American Reputation or African Welfare? The proper response to the Ebola epidemic
By Robert DeNunzio
October 14, 2014
Like many international stories, the Ebola outbreak in Western Africa featured prominently in the news during its early stages, and was then relegated to the back pages of newspapers and magazines. The American media ignored the unique and potentially disastrous nature of the epidemic as well as the inadequate response of the United States government, which has failed to take advantage of experimental drugs, and to establish programs to combat future outbreaks. The urgency of the situation has only recently been impressed on American audiences after the death of an Ebola patient in Dallas due to mistakes by American medical staff. The current crisis will not be contained without significant international aid, and remains not only a tragedy for the people of afflicted countries, but also a security risk for the United States.
Discovered in 1976, the Ebola Virus is historically endemic in Western Africa. The recent outbreak is located in Liberia, Sierra Leone, Nigeria and Senegal, with a separate outbreak in the Democratic Republic of the Congo. The virus is transmitted through contact with the bodily fluids of a carrier. Preliminary symptoms such as fever, sore throat, muscle pain and headaches typically emerge 2 to 21 days after infection. Severe cases develop diarrhea, vomiting and a rash. According to the World Health Organization, Ebola causes fatal bleeding in 50% of cases. The deadliest outbreaks of the disease occurred in 1976, 2000 and 2014. Medical officials recorded 431 deaths in the 1976 epidemic, and 224 deaths in 2000. There have been over 3,000 confirmed fatalities and 6,200 cases since March, making this outbreak more deadly than all previous ones combined. Further, the Center for Disease Control (CDC) and the World Health Organization (WHO) believe these numbers severely underestimate the number of cases due to underreporting. The two organizations predict that there could be as many as 1.4 million cases by January if the outbreak is not contained effectively.
Although the disease is extremely unlikely to spread within the United States in its present form, the virus has already mutated several times during the current outbreak, and could evolve into a more dangerous and transferable strain. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, stressed the importance of confronting the epidemic now saying, “If, in fact, this thing smolders on and on, we know mutations will accumulate.” In accordance with this view, President Obama emphasized the need for a more comprehensive response to the crisis in a speech on September 26. President Obama authorized the deployment of the U.S. military to the region in order to provide isolation facilities and other logistical support. In total, the Obama administration has requested 250 million dollars of spending to control the epidemic. In context, United Nations experts believe 600 million will be necessary to put an end to the crisis. Obama also expressed frustration with the lack of international cooperation regarding the disease saying, “Each time the world scrambles to coordinate a response, each time it’s been harder than it should be to share information and contain the outbreak.” President Obama is certainly right that cooperation is crucial to containment, but he has thus far failed to remedy the deficiency.
The United States approach, while necessary and admirable, does not do enough to confront the Ebola outbreak. In particular, an effective program would involve exploring the potential benefits of experimental drugs, and the establishment of a comprehensive medical unit equipped to handle high speed flare ups. As Jack Chow, Professor of global health at Carnegie Melon University, and former WHO assistant director put it, “The Obama mission to Liberia, which is relying on the military at the last minute, shows that the U.S. and other industrial countries haven’t built up comparable deployable medical units on the civilian side, and need to do so to prepare against future ‘flashdemics’ — high-velocity, high-lethality outbreaks.”
During past outbreaks, governments were able to restrict the spread of the disease by tracing and quarantining infected individual’s contacts. However, this was effective only because past outbreaks were limited to sparsely populated rural areas, whereas the current emergency has spread to urban centers. Professor of Microbiology and Immunology at Georgetown University Medical Center Daniel Lucey argues, “What’s always worked before – contact tracing, isolation and quarantine – is not going to work, and it’s not working now.”
While an improved U.S response could improve the situation, significant cultural barriers restrict the effectiveness of international aid, and are more difficult to overcome. Caring for an infected individual without the proper preparation often leads to infection but African communities often prefer to treat cases internally, without involving outsiders. For instance, traditional burial ceremonies in Africa involve contact with the body, and the potential for infection, but have continued to be practiced despite contrary recommendations. The situation is worsened by spreading fear and paranoia. For instance on September 16, Guinean pastor Moise Mamy and 7 workers from the Water of life organization were tragically killed in Wome, a remote village, while attempting to give villagers information on proper washing and water purification practices. A friend of Mr. Mamy said the villagers thought the bleach that workers distributed was actually the virus. Unfortunately, the attitude of the villagers is not uncommon in areas of Guinea and Liberia.
“While an improved U.S response could improve the situation, significant cultural barriers restrict the effectiveness of international aid, and are more difficult to overcome.”
The ultimate solution to the Ebola outbreak will be a medical vaccine or a cure, and it is in this area that U.S aid can be most effective. Currently, even if victims seek medical aid, they may not survive their encounter with the infection, as there is no cure for the virus. Victims are often reluctant to be quarantined and separated from their families, even in the name of preventing the spread of infection. Two experimental drugs, ZMapp and TKM-Ebola, have been used during the outbreak. Neither drug has undergone a randomized clinical trial, but both were approved for urgent use in Americans exposed to Ebola under the Food and Drug Administration’s Expanded Access Program. Developed by Leaf Biopharmaceutical Inc., a San Diego company, ZMapp was used to treat 7 individuals infected with Ebola, and 2 died shortly after. The drug was given to European and American aid workers and 3 Liberians, before supply ran out. Still, the use of ZMapp to treat primarily Europeans and Americans sparked controversy when Peter Piot, a co-discoverer of the virus, called for the vaccine to be openly distributed among afflicted African countries.
Other doctors, such as the director of AIDS research in South Africa, Salim Karim, warn that the untested use of an experimental drug in Africans would be, “the front-page screaming headline: ‘Africans used as guinea pigs for American drug company’s medicine.’” This argument represents a shameful disregard for the public health of the people of Sierra Leone, Guinea, Liberia, and Senegal and effectively argues that the reputation of the United States is more important than the lives of millions of Africans. The argument mistakenly suggests that the American reputation is enhanced by restricting African access to a drug that we give to our own citizens.
Sadly, President Obama has yet to support United States support for vaccine development, saying, “We’re focusing on the public health approach right now, but I will continue to seek information about what we’re learning about these drugs going forward.” The President went on to say that a program to fast track the drug would be, “premature” at this point. While unregulated distribution of ZMapp is clearly not the answer, the United States could be working with Leaf Biopharmaceutical to achieve a more timely clinical trial to verify the drug’s effectiveness and using a portion of the 250 million dollars of proposed spending to increase production of the currently exhausted drug to meet the demands of the epidemic before it spreads beyond the limits of containment. AFP