19 August 2014

West Africa: Ebola Response - the Real Measure of Success

Photo: Vanguard
A doctor preparing to treat patients diagnosed with Ebola.

Responding to the outbreak shouldn't just be about stopping its spread, but also about heeding the warning sign.

From a global perspective, it might be tempting to call the Ebola outbreak a 'scare', especially if its impact remains confined to West Africa. But to deal with it as purely a short-term or isolated crisis means missing one of the more important questions it asks of the health and development community: how many warnings does it take to get serious about fixing global health systems?

Recent reports on the outbreak quote the WHO as saying that cases of Ebola are growing in West Africa, and are vastly underestimated. [1] The thought that people with undetected Ebola are out there going about their daily lives may stoke fears of the disease spreading around the world as a pandemic.

This is a worrying uncertainty. For infectious diseases such as flu, public health scientists go to great lengths to estimate the number of undetected cases for each one that gets detected precisely for this reason: to get a better handle on the true scale of the problem they're facing. This, in turn, informs the scale of the response.

The good news is that this Ebola outbreak is unlikely to become a pandemic. [2] Developed countries are just too well equipped and prepared to allow that to happen. And unlike diseases such as SARS (severe acute respiratory syndrome) and avian flu, which spread through the air, Ebola needs close contact to get passed from one person to another. So it can be contained where there's enough capacity to identify, isolate and treat patients.

Preparedness and measured responses

Yet it's probably hard to escape fear if you're at risk of catching Ebola. After all, the zoonotic origin (the virus first spread from an infected animal) and mode of transmission are reminiscent of HIV. [3] The chances of dying after catching it are very high and - bar some experimental treatments - there is no cure.

As Ebola is an unfamiliar, serious disease that hasn't been contained, it's hardly surprising that it has caught the attention of mainstream media. On the other hand, certain factors, such as how it spreads, work in favour of the scientists and health workers battling to control it.

One is that it needs close contact to pass from person to person. Another is the high case-fatality rate. This means that the virus has a short lifespan and so less chance of mutating into a form that keeps patients alive longer (which would give it more time and opportunity to spread further). In a way, it works against itself, killing too soon to help its own survival.

So the wildcard of undetected cases notwithstanding, there's reason to believe that this outbreak is unlikely to spiral into a pandemic. But this is hardly the end of the story. What it does, for starters, is put the spotlight on Africa where, despite a general sense of promise for economic development, public health systems and governance are still weak.

One key aspect of good preparedness for emerging infections such as Ebola is also a long-term measure of a good public health system: having in place the personnel, knowledge, systematic data and tools to be able to pick up unusual cases of disease, even in this case when the early symptoms are similar to those of malaria.

Good governance will help with this but also with launching measured responses to health emergencies. Quarantines are necessary where there's a risk of spread. But as the Dakar-based editor of our French Sub-Saharan Africa edition tells me, unnecessary curbs on social contact do impact daily lives (and local economies) even in countries yet untouched by the outbreak - because politicians want to be seen as taking action.

Ebola and the SDGs

The outbreak raises various issues of global relevance: border containment, the research and control of zoonoses, surveillance capacity, and drug licensing and guidance. For those issues that developed countries have a pretty good handle on, but that remain particularly hard challenges for Africa, more should be done to transfer knowledge.

But, in some cases, those challenges will have a unique local flavour. Reports including an interactive SciDev.Net story on the outbreak expose how social dynamics, beliefs and practices (such as people hiding family members with symptoms) might alter risk perception and how well certain response measures might work in the developing world.

These issues are a fitting focus for local research to generate practical knowledge. It may not result in top-notch papers in international journals, but an outbreak like this should be incentive enough for governments and donors to support such work.

By extension, the outbreak also puts the spotlight on Africa's development partners - traditional and new - and on the development sector more widely. Before the post-2015 development goals are finalised, the UN and those at the negotiating table may want to scan the list of targets with Ebola in mind and make sure that they can mobilise actions to strengthen the systems and capacities that will equip countries to keep new and fast-spreading diseases at bay.

Médecins Sans Frontières has warned that the current outbreak will last at least six more months. [4] Our measure of success in responding to it shouldn't be just about stopping its spread or about discussing the fine points of the WHO's response, which was one of the main subjects of debate during coverage of the 2009 flu pandemic. It should also be about heeding the warning sign by doing more to make sure developing countries are better resourced to deal with any infectious disease, emerging or not.

With SARS, swine flu and Ebola having struck within a matter of years, we as a global community have been warned enough.

Anita Makri is opinion and special features editor at SciDev.Net. @anita_makri


[1] Monika Mark and Sam Jones Ebola outbreak vastly underestimated, WHO says (The Guardian, 15 August 2014)

[2] Fever rising (The Economist, 16 August 2014)

[3] Unseating the first horseman (The Economist, 14 August 2014)

[4] Ebola crisis to last 'at least six months' - MSF (BBC News, 15 August 2014)

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