The Ebolapocalypse will soon be over. Liberia and Sierra Leone, two of the three West African countries ravaged by the Ebola virus, have been declared free of the disease. The number of fresh cases in the third country, Guinea, is declining, with only one reported so far this month — a baby born to a dying, Ebola-stricken mother.
For the World Health Organisation to give Guinea a clean bill of health, the country has to be disease-free for 42 days, measured from the day after the burial of the last victim or from the date a second virus-free blood sample is drawn from the last confirmed case.
Such a declaration is unlikely to come before Christmas, but the worst of this epidemic, which has killed more than 11,000, has passed. Surveillance is decent. Coughing air passengers no longer induce panic and strangers can shake hands once more. These countries, and the organisations that helped them, are to be congratulated.
It is tempting to bury the bad memories of this outbreak along with the final corpse, but celebration must be tempered by introspection. Ebola may have slunk from the spotlight but, although there is one effective vaccine, it has not been licensed and cannot be manufactured at speed. The World Health Organisation admitted it was slow to react, but has not yet substantially re-organised itself to keep a livelier watch.
There is also a legacy of clinical uncertainty, with survivors reporting sight problems, fatigue and joint pains, as well as the anguish of losing relatives and friends. The ordeal of British nurse Pauline Cafferkey — who survived after becoming infected in Sierra Leone, but suffered a severe relapse from which she is still recovering — shows that the Ebola virus is not easily conquered. It lingers in bodily fluids and can flare up again when the immune system falters. This is a challenge for countries with poor health infrastructure.
All the while, demographic trends conspire to turn future epidemics into moving targets. Forty per cent of Africa’s population lives in cities and this is projected to rise to 56 per cent by 2050. The potential for infectious diseases to spread rapidly is obvious. The need for living space means that urban perimeters creep outwards, into rural areas. This overlap forms one crucible in which zoonotic diseases (those passed from animals to humans) are forged. The livestock industry, which is expanding to feed a growing world population, is another. There are about 200 known zoonoses — including avian influenza, malaria and tick-borne diseases — and climate change is extending their reach.
Margaret Chan, World Health Organisation (WHO) director-general, acknowledges that disease forecasting is an imprecise art: Scientists long expected an epidemic of bird flu, but were blindsided in 2012 by the Middle East respiratory syndrome in Saudi Arabia. As she said in March: “No one expected that an arid desert environment, and camels instead of chickens, would give rise to a new disease.” Nobody saw severe acute respiratory syndrome coming either.
If we cannot predict new diseases, our only option is to stamp on them swiftly. By the start of next year, four influential reports on post-Ebola global health governance will have been published; one overseen by Dame Barbara Stocking, Oxfam’s former chief executive, has already called for a separate body within WHO to co-ordinate emergency preparedness. Other reports are likely to echo its suggestion that the body should be bankrolled by a ring-fenced fund and run fearlessly by its own director, who would have the power to call countries and companies to account. Currently, the WHO cannot force countries to notify it of outbreaks — and cannot penalise unaffected countries that sever trade and travel links. This cold-shouldering turns medical emergencies into economic ones. The World Bank estimates that Guinea, Liberia and Sierra Leone together lost $1.6 billion (Dh5.88 billion) in economic growth during 2015. Stricken nations thus need to be given incentives (and insured) to reveal epidemics early and others given incentives not to cut links. A new body under the WHO umbrella just needs political willpower and it should be the real test of lessons learnt.
— Financial Times
Anjana Ahuja is a science commentator.
