In the late 1960s, U.S. Surgeon General William H. Stewart said it was “time to close the book on infectious diseases” and “declare the war against pestilence won.”
So much has happened in recent decades — with the eradication of small pox, the development of vaccines against polio and other diseases, and the emergence of new antibiotics — that the war against infectious diseases seemed won. The AIDS epidemic would prove how tragically wrong that declaration was, and now in West Africa an epidemic of Ebola virus is out of control.
The epidemic begs two questions: How do we control it in West Africa, and how do we keep it from spreading to other countries, including the United States? The answer is the same to both questions: Amass the worldwide resources needed to conquer it where it exists.
We must not underestimate the potential for an existing infectious disease to spread or to mutate into new ones. Microbes are evolution in motion, changing their genetic makeup through mutation to expand their host range and resist therapies. What’s more, infectious diseases know no geographic boundaries. Before jet travel, oceans usually kept societies and their diseases apart. No longer.
So let us not regard Ebola as a West African problem; it is a global one because the danger of inadequate response threatens all of us.
Ebola was discovered in Central Africa in 1976, but this is its worst outbreak in history — responsible for more deaths than all previous Ebola epidemics combined. Almost certainly, poverty and the lack of a viable health care infrastructure are to blame. The three countries primarily affected in West Africa are among the poorest in the world.
The tragic irony is that we know what needs to be done to successfully defeat the virus: rapid identification and isolation of suspected cases and of people who have had direct contact with them. And the utilization of strict barrier precautions and infection control measures for anyone with symptoms of Ebola. Success depends on making sure that appropriate personal protective gear and adequate training on meticulous infection control are available for health care workers, educating people in epidemic areas about how Ebola is spread, and the need to seek medical care if they have been exposed.
A worldwide response is needed to contain this epidemic. The response to date has been inadequate. The United Nations, the World Health Organization, the United States and other wealthy countries must dispatch an aggressive and speedy response. Global resources are needed to provide field hospitals with appropriate containment facilities, to bring in more trained personnel to aid overworked and depleted health care workers, and to provide more rapid diagnostic tests. We must also continue to support the development of drugs and vaccines that might give us powerful new tools to fight this disease.
In its current form, it’s unlikely the virus would reach devastating proportions in the United States because of our strong health care infrastructure, the preparedness of our public health system, and our ability to educate the public. But we can’t afford to underestimate the Ebola virus or the threat posed by any lethal infectious disease.
The best way to ensure an Ebola outbreak does not reach our shores is to conquer the virus where it exists — with a massive infusion of resources to stop it in its tracks.