The world's reaction to Ebola

18 November 2014

Interview with

Suzie English, Colin Russell and Peter Walsh, University of Cambridge

Every day there are new headlines about Ebola as the death toll rises. But do we in the West have a reason to fear Ebola? Are we doing enough to stop Africa healthcaredisease outbreaks in the developing world?

Suzie English, Colin Russell and Peter Walsh, all from Cambridge University, discuss the likelihood of Ebola spreading, how health organisations work against disease outbreaks and the media's fascination with the virus.

Chris -  Now, let's take a sort of broad view and ask everyone's opinion on this.  Suzie, let's begin with you. What do you think actually the threat is in terms of a British or an Australian, a sort of western healthcare system?  Do you think we're well-prepared?

Suzie -  Well, we've had warning.  We've been able to observe the outbreak occurring in west Africa.  And I think that early warning is very important for us to be able to mobilise people in our own health system, both in public health, in hospitals, in GP practices to be aware of Ebola, to know what to look for, to know who's at risk of catching Ebola.  These are really important for preventing an outbreak in Britain or Australia.

Chris -  Peter, do you think that we are at risk of this thing spreading much more if it were to go in a toehold in a country like Britain?  Would it spread or would it just fizzle out?

Peter -  It's not going to spread in Britain or in Australia.  As Suzie said, we have very good public health systems.  It's not really that's transmissible.  The flu which Colin studies is much, much more transmissible.  It's relatively easy to contain if you know what to do and you have a public health service.

Chris -  Colin, Peter is saying that many of these international organisations don't play well together.  You're saying that in order for them to interact, if we're going to succeed and stop this and other kinds of outbreak like this in the future, they need to be playing well together.  That doesn't sound like good news then.

Colin -  For influenza for example, WHO and Centres for Disease Control (CDC) work very well together.  But it's the lack of international coordination on a variety of different levels that ultimately creates problems.  Coming up with this sort of ability to respond locally to outbreaks which is what we really need because international response is great.  But if you're really going to catch on the first day or the second day, you really need people on the ground in each country who are ready to respond at a moment's notice.  That's something that is not going to be necessarily developed by a big international organisation.  But it's something we have to develop within these countries themselves.

Chris -  Peter, what about other sorts of disorders which might be lurking out there because Ebola is just one of the many?  What should we be doing to be more on our guard against those?

Peter -  It's a resource allocation problem.  Until they've killed a bunch of people, nobody is wanting to spend any money.  What we really need to be doing is we need to do the research and surveillance but before the fact, nobody is willing to spend the money to do it.  And so, it's a huge problem.

Chris -  Colin, you're nodding.

Colin -  I think the current situation really highlights a broader international problem that we have which is, until there's a lot of people dying in some other place and then there's a threat to us here in the UK or the United States or Australia, it's their problem.  But we don't invest enough to develop that sort of very basic public health infrastructure to actually help them stop the problem before it becomes a potential problem for us.

Chris -  So, why has there been such a media storm?

Colin -  Always, as humans, we're attracted to things that are spectacular and extreme.  In terms of horrific disease, Ebola is one of the worst that there is.  We're not concerned that much about the things that actually kill us, like influenza for example.  Approximately 500,000 people die of influenza every year, but we're so comfortable with what flu is and the fact that we've had it and didn't die from it, that we don't worry about it that much.

Chris -  Peter...

Peter -  I agree completely.  Another contributing factor is zombie movies.  People have gotten so used to these movies where like, you get one little splatter and then 30 seconds later it's a zombie.  Everybody is a zombie and everybody is going to die, that they have come to think that's actual science rather than science fiction.

Chris -  Don't come to the cinema with me.  Not if you're going to wave your hands around like that. I mean people will give us funny looks. But no, it's true though.  People do like a good story and they do like being professionally scared really.  But it is important though.  Someone was also highlighting to us,  isn't it interesting that lots and lots of people have died in Africa of this for 40 years like Suzie is saying and it's when finally, someone dies in America that people go, "Oh, maybe we should take some notice of this"?  Suzie...

