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Why we ignored Ebola...

Thu, 9th Oct 2014

Research suggests the current Ebola crisis could have easily been prevented. So why were the risks ignored until now?

Chris Smith

In writing this column I had to weigh up two options. On the one hand, it's Nobel week and we're celebrating world-breaking scientific endeavours that include the discovery, by UCL's John O'Keefe, of the brain's equivalent of a GPS system that stops us getting lost. There's also the Japanese team who have revolutionised the way we light up our homes and workplaces thanks to their pioneering work on gallium nitride-based blue LEDs; and then there are the chemists who found a way to use a light microscope to see details inside cells that are smaller than the light waves themselves.

These are amazing advances, but while all this scientific back-slapping is going on, the dark cloud on the horizon is the emerging Ebola epidemic in West Africa and the warning undercurrent that comes with it. At the time of writing at least 7000 people have been infected and half of those have died. The CDC in America also estimate that, because the level of reporting is so poor, the numbers can, in all likelihood, be doubled or even tripled. And because the rates of infection appear to be growing exponentially, tens of thousands, or even millions, might ultimately be affected.

Ebola virus particleTo put the scale of the present situation into perspective, since the first recorded case of Ebola in the Democratic Republic of Congo 38 years ago there have been fewer than 2,500 deaths documented in total. So this single present outbreak is already three times larger than the entire Ebola death toll ever. It's also no longer just an African problem. The West has had its own wake-up call this week as the US and Spain, countries previously regarded as immune to the threat thanks to modern medicine, have reported imported cases of the condition and, despite strict infection-control guidelines and practices, onward transmissions of Ebola on their home soil.

What is remarkable though is that, while Ebola is terrifying and dramatic in its impact when it causes an outbreak, it appears to be a relatively easy agent to fight. Experimental vaccines tested so far on animals have been impressively effective, protecting against even injection of the live Ebola virus. But because they are at a test stage, these agents, which will be critical if we're to nip this outbreak in the bud, are nowhere near ready for mass production. Trials are only now getting underway of human versions of the vaccines in Oxford, UK, and the US. "Way too late," many are saying, to prevent the inevitable.

So why is it that, nearly 40 years after Ebola first surfaced, the world finds itself in a state of panic, and up to ten thousand people are dead, owing to a bug that's probably preventable thanks to scientific research done decades ago? The answer is that Ebola was regarded as someone else's problem. It was a tropical disease of low importance and (presumed to be) constrained by geography and climate to a part of the world that held little economic interest to the rest of us. But therein lies a salutary lesson: because if even a tiny fraction - less than 1% - of what the present outbreak is now costing the world in terms of lost productivity, humanitarian aid and human lives lost had been spent 20 years ago to develop an Ebola vaccine, we probably wouldn't be in this position now. It's easy to dismiss tropical diseases as an issue that won't affect the West, but the present situation is a warning shot across our bows that we ignore at our peril.

Even over the relatively short time that I've been a virologist we've seen several potential pandemic agents emerge: SARS appeared in 2003, bird flu has been an ever-present threat since the late nineties, swine flu struck in 2009, MERS-Cov, the SARS-like agent from the Middle East, appears to be widespread in camels and can kill susceptible humans, and now Ebola has taken everyone by surprise. What connects all of these outbreaks is that, by and large, they have all stemmed from poor countries.

Emerging infections amongst humans are overwhelmingly zoonoses - in other Sierra Leone: into the Ebola epicentrewords infections that originate in an animal and jump into humans. The places where this is most likely to happen are under-developed nations, with poor healthcare infrastructure, poor sanitation, high population densities and close contact between humans and wild animals. Once it's established in humans, however, an emerging disease is no longer constrained by habitat of its original host and can go global. HIV, which has infected and killed over 70 million people worldwide, originated in one small part of colonial Africa in the early 1900s when the chimpanzee disease SIV spread into locals who were butchering the animals for bush meat.

What drove the HIV explosion was the very same recipe that is putting the modern world at risk from other emerging diseases like SARS and now Ebola. These are urbanisation, population pressures and fast global transport networks. Add the predicted effects of climate change to the mixture and the resulting toxic cocktail is sobering to consider.

The bottom line is that, in our quest for immortality, cheaper trainers, a thinner iPhone, batteries that last longer and budget holidays on tap, we're cruising for a virological bruising. And although we've now got white LEDs, microscopes capable of seeing structures smaller than light itself and we understand how the brain helps us to find our way to the fridge and back to retrieve a microwave meal, we could easily fall victim to diseases preventable by much more ancient technology...

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Good article Chris. However, will the rich West really come to the aid of poor African countries? Short answer: No. If enough researchers could sell their national health services (i.e. CDC) that it is a good disease model, then maybe they could some funding. Meanwhile, I'm supporting Doctors without Borders. TomQA, Tue, 14th Oct 2014

Very interesting point! The fact that humans get too preoccupied with other "important" tasks only foreshadows a possible downfall for our race. I wish your warning could be shared with more people and, more importantly, to the younger generations since they will be in charge of our mess when we are gone. Let's hope this Ebola virus has served as an effective wake-up call amidst our distractions. prkitkat, Wed, 15th Oct 2014

Is Black Swan theory - http://en.wikipedia.org/wiki/Black_swan_theory - perhaps relevant to this debate? Malcolm Smith, Sat, 25th Oct 2014

"The black swan theory or theory of black swan events is a metaphor that describes an event that comes as a surprise, has a major effect, and is often inappropriately rationalized after the fact with the benefit of hindsight." (Wikipedia)

I don't agree, Malcolm. Emerging infections experts have been warning about this possibility for some time. It's certainly been a feature of the lectures I've been delivering at Cambridge to the medics, vets and natural sciences students for the last 7 years. The issue has been one of economically-led inactivity. chris, Sat, 25th Oct 2014

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