The Ebola epidemic in West Africa has the potential to alter history as much as any plague has ever done.
There have been more than 4,300 cases and
2,300 deaths over the past six months. Last week, the World Health
Organisation warned that, by early October, there may be thousands of
new cases per week in Liberia, Sierra Leone, Guinea and Nigeria. What is
not getting said publicly, despite briefings and discussions in the
inner circles of the world’s public health agencies, is that we are in
totally uncharted waters and that Mother Nature is the only force in
charge of the crisis at this time.
There are two possible future chapters to this story that should keep us up at night.
The first possibility is that the Ebola
virus spreads from West Africa to megacities in other regions of the
developing world. This outbreak is very different from the 19 that have
occurred in Africa over the past 40 years. It is much easier to control
Ebola infections in isolated villages. But there has been a 300 per cent
increase in Africa’s population over the last four decades, much of it
in large city slums. What happens when an infected person yet to become
ill travels by plane to Lagos, Nairobi, Kinshasa or Mogadishu — or even
Karachi, Jakarta, Mexico City or Dhaka?
The second possibility is one that
virologists are loath to discuss openly but are definitely considering
in private: that an Ebola virus could mutate to become transmissible
through the air. You can now get Ebola only through direct contact with
bodily fluids. But viruses like Ebola are notoriously sloppy in
replicating, meaning the virus entering one person may be genetically
different from the virus entering the next. The current Ebola virus’s
hyper-evolution is unprecedented; there has been more human-to-human
transmission in the past four months than most likely occurred in the
last 500 to 1,000 years. Each new infection represents trillions of
throws of the genetic dice.
If certain mutations occurred, it would
mean that just breathing would put one at risk of contracting Ebola.
Infections could spread quickly to every part of the globe, as the H1N1
influenza virus did in 2009, after its birth in Mexico.
Why are public officials afraid to
discuss this? They don’t want to be accused of screaming “Fire!” in a
crowded theatre – as I’m sure some will accuse me of doing. But the risk
is real, and until we consider it, the world will not be prepared to do
what is necessary to end the epidemic.
In 2012, a team of Canadian researchers
proved that Ebola Zaire, the same virus that is causing the West Africa
outbreak, could be transmitted by the respiratory route from pigs to
monkeys, both of whose lungs are very similar to those of humans.
Richard Preston’s 1994 best seller, “The Hot Zone”, chronicled a 1989
outbreak of a different strain, Ebola Reston virus, among monkeys at a
quarantine station near Washington. The virus was transmitted through
breathing, and the outbreak ended only when all the monkeys were
euthanised. We must consider that such transmissions could happen
between humans, if the virus mutates.
First, we need someone to take over the
position of “command and control.” The United Nations is the only
international organisation that can direct the immense amount of
medical, public health and humanitarian aid that must come from many
different countries and nongovernmental groups to smother this epidemic.
Thus far, it has played at best a collaborating role, and with everyone
in charge, no one is in charge.
A Security Council resolution could give
the United Nations total responsibility for controlling the outbreak,
while respecting West African nations’ sovereignty as much as possible.
The United Nations could, for instance, secure aircraft and landing
rights. Many private airlines are refusing to fly into the affected
countries, making it very difficult to deploy critical supplies and
personnel. The Group of Seven countries’ military air and ground support
must be brought in to ensure supply chains for medical and
infection-control products, as well as food and water for quarantined
areas.
The United Nations should provide
whatever number of beds needed; the World Health Organisation has
recommended 1,500, but we may need thousands more. It should also
coordinate the recruitment and training around the world of medical and
nursing staff, in particular by bringing in local residents who have
survived Ebola, and are no longer at risk of infection. Many countries
are pledging medical resources, but donations will not result in an
effective treatment system if no single group is responsible for
coordinating them.
Finally, we have to remember that Ebola
isn’t West Africa’s only problem. Tens of thousands die there each year
from diseases like AIDS, malaria and tuberculosis. Liberia, Sierra Leone
and Guinea have among the highest maternal mortality rates in the
world. Because people are now too afraid of contracting Ebola to go to
the hospital, very few are getting basic medical care. In addition, many
health care workers have been infected with Ebola, and more than 120
have died. Liberia has only 250 doctors left, for a population of four
million.
This is about humanitarianism and
self-interest. If we wait for vaccines and new drugs to arrive to end
the Ebola epidemic, instead of taking major action now, we risk the
disease’s reaching from West Africa to our own backyards.
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