Ebola Part Two- Education in Epidemiology 29
The 2014 Ebola epidemic that claimed 11,310 lives began with a two-year-old in Guinea that contracted the disease and died from infection, spreading the disease to the attendants of his funeral, then throughout the village, and later across other countries. This outbreak spiraled far beyond previous events, infecting 28,616 individuals, opposed to the few hundred cases in previous outbreaks. In addition to the standard challenges of controlling an outbreak, this event faced unique obstacles, such as poor infrastructure that made it difficult to transport patients to hospitals. In addition, the public health response to the epidemic has been criticized, as it took months for the WHO to announce the outbreak as a major health risk, and tensions arose between local individuals and public health officials.
Those impacted by Ebola were hesitant to trust the foreign entities sent to address the crisis, and their skepticism was further bred by the lack of effective treatments to treat the disease, resulting in deaths regardless of the attention of medical professionals. Without a cure, “treatment centers” were established that focused on quarantining infected individuals rather than increasing their chance of survival, leading to further resistance towards authority figures. When people saw their loved ones die under the care of foreign strangers, their presence felt like an unwelcome intrusion. Distrust made cooperation difficult, especially when addressing cultural practices like funeral procedures, mandating cremations despite local opposition.
Considering the aftermath of this catastrophe, many have advocated for proactive solutions like building infrastructure and health systems in regions that lack it instead of waiting until the outbreak has already begun. Local experts that can fight outbreaks in their home country are more capable of addressing disease transmission while maintaining respect for cultural practices. Allocation of public funds to the sponsorship of regional experts can spur a strong and independent response, instead of relying on strangers from other places to control disease transmission.
Since the 2014-2016 epidemic, outbreaks once again returned to numbers between a few dozen to the low hundreds, except from 2018-2020 in the Democratic Republic of Congo, which resulted in more than 2,000 deaths (CDC, IDSA). One key difference in Ebola response following the 2014 epidemic is the development of an effective vaccine. A lot of research had been done on Ebola prior to 2014 due to its potential as a bioterrorism weapon, and though funding had diminished by the time the epidemic hit, existing research contributed to the release of the rVSV-ZEBOV vaccine in 2015. In an initial study, none of the 5837 recipients contracted the disease in the ten days following vaccination, whereas 23 of the 5837 unvaccinated participants became infected in that same time (WHO). This is a huge testament to the vaccine’s effectiveness, and it was approved by the FDA in 2019 (IDSA). This showcases the importance of researching diseases, even those that aren’t active, because the knowledge gained is priceless when outbreaks threaten global health.
Though the virus has been relatively quiet over the past few years, another outbreak of the Sudan strain was reported in Uganda in January (CDC). Public health officials are working to contain the virus, but as the outbreak was only declared on January 29, it’s a little early to determine its trajectory. As always, pathogens are everywhere and will continue to infect humans. The interesting part is how we choose to respond.
I found the commentary about disease response really interesting here, specifically in regard to the 2014 epidemic. While I agree with the hosts of the source material that the WHO’s response was flawed, I don’t know how this can be practically addressed. Even in the US, the richest country in the world, I know so many people who object to the concept of foreign aid, let alone proactive methods, which are a greater investment. Time and time again, countries fail to properly prepare for disease outbreaks despite the desperation of experts that understand the threat of disease. As demonstrated by the COVID-19 pandemic, even wealthy countries are woefully unprepared, even for diseases with relatively low mortality and infection rates.
Often, the only way to motivate privileged countries that aren’t strongly impacted by infectious disease is by illustrating how it can affect them. Hey, rich countries, allowing tuberculosis to infect millions of people each year will drive antibacterial resistance, which can then spread to you. Refusing to invest in outbreak response can cause pandemics that threaten the globe and impact your economy. But since these results aren’t immediate or direct, it’s really hard to dedicate funds for these causes, because people can be shortsighted and their representatives won’t profit from trying to change their minds. All this is to say, if we can’t stop TB, which takes more than a million lives each year, how can we possibly fund experts stationed all across the globe to respect cultural practices?
This is not my area of expertise. I don’t pretend to know anything about policy and fundraising in pathology and epidemiology, but I feel like we need to evaluate our priorities considering the budget warrants so much improvement. Of course, we should also speak out about these issues to increase the budget overall, but those activities are not mutually exclusive. Considering the fact that the US isn’t even part of the WHO anymore, I don’t expect our disease response to flourish anytime soon.
Thanks for reading part two of the Ebola series! Hope you enjoyed, and stay tuned to learn with me!
My citation system has changed a bit over the years, so here’s an overview in case you want to look into my sources: when I started my website, each post was based on a single article or podcast episode, but over time, I’ve incorporated more sources in each post. Any referenced sources are linked at the bottom of the post. If I use one source for the majority of the content but include others for additional information (as is the case this week, with support from the WHO in regards to the 2015 vaccine), I include an in-text citation of the source for any extra evidence. However, if the article features multiple stories from different sources, I notate each source with its respective topic. Posts written in essay format are cited as MLA with a respective Works Cited list.
Click to access TPWKY-Episode-11-Ebola.pdf
https://www.cdc.gov/ebola/outbreaks/index.html
https://www.idsociety.org/public-health/ebola/ebola-resources/ebola-facts/
Health Alert Network (HAN) – 00521 | Ebola Outbreak Caused by Sudan virus in Uganda