RO=1.6.
Stopping the current epidemic and preventing the next one.
What seems clear today is that preventing the next deadly outbreak is going to require lots of money, a great many skilled health workers, hundreds of epidemiologists, infrastructure support, sanitation, and nutritional support for the people of West Africa. If we continue to cut funding to public health agencies and believe ourselves impervious to the Ebola’s of the tropical nations may soon discover we are not so isolated.