Return of Ebola

    The deadliest Ebola outbreak in forty years only ended on June 9 2016, and now, less than a year later, the World Health Organization has announced the return of the virus. Between 2013 and 2016 Ebola infected more than 28,000 people and killed at least 11,000 in West Africa. The pandemic sparked a political frenzy that led to travel bans and restrictions in more than thirty countries. The newest outbreak so far only has two confirmed cases, three probable and 37 suspected. Why the disparity? Much can be said of the circumstantial differences in these infections, but efforts by national health ministries, international groups and the World Health Organization mark a dramatic improvement in human response.

Simon Davis/DFID'.

Simon Davis/DFID’.

The outbreak which ravaged West Africa struck many dense urban areas and reached hubs of international travel. In contrast, the new outbreak arose in an extremely remote region in the Congo jungle, one with little urban development and which is largely inaccessible. It has been described as “isolated and hard-to-reach, with virtually no functioning telecommunications and few paved roads.” Further differentiating the two outbreaks is the rapid identification of the infection. Ebola had not appeared in West Africa prior to the outbreak and because of this it was consistently misidentified between December 2013, and March 2014. By comparison, the Ministry of Health for the Democratic Republic of Congo notified the World Health Organization of a confirmed case of the infection on May 11, merely a few weeks after the first patient was identified on April 22.

These factors contribute to the currently assessed ‘low’ risk of a widespread expansion of the infected area, but cross-border travel and a recent influx of refugees raise that assessment to a ‘medium’-level risk of regional spread. In 2014 the Ebola infection spread in three waves, and the first two were minor. Liberia believed the situation was contained by April, but  four months later more than 170 new cases and 90 deaths were recorded. The true figures were likely higher as a combination of local skepticism and superstition discouraged the infected from coming forward for treatment, and families from revealing afflicted relatives.

    In the Congo, no new cases have been confirmed since May 11. In fact, 80% of computer models run by the World Health Organization now predict that no new cases will be confirmed in the next 30 days. Even if these models are incorrect, significant medical advances will contain the threat. A vaccine produced by the Canadian government and Merck, known as rVSV-ZEBOV, is being prepared for use. However as an unlicensed drug it can only be used in clinical trials to measure its effectiveness, and only after it is given a pass by an ethical review board. The current proposal is to use it in a ‘ring’ vaccination scheme. This would mean the vaccination of the infected, and anyone they have had contact with since infection. If any of those individuals are confirmed infected, the process repeats until the infection dies out. Even now that this plan has been approved it still faces significant challenges. The proposal calls for enough vaccines for 5,000 doses, and 10.5 million dollars to fund the project. The World Health Organization has put out a Donor Alert to raise the funding. However due to the difficulties of testing the vaccine, it’s effectiveness is uncertain. Although proven to be effective in short-term immunization, there is little information about its long-term effects or even how long the immunization lasts. Partly because of this, and the challenges that accompany the proposal, the President of the International AIDS Vaccine Initiative, Mark Feinberg, says that, “this is an important opportunity to test how prepared countries are to decide whether or not they want to deploy new vaccines, and how, before they are licensed.” Any deployment of this vaccine will also be supported by volunteers from RTI (Research Triangle Institute) International with funding from the U.S. Centers for Disease Control and Prevention.

    Optimism however is kept in check by multiple conclusions that the world is not prepared for the next major outbreak of disease. The reasons are multiple. To start, vaccine research is often slow to develop or goes unfunded entirely because it’s driven by a corporate recognition that such vaccines are not very profitable. Further complicating this is World Health Organization policy that once immunization drugs are licensed to a manufacturer they are open to lawsuits arising from complications. Worse still the media-panic in the West which follows news of a major pandemic usually results in wealthy nations accruing a stockpile of vaccinations rather than dispatching the medicine to where it can fight the outbreak. Just as harmful are trade and travel restrictions imposed on affected regions which prevent international volunteers from returning to their home countries. These restrictions also damage the economies of afflicted nations and complicate macro and micro level efforts against infection. It makes world leaders less willing to share information about the spread and severity of disease. It makes individuals conceal infected family members, or even their own illness. The full risks and steps to overcome these were outlined in the 2016 report “The Neglected Dimension of Global Security.”

These concerns were largely echoed by the Obama administration in 2014 amid growing calls for travel restrictions to be imposed on West Africa. If the current administration would have any hesitation in imposing such restrictions in similar circumstances is questionable, at best. Doing so would harm American interests in the long term by preventing health professionals, resources and services from helping to mitigate and contain any outbreak abroad. The spread of a viral pandemic in such a situation would likely fuel further concern. Democrats would also be in the difficult position of having supported restrictions in 2014, and having fought a Democratic President in doing so, while having argued against the Trump administration’s Muslim immigration ban. Two issues would thus arise. First, it’s uncertain how many Americans would appreciate the differences between the situations, or if such a restriction would be more acceptable to them. Arising from this is the second issue: it’s uncertain whether the burgeoning resistance to every decision by the Trump administration would divide over the issue and lose support or be able to unite Democrats in opposing the move. When the Democrats previously supported restrictions, those who did so were facing tight elections. Were the situation to arise around the 2018 midterms that impetus may not be present. On the contrary, it may encourage Democratic resistance to invigorate their voter base. Hopefully, it would also spur greater assistance to afflicted areas, such as in the Democratic Republic of the Congo.

Adam Templer

Adam Templer

Policy Intern at InPRA
Adam is a recent graduate of McGill University with a double major in history and political science. He has previously written with The Political Bouillon and has been published in Hirundo, the McGill University Classics Journal. A member of the Canadian Infantry Reserve, he cares about promoting human rights, democratic governance and peaceful international cooperation. Although extremely interested in peace and security issues, Adam also cares deeply about acting to preserve the environment and counter the threat of climate change. He hopes to take a more active role in supporting his local communities through working with pubic officials, and engaging with his representatives in Parliament.
Adam Templer

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