The Ebola Epidemic Part I

The Ebola Epidemic 1

In 2014, the world was taken to bed when Ebola managed to spread in parts of West Africa and kill over eleven thousand people.

  • How did Ebola spread?
  • Why was it not possible to prevent an epidemic from occurring?
  • Why was Ebola not taken seriously from the beginning?
  • Is the world better equipped if Ebola breaks out again?

2: 1a: How could Ebola spread so easily?

Ebola is similar at first glance to a number of other diseases, such as the flu or the common cold (see box). An Ebola case can only be determined – with one hundred percent certainty – through a laboratory test . Therefore, Ebola can often spread without the authorities being aware of it.
Poor countries often lack the necessary equipment to test for Ebola. Therefore, it took several months from the first case of Ebola until the international community at all became aware that the virus was on the rise. We now know that the first Ebola patient was infected in December 2013 , but no one knew that there was Ebola in the area before March 2014 . There are therefore three things that are important in potential Ebola cases:

  • rapid diagnosis
  • detection and follow-up of suspicious cases
  • isolation of patients to avoid transmission to others.

Poverty leads to poor health care

In countries with a well-functioning health care system , such as Norway, this is not a major problem. Here, everyone has access to a doctor. Once a person notices severe symptoms, he or she can easily receive treatment and follow-up, and hospitals can afford and have space to treat confirmed cases in isolation. Furthermore, we do not live so close, and we live in good sanitary conditions – with access to clean water, our own showers and good toilets. This reduces the risk of infection. In addition, we have a good population register , where everyone is registered with name, address and telephone number. This makes it easy to track and get in touch with people when needed. In countries such as Sierra Leone, Guinea and Liberia does not exist – it is therefore much more difficult for the authorities in these countries to follow up and keep track of suspicious Ebola cases.

In fact, Sierra Leone, Liberia and Guinea were not the only countries where Ebola was detected in 2013-2014. Ebola also appeared in Nigeria and Senegal , but without any epidemic developing. In these two countries, a total of only ten patients became infected, four of whom died. The reason for the low numbers was primarily due to the fact that the health authorities there had the capacity to prevent the spread.

An example from Nigeria shows this. When they suspected that a single patient had been infected with Ebola in July 2014, they had it tested in the laboratory immediately. When it turned out that the patient had Ebola, they tracked down no less than 898 people the patient had been in contact with. All of these were tested every single day for 21 days, and people with fever were immediately sent for further examination. In addition, the authorities immediately began broadcasting messages on television and radio about the dangers of Ebola and its symptoms. This allowed people to recognize Ebola, and they knew what to do if they suspected it.

Nigeria is a relatively rich and mainly peaceful country (with the exception of areas in the northeast where Boko Haram is ravaging) compared to its neighbors. Sierra Leone, Liberia and Guinea, on the other hand, have been plagued by both civil war and severe poverty for decades. Lack of doctors and nurses, poor infrastructure, lack of facilities and little money in the health care system meant that several cases of Ebola were not diagnosed in time. Thus, one could not follow up those who had been infected.

Some cultural traditions can increase the risk of infection

It is always easier and less expensive to prevent a disease from spreading than to treat patients after they have been infected. But some cultural traditions and lack of knowledge in the population can be an obstacle. One example here is funeral rituals: In many parts of West Africa, it is a tradition for friends and family to wash the body of the deceased together – an important part of the rituals associated with death and burial. Since Ebola can still be transmitted from dead people, such traditions can lead to more people becoming infected – to spreading.

Culture is also about how people think about illness and treatment. For example, doctor visits and hospitals can be something that people primarily associate with death. The probability of dying in hospital is much higher in the Ebola-affected countries than what we in Norway are used to from our well-functioning health care system. Where health care is poor, it is natural for people to try to avoid it. This attitude is reinforced when epidemics such as Ebola break out, since hospitals are seen as a place where there is a high probability of becoming infected . Therefore, many refused to seek help even though they suspected that they had contracted Ebola.

Political conditions make health work difficult

Doctors and other personnel can only follow up patients within their own national borders – borders that the Ebola virus does not take into account. Previous Ebola outbreaks have occurred in isolated villages, but this time the virus appeared in border areas divided between three countries : Sierra Leone, Guinea and Liberia, countries located in Africa according to

In this area, the inhabitants move quite often across national borders. In this way, the Ebola virus could also move freely back and forth between different countries. This made it difficult to get an overview of the prevalence of Ebola, since national health authorities only knew about the Ebola cases on their side of the border. Thus, the virus could suddenly appear unexpectedly in a new village because someone there had been in contact with Ebola victims on the other side of the border.

3: A world that does not care

Ebola was discovered over forty years ago, so why are there no vaccines or drugs against the virus? It mainly requires a lot