The Ebola pandemic cutting a swathe through West Africa is thought to have begun in December 2013. A year later the WHO estimates more than 20,000 men, women and children have been infected with the virus and more than a third of these have died. These dreadful figures are almost certainly underestimates.
This is a tragedy. It is also an egregious inequity because most of the harm caused by Ebola could have been avoided if vaccines and treatments had been developed decades ago and if the international community had taken seriously their obligations to enable Sierra Leone, Guinea and Liberia to raise themselves from near the bottom of the United Nations Development Index.
The response in 2014
After an atrociously slow start – described by the President of Medecins Sans Frontieres as “totally, and lethally, inadequate” – the world was galvanised into action mid-way through 2014. The Director-General of the WHO led the charge by declaring a “public health emergency of international concern” for only the third time ever after the swine flu outbreak in 2009 and the resurgence of polio in 2014.
Since then a number of inter-governmental organisations, national governments and philanthropists have stepped up to the financial plate. The European Commission has pledged US$181 million, the USA US$750 million, and the Gates Foundation US$50million. The response from the general public has also been significant; £4 million was donated in just two days after the UK Disasters Emergency Committee launched a campaign against a specific disease for the first time in its 50 year history.
Human resources are also being mobilised on a large scale. Thousands of healthcare workers from Africa and beyond have volunteered to provide care on the ground and researchers in both the public and private sector are working around the clock to develop novel vaccines and treatments. Some countries have even sent soldiers to the worst affected areas to try to stem the tide.
This unprecedented global response makes it easy to forget that Ebola is not the deadliest disease known to humankind. HIV kills around more than 1.5 million people annually. So does Type 2 Diabetes. A similar number succumb to their injuries following road traffic incidents. Even in the worst affected country there is no comparison; malaria will claim more lives in Sierra Leone this month.
Given that there is no fundamental moral difference between the death of a child who develops fever and dies of Dengue and one who develops fever and dies of Ebola it is important to ask whether it is ethically and empirically justifiable to invest so much energy and effort in fighting this one disease, especially if this means that other causes of death are temporarily neglected.
Cynics will argue that the primary reason Ebola commands so much attention is because it represents a direct threat to wealthy countries in a way that other diseases – such as malaria – do not. It is hard to deny that many in the Global North only started to take serious notice of Ebola when it landed in the US and Europe. But even if the cynics are partially correct, there are at least three ethically and empirically sound reasons why it is right to lavish resources on fighting the disease.
An unknown toll
The first reason is that Ebola is continuing to spread at an alarming rate, especially in Sierra Leone. This means the current figures significantly underplay the direct impact that Ebola is going to have on health.
It is not clear how much harm Ebola is going to unleash as it uncoils; there are too many unknowns. If the optimists are right Ebola will claim significantly fewer lives in 2015 than it did in 2014 and it will be effectively under control by 2016. If the pessimists are right, more people will die of Ebola in Sierra Leone this time next year, than will die of any other single cause of death in this country. Either way, the current total mortality figures do not come close to capturing the grim harvest that Ebola will reap in the coming months.
The risk to health workers
The second reason has to do with the impact Ebola is having on the health infrastructure in Sierra Leone, Guinea and Liberia. Ebola is especially dangerous to healthcare workers because patients are very contagious when they are symptomatic. This means that caring for people who have the disease is dangerous, especially in countries where there are insufficient health facilities and lack of protective equipment.
Hundreds of doctors have already died of the disease in West Africa – including Dr Sheik Umar Khan who led the fight against Ebola in Sierra Leone – and others are too afraid to go to work. Patients are also reluctant to attend clinics because they worry that they might catch Ebola from other patients or from the healthcare professionals.
The consequence of all of this is not simply that patients with Ebola are more likely to die – and to die without receiving any supportive and palliative treatment. It is also that many other illnesses and injuries will not be attended. As such, spending significant resources on Ebola is sensible because doing so is the only way to restore the healthcare system to some degree of functional capacity. Put bluntly, if we want to stop people dying of malaria, we need to stop healthcare workers dying of Ebola first.
The third reason why it is right to prioritise Ebola is because this disease, unlike many others, has the potential to dissolve the glue that holds societies together. Ebola has this apocalyptic power for a number of reasons.
At the most personal level the disease makes the fundamental act of caring for the sick and dying very difficult. Direct human touch is important to patients as well as to their family members, friends and healthcare professionals. Ebola infuses these actions with dread as well as making them very risky; this can seriously diminish the quality of the care provided to patients.
The problem even extends to burial because the bodies of those who have succumbed to Ebola are extremely contagious. This is especially concerning in cultures where funeral rites matter hugely and involve direct touch. Knowing that these rites will have to be interfered with causes distress to those who are dying as well as the bereaved.
Fear can also decimate trade. Locally, farmers need to feel safe enough to bring their produce to markets, and consumers equally to feel safe enough to buy produce, otherwise starvation can ensue. Nationally and internationally, airports, seaports and land borders need to be kept open to allow movement of people and goods, otherwise governments will cease to function and states may fail.
Ebola has already caused GDP to plunge in the worst affected countries and the total fiscal impact in Liberia, Guinea and Sierra Leone was well over half a billion US dollars in 2014. For countries that were incredibly poor before the advent of the virus, the social impact of these financial losses is going to be colossal.
We have to keep fighting. Few diseases have the power to fundamentally break a society. Ebola is one of them. The world should act accordingly in 2015.