Heading off a bigger Ebola catastrophe

Article Highlights

  • Ebola is a clear and present danger to [W. Africa] and a moment for the U.S. to ...demonstrate our commitments to those nations.

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  • Could Ebola mutate and become airborne?

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  • U.S. should lead an immediate effort to assist stricken nations in West Africa.

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The Ebola virus, which has already killed more than 1,500 people since the epidemic began earlier this year, is wreaking havoc in West Africa, leaving death, economic hardship, social stigma and civil unrest in its wake.

In response, the Obama administration has stressed that the disease is highly unlikely to spread inside America. Given international travel, we will certainly see cases diagnosed here, and perhaps even experience some isolated clusters of disease. For now, though, the administration's assurances are generally correct: Health-care workers in the U.S. and other advanced Western nations maintain infection controls that can curtail the spread of non-airborne diseases like Ebola.

Yet our ability to prevent an epidemic here doesn't reduce our obligations abroad. Even if the epidemic remains only in West Africa, the continued spread of Ebola infections could eventually rank as one of the cruelest natural catastrophes of recent times—if not in human death and suffering, then certainly in the economic and social devastation caused by declining commerce, restricted travel and the strife resulting from mass quarantines. Compared with a storm that delivers its destruction all at once, the swelling nature of a viral epidemic can magnify its impact on economic and civil life.

To address this problem, the U.S. should lead an immediate effort to assist stricken nations in West Africa. This effort should have three main elements.

First, Ebola's basic structure has similarities to other viruses that we have been able to target with drugs and vaccines. So it should be addressable with modern therapeutics—and we should initiate a concerted effort to rapidly, though carefully, advance a number of promising drugs and vaccines that have been tested in animals but not yet in man. In ordinary circumstances, an experimental Ebola drug couldn't be tested on healthy people to see if a medicine can work. But now we have infected people whose only hope of survival may be an experimental medicine.

There is an ethical way to approach this. The Food and Drug Administration, working with the Centers for Disease Control and private sponsors, can create a special program to advance treatments that have already demonstrated some measure of safety, and where there is plausible scientific data showing that they might be active against Ebola in humans. In the mid-2000s, the Bush administration worked with industry to plan for accelerated vaccine development in case of flu pandemic. This groundwork bore fruit during the effort to fashion a new vaccine against pandemic swine flu in 2009. We need to undertake a similarly urgent drug effort against Ebola.

Second, President Obama should lead a major charitable effort to raise resources to combat the outbreak and stabilize the affected countries. The World Health Organization estimates that its battle strategy for bringing the outbreak under control will cost $489 million. That figure may increase if we don't act soon. As recently as early August, the WHO estimated that it would need $71 million.

More than half the money will be needed for treatment and isolation centers, laboratory diagnostic capabilities, and surveillance and contact tracing in the countries experiencing the epidemic. The rest will go to managing the relief effort and strengthening capabilities in countries at risk for the virus but so far without major outbreaks.

The first major gifts could be donations from our own inventories and private sources of basic supplies like field-hospital equipment, gloves and other protective gear for medical staff. If we can't raise sufficient resources through private or charitable sources, Congress should consider leading by example and appropriating money for an international effort to fund these assets.

Third, we need to help countries adjacent to the hard-hit West African nations implement effective screening and track-and-trace procedures for people thought to be infected. Too many countries in the region that have avoided outbreaks are simply sealing borders and suspending travel from affected nations and hoping that will be enough.

But border closings and flight bans will exacerbate the economic and social impact on countries currently combating the epidemics. If we help unaffected nations implement better procedures to contain new cases, we could reduce the temptation of understandably scared governments to use draconian measures.

The most optimistic assessments envision slowing the expansion of this epidemic within two months, and stopping all transmission in six to nine months. The WHO said on Aug. 28 that the epidemic was still accelerating and could infect more than 20,000 people before it's brought under control. That is the standard projection, but the numbers could get substantially worse.

Could Ebola mutate and become airborne? It would be highly unlikely for a virus to transform in a way that changes its mode of infection. Yet this disease produces a massive level of the Ebola virus in the blood, called viral load, which can lead to excessive mutations. An Aug. 28 article in the journal Science shows that Ebola is already mutating during the current outbreak, in ways that could make it harder to diagnose. So the longer the virus spreads unchecked, the greater the chance of other random mutations that could also make it harder to contain, or to target with a new drug.

President Obama has made outreach to Africa a cornerstone of his foreign policy. Ebola is a clear and present danger to that region and a moment for the U.S. to act with forcefulness—and demonstrate our commitments to those nations.

Government cordons may be all some African countries can do with their existing resources, although this is creating panic and stoking civil unrest as army units try to enforce quarantines, sometimes with deadly force. Absent more help from America and other donors, this macabre strategy may leave tens of thousands to die inside hot zones of disease, and it may fail to stop Ebola's merciless spread.

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