Why is the current Ebola epidemic so difficult to control ?
The first recorded outbreaks of Ebola Virus Disease (EVD) occurred simultaneously in South Sudan (then The Sudan) and the Democratic Republic of Congo (DRC, then Zaire) nearly forty years ago. Although the causative agent and how it was transmitted were initially unknown to those with the task of containing these outbreaks, only 602 people became infected, 431 died and the outbreaks were controlled within three months. The latest WHO data record that the current epidemic, the first case of which occurred in Guinea in December 2013, has so far infected over four thousand people in five West African countries and caused over two thousand deaths, more than in all previous outbreaks put together. In a separate outbreak in the DRC there is a total of 24 suspected cases and 13 people have died so far. The obvious question is why, in spite of the initial ignorance about the disease in 1976, was the epidemic contained so promptly when all our current knowledge is now failing to stop the disease spreading exponentially?
Having established that the Ebola virus was spread via contact with patients’ body fluids, the teams investigating the 1976 outbreaks closed hospitals that were reusing their few needles, quarantined infected people and their contacts, and effectively disseminated information on simple barrier nursing of patients and safe burial practices. The 2014 outbreak, though, started in a much less isolated region where people regularly travel between countries using motor vehicles. Healthcare workers from outside were often distrusted, and local hospital staff had no previous experience of EVD. In addition Muslim law requires family members to wash their dead before burial. As the initial outbreak became an epidemic, control efforts were hampered by lack of suitable hospital facilities, basic equipment and staff, forcing patients to return home and infect others. And sadly some protective responses from the international community, such as closing airline routes, have greatly exacerbated the problem in West Africa by preventing medical experts and supplies, even food, from reaching affected areas.
The WHO now predicts that it will take 600 million dollars and at least six to nine months to control the epidemic. The European Union, United States and the Gates Foundation have all committed funds for vaccine development and treatment, but according to Medecins Sans Frontieres the international response is still “lethally inadequate”. The imperative need now is for experts in biohazard containment.