Suzie -  Absolutely.  I agree with everything that my fellow speakers have said about the need for infrastructure in countries that are least able to cope.

Chris -  So, following on from that then.  We've got this question that's just popped up on social media.  Does the media reaction actually affect how we respond?  Colin, what do you think?

Colin -  Well, indeed it does.  There's a couple of different components to it.  So, the short term is that a really strong media reaction can help facilitate the funding of a long term international response which is incredibly positive.  However, one of the things that happens over time is that Ebola ceases to become news.  So, if we look at the number of headlines that reported the word 'Ebola' over the past 3 months, they actually peaked in October and they've been declining ever since then.  Because at this point, everyone knows there's a big outbreak going on in west Africa.  So, it's not so much news anymore.  We get fatigued from it.  It's not that similar to the situation with influenza.  H5N1 bird flu back in 2006, it was the big scary thing that was going to kill us all and there was a big threat.  But it's not in the news anymore, but the threat itself hasn't changed.  And so unfortunately, we, as humans, we get tired of hearing the same thing day after day and so, we have to hear new stories.  One of the things that really needs to be balanced in terms of what the media does and how it covers the Ebola outbreak is to stimulate long term public interest.  

Chris - Today, the Wellcome Trust have announced they're putting in one and a half million Pounds to fund a number of little start-up projects to try to come up with new sort of Ebola initiatives.  You're nodding at that, Peter...

Peter -  The director of the Wellcome Trust, Jeremy Farrar, was - if you can pick one person who was instrumental in actually creating reaction to this outbreak was he.  He really shamed the international community into acting on this when everybody else was not doing anything.  He's a hero for that.

Chris -  Suzie, are you getting lots and lots of phone calls to the hospital from worried well?  That's another way that people are reacting.

Suzie -  We're getting so many calls from the worried well though I'm sure that GPs and hospital emergency departments undoubtedly will be seeing people who are very concerned about Ebola.  The fear is real whether or not there is a true threat.  That is something that health professionals have to deal with.  Certainly, people who've been coming back from west Africa from treating people have encountered an awful lot of fear and that fear is real.  So, we do have to be sensitive to what people think and the reaction that the media attention has generated.  I'm hoping that this media attention will bring about changes including vaccines and treatments which will be a legacy that can be used to treat Ebola going into the future.

Chris -  So, what do you think should be done right now?

Suzie -  So, I'm very happy that the treatments and the vaccine trials are progressing more quickly.  I think this is long overdue.  Furthermore, a concern from the current outbreak is that Ebola virus will become endemic in west Africa when it hadn't previously been there before.  And so, there may be more outbreaks going into the future and we desperately vaccines and treatments to combat these outbreaks.

Chris -  Colin, I guess on your wish list would be better international surveillance and cooperation, wouldn't it?

Colin -  Indeed and it's something we're going forwards from here.  Hopefully, we'll be in a situation where we can end the current epidemic with no subsequent endemic circulation.  But once this outbreak is over, that doesn't mean that the threat from Ebola is gone.  It came from an environmental reservoir somewhere and that threat will persist over time.  We have to find good ways to monitor it and we have to find better ways to respond next time.

Chris -  Peter...

Peter -  First of all, as Colin knows, I think we should be modelling bat populations.  I think this is much more predictable than people will admit.  I think that if - in 2005, colleagues and I published a paper saying that it was predictable and if you did X, monitor bat populations, you could predict it and had they done that, this might not have happened.  And so, I think that there has to be some money invested.  What I was going to say is that the media has to be much more intelligent about advocating things that are actually solutions rather than just crying about how dangerous things are.  And they must be much more sophisticated, but understanding what's actually a good response and a constructive response and what's just inciting fear.  That's what has not happened enough to date.

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