Ebola: an avoidable catastrophe
2 October 2014
As the deadly Ebola outbreak in West Africa continues, Professor Peter Piot, Director of the London School of Hygiene & Tropical Medicine and co-discoverer of the Ebola virus, writes that international community took too long to react to the outbreak and that we must now put in place mechanisms to handle better the next inevitable epidemic. This article originally appeared in TIME.
The news from Dallas that the first Ebola case outside of Africa has been diagnosed on U.S. soil is a stark reminder that epidemics on the other side of the world are a threat to us all. No epidemic is just local.
As long as this still expanding Ebola epidemic in West Africa continues, there is a constant source for it to spread to other countries - in the first place to neighbouring African countries. This outbreak is the largest and longest ever, with 7,157 cases and 3,330 deaths so far. It is the first outbreak that involves multiple and entire countries, and the first one that affects capital cities.
With increasing global mobility, it was always possible that someone travelling from an infected country would be carrying this deadly virus with them, and it will happen again. Fortunately, the U.S. and other high income countries have robust infection control measures and clinical practices to stop the onward spread of the virus within the country. Health services are well equipped to isolate the patient, to trace everyone he has been in contact with, and to put those contacts under surveillance for signs of fever. Health workers need to be alert for anyone with early symptoms of Ebola by always asking about people's travel history (which is good practice any way). The risk to citizens is extremely small.
We would need to be far more concerned if someone with Ebola travelled to a country where health services have poor infection control and lack hygiene practices. If an infected traveller enters an environment like this, it will result in new outbreaks. In addition, nursing and medical staff are at high risk of contracting Ebola virus infection as they often lack protective gear. Over 200 health care workers have already died in this epidemic alone.
This confirmed case in the U.S. does not mean we should respond by stopping flights from Liberia, Sierra Leone and Guinea, as some are calling for. The current outbreak is already disrupting entire societies because hospitals have stopped functioning and commerce is coming to a halt. Cutting these countries off from the rest of the world will only worsen the social and economic impacts, hamper aid efforts, and increase the panic and fear. In addition it won't stop the spread of the virus, and is not recommended by the World Health Organization.
Instead, we must bring the humanitarian catastrophe under control by greatly expanding the national and international response. We must build field hospitals and Ebola care centers, send healthcare staff, medical supplies and logistical coordination, as well as supporting governments and NGOs to stop Ebola transmission through community mobilisation to avoid risky funeral and care practices. Shortening the time between infection and presentation to treatment and isolation facilities is probably the most critical action today to end this epidemic. At the same time, experimental therapies and vaccines are finally being evaluated for their efficacy, but will come too late for too many. Above all, we must rebuild trust.
The international community initially took too long to react to the outbreak and our response is still far from perfect. But the U.S. commitment last month to send up to 3,000 troops to help tackle Ebola in Liberia was a decisive moment, as is the UK's massive support to Sierra Leone, including by convening a donor conference on October 2. Other European countries must now join in immediately.
This was an avoidable catastrophe, above all if there had been earlier recognition, and prompter and vaster national and international responses. The world must now put in place mechanisms and means to handle better the next epidemic, which will undoubtedly come.