Between 2014-2016 the world saw its largest outbreak of Ebola, affecting 28,616 people mainly in Guinea, Liberia and Sierra Leone, with 11,310 deaths. Prior to that the largest Ebola outbreak killed 280 people in 1976. That’s an increase of about two orders of magnitude. This massive increase shocked the World Health Organization (WHO) and caused a minor panic. Clearly the potential of this virus was underestimated, the response was too slow, and the result was a massive outbreak.
In a sense, with that outbreak we dodged a bullet. The reason Ebola outbreaks have historically been so limited is that the virus is endemic in very rural areas. It took off in 2014-16 because the infection spread to towns, and the higher population density magnified the outbreak. It did not, however, spread into major cities. If that had happened we may have seen the first Ebola epidemic.
We are in the midst of the first Ebola outbreak after the gamechanger in 2014-16. This outbreak is in East Africa, mostly in the Democratic Republic of Congo (DRC). So far there have been 1,600 deaths. What’s interesting is that prior to 2014 this would have been major news, but now it does not seem to be getting the attention it deserves. This outbreak is still about 10 times larger (so far) than all previous outbreaks save for the 2014-16 outbreak. I guess being second best does not garner attention.
We now have recent reports of the first confirmed case of Ebola in Goma, a city of about 2 million people in Eastern DRC on the border with Rwanda. This city is also a major regional transportation hub, and includes an international airport. The WHO believes that this case was quickly contained and do not seem concerned. That’s good, because if Ebola breaks out in a city like Goma that would significantly change the nature of this outbreak, and bring it one step closer to becoming an epidemic.
Last month the WHO reviewed the outbreak and declined to declare a public health emergency of international concern (PHEIC). There are now renewed calls to do just that.
There is some good news in all of this. The 2014-16 outbreak was a wakeup call. It did give a boost to Ebola research, progressing, among other things, the development of a vaccine. That’s right, we now have a vaccine for Ebola, which appears to be about 97.5% effective in the current outbreak. Over 90,000 doses have already been given, but it seems we may now be running low on existing supplies, which could be a challenge if the outbreak suddenly hits a major city. If we need millions of doses on short notice, that would be a problem.
Also, the CDC recently created a synthetic version of the current Ebola strain, which will aid them in doing research. However, this also highlights the fact that outside scientific labs have not been given access to the current outbreak strain for research, which is why they developed a synthetic version.
There are a few lessons from the current Ebola outbreak. First, it reminds us yet again that we now live in a connected world. What happens in East Africa can, potential, affect all of us. Anyone who has played the game Plague, Inc. has a simulated sense of this. Perhaps this game should be offered to all vaccine deniers – see how much easier it is to wipe out all humanity (the goal of the game) without vaccines.
An Ebola outbreak in the DRC is our problem. It is the world’s problem, even before the WHO declares a PHEIC. That’s because the goal should always be to prevent outbreaks from becoming a PHEIC, and once they have, in a sense, we have already failed. Of course, there is a humanitarian reason we should all be concerned, but it is worth noting that we all have a personal stake as well.
This truth extends beyond Ebola. Our population densities and interconnectedness makes us vulnerable to infectious disease. Epidemics and even pandemics are virtually inevitable; it’s more a matter of when and how bad, not if. If not Ebola, it could be the next flu strain, or something like the Zika virus.
One of the things that is making this current outbreak more challenging is the political disruption in the region. There is still a problem with violence, and with distrust of authorities. Many of the people infected with Ebola are too afraid to go to the clinic. Authorities are trying to get people to change their burial customs, which also requires trust. The potential for an epidemic is just one more way in which political unrest in a far corner of the world can affect anyone.
Second, it is amazing to me how quickly we become complacent. Perhaps Ebola outbreaks with thousands or tens of thousands rather than hundreds of death is the new normal. We are psychologically adaptable, which can be a strength, but also leads quickly to complacency. This outbreak is still highly risky and concerning, even if it’s only the second largest in history.
Finally, something which is both good and bad news, is that we have the science to deal with these challenges, if they are properly supported. Perhaps part of the reason for complacency this time around is that the response was more rapid, and we have a vaccine ready to go that is more effective than anything we had in previous outbreaks. If we dodge another bullet with the current outbreak, vaccines will largely get the credit.
However, scientific progress will only save us if it gets the proper support. This means several things, including proper funding, but also proper access to things like the current strain of the virus. This needs to be a global effort, well funded, and politically supported.
But also the general population needs to support the science and its application. This highlights how potentially deadly the anti-vaccine movement can be. There is growing pushback against science, with science denial, conspiracy theories, distrust of experts and institutions, and a proliferation of fake news and misinformation. If vaccines can save us from an Ebola epidemic, than vaccine denial can kill us. Anti-vaccine pseudoscience and fearmongering has already caused a measles resurgence, and prevented the eradication of polio.
If humanity does one day meet its end, I strongly suspect that science-denial and irrationality will have been critical to facilitating our demise.
Update 07/19/2019 – The WHO finally declared the current Ebola outbreak a public health emergency.
