West Africa’s Galloping Ebola Crisis

Ebola is a highly fatal (normally 60 percent) virus, for which there is no cure or vaccine. Infection is through needles, touching, and most commonly, through contact with bodily fluids (e.g., blood, vomit, feces, sweat). The animal reservoir(s) for Ebola is not known conclusively, though there is strong evidence that it is associated with bats. Treatment is typically rehydration and antibiotics.

Q1: How is the West African outbreak different?

A1: The past few days have brought to the attention of Americans the alarming dimensions of the quick-moving Ebola crisis in West Africa. Never before, since the first recorded outbreak in 1976 in then-Zaire, has there been an outbreak that jumps rapidly from a first country, Guinea in this instance, to neighboring states, Sierra Leone and Liberia, and subsequently via an infected air passenger to a fourth, Nigeria. Never before has Ebola reached three national capitals. And the scale is unprecedented: the number of persons diagnosed with Ebola (over 1,300) and dead (over 700) are multiple times higher than the heretofore highest previous outbreak. The fatality rate is estimated at 60 percent and in some places may be much higher.

There is now a widespread perception that the outbreak is effectively out of control and that it has become a regional security emergency, with the potential to spread, especially to neighboring or nearby states. Ebola has utterly outstripped the region and is winning: it has killed Sierra Leone’s senior Ebola doctor, a prominent Liberian medical expert, and other officials.

The president of Sierra Leone has declared a state of emergency, banned public gatherings, and deployed troops and police. The president of Liberia has taken similar measures. Each has canceled plans to attend the U.S.-Africa Leaders’ Summit planned for Washington, D.C., August 4–6.

Q2: What are the special factors that made this wildfire possible?

A2: Sierra Leone, Liberia, and Guinea are three exceptionally poor, contiguous countries, each with acutely inadequate public health infrastructure, poor governance, and up to now utterly ineffectual national leadership. The first cases of Ebola are believed to have occurred in December 2013, yet with scare surveillance and laboratory capacities, it was not until four months later, on March 21, 2014, that a confirmed case was actually reported. Intraregional migration is extensive, and borders are porous and largely unregulated. The jungle areas from where the Ebola virus emanates are closely proximate to coastal capitals. Cultural and political factors create major barriers: mistrust, stigma, superstition, traditional practices in the treatment of the ill, and washing and burial of the dead.

As Ebola has spread, trauma, panic, and paranoia have deepened. Medical personnel have been violently targeted, suffered high infection rates, and struggled with inadequate protections.

The World Health Organization (WHO), the lead international body responsible for organizing the response to pathogenic outbreaks, has seen its capacities eroded significantly in recent years, as its budget crisis has worsened and seasoned senior staff have retired and not been replaced. The nongovernmental organization Doctors Without Borders (or Médecins Sans Frontières—MSF) has valiantly responded to the outbreak and deployed over 300 personnel, but it has reached the outer limits of its capacities.

Q3: What is to be done?

A3: Essential steps are public communications campaigns, surveillance to detect and confirm cases, strengthened border control measures, separation and isolation of infected persons, tracing of persons who might have been exposed to the Ebola virus, sharing of data across countries, and provision of protective equipment. At a minimum, three to six months will be required to arrest the outbreaks. The WHO, the Centers for Disease Control and Prevention (CDC), and other donors are providing an estimated $100 million in surge support. WHO has 120 staff now in the region; CDC is adding 50 staff.

Q4: How does this affect or threaten Americans?

A4: One American citizen has died of Ebola in Nigeria. Two American staff of the charity Samaritan’s Purse have been infected. The U.S. Peace Corps has temporarily removed 340 volunteers; nongovernmental organizations have also begun withdrawing staff.

The CDC has issued a “Level 3" alert, advising against nonessential travel by Americans to the region. CDC further advises that U.S.-based medical providers and border authorities in the United States be extra vigilant of travelers returning from West Africa and be familiar with Ebola symptoms and infection control measures. The actual risk to the United States and its residents is considered low, given the low probability of infected persons traveling by plane to the United States, the quality of infection control measures in the United States, and the fact that transmission requires close personal contact.

Q5: Is there a core message from this crisis?

A5: Ebola in West Africa is a wake-up call to the region and the wider international community of the need to put a higher priority on ensuring that there are the basic capacities in place to prevent, detect, and verify outbreaks and respond effectively. It reminds us of the need to accelerate efforts to develop and disseminate vaccines and treatments. When health security capacities are absent, as is the case in Liberia, Sierra Leone, and Guinea, that creates an acute vulnerability to sudden outbreaks spreading wildly, outstripping local and international authorities, and threatening the stability of multiple societies. One long-term consequence is that Ebola then becomes endemic to a wide swath of territory, where it will recur in the future.

J. Stephen Morrison is senior vice president and director of the Global Health Policy Center at the Center for Strategic and International Studies in Washington, D.C.

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