The announcement this week that a man in Dallas has been diagnosed with Ebola – the first incursion of the disease into a non-African country – has stoked widespread fear. Some Texas parents are keeping their children home from school, and reports that the man had direct or indirect contact with some 80 others, including children, while contagious have rippled through the media.
The reaction points to the grip Ebola has on public thought. Though it is difficult to catch, the disease presents a particularly alarming picture, and there is no non-experimental medicine to suppress it. What’s more, the outbreak highlights the difficulty of preventing pandemics in an era of global travel.
But as the US and the world ratchet up their humanitarian response to an outbreak President Obama has called “a threat to global security,” health authorities remind Americans that other diseases that threatened to spread even more easily have been kept in check in the recent past. Massive investments in public health funding, medical research, and containment strategies have played a major role in keeping diseases including SARS, avian flu, H1N1 (swine flu), and Ebola from gaining serious footholds in human populations, especially in the West.
The US response to Ebola has not been perfect – witnessed by the fact that the Dallas hospital did not at first diagnose the man with Ebola and sent him home for two days. But the overall response from the federal Centers for Disease Control and Prevention and the World Health Organization has been good, Davidson Hamer, an infectious disease specialist at Boston University has said – especially given huge impediments, such as cultural challenges, remote areas, and fears of doctors in stricken villages.
Moreover, CDC Director Tom Frieden’s assurances that the US will stop Ebola “in its tracks” is based on a strong track record by public health systems in the US and beyond. Not only have similar viruses to Ebola arrived in the US before and been successfully contained, but four US health care workers diagnosed with Ebola all survived after receiving treatment in the US.
Meanwhile, past predictions of massive casualties from viruses like avian flu, SARS, and H1N1 in the past decade diminished dramatically as world health groups, often spearheaded by the Atlanta-based CDC, responded aggressively.
None of which is to say the world’s reaction to the current Ebola outbreak has been ideal. The political will to send troops and humanitarian aid to West Africa didn’t come until two American health workers were infected and subsequently successfully treated back home. The WHO didn’t declare a humanitarian crisis until August, when thousands had already been diagnosed.
Such missteps are cause for concern going forward, critics say. The root of the Ebola crisis was not biological changes in the virus, but a combination of “dysfunctional health systems, international indifference, high population mobility, local customs, densely populated capitals, and lack of trust in authorities,” Jeremy Farrar and Peter Piot, the co-discoverer of Ebola, wrote recently in the New England Journal of Medicine.
The world, added a 2011 World Health Organization expert panel, is “ill-prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public-health emergency.”
Critics argue that assessment has been borne out by the current Ebola outbreak in Africa. “This Ebola outbreak – and the failed response – shows in the clearest way how unprepared we are for global pandemics,” write Julia Belluz, an award-winning medical journalist, and Steven Hoffman, an expert on global health law, on Vox.com.
The world's recent track record with pandemics, however, has been marked by success, and American resources have contributed significantly. The CDC supports public health initiatives in Africa and beyond, the Pentagon invests heavily in disease surveillance, and the National Institutes of Health has become the largest funder of investigatory public health research in the world.
- SARS, a pneumonia variant, threatened millions in 2003, but was thwarted when public health organizations, including the WHO, broke what’s called the “chain of transmission” that could have turned local outbreaks into a broader pandemic.
- In 2005, avian flu raised concerns about disease migration from fowl to humans, which could impact 20 percent of the world’s population. But human-to-human transmission of the variant never materialized, though 59 people died.
- The 2009 pandemic of H1N1 killed nearly 15,000 people worldwide but was stopped in the US in part by emergency productions of a vaccine. Global public health lessons learned from the 2005 avian flu also played a role in containing the pandemic, officials said.
Ebola is the newest threat. According to CDC models, Africa could witness 1.3 million cases of Ebola if nobody lifts a finger to help. Conversely, the same models show that if Western and richer African nations manage to help get 70 percent of patients into care by December, the epidemic would be largely over by Jan. 20.
That’s the current trend line. "There is a regular and by now daily positive change in terms of what resources and capabilities countries are putting on the table," Gayle Smith, senior director of the National Security Council, told reporters this week.
And one case study shows that public health authorities in poorer countries can successfully tamp down the disease and squash a pandemic at its roots.
Nigeria was under threat of an outbreak when a Liberian man diagnosed with the disease traveled to Lagos earlier this summer. With inadequate and fragile infrastructure, Lagos – Africa’s most populous city – was seen as vulnerable to an outbreak.
Yet “swift action, including tracing nearly all exposed people and creating facilities to isolate them during the needed 21-day monitoring period, stopped the virus cold,” writes Michael Smith, a correspondent for MedPage Today.
Four family members are under such quarantine in Dallas as a precaution after being exposed to the Liberian man diagnosed there last week. Authorities are also monitoring the dozens of other people potentially exposed through contact with the man directly or through other people who had contact with him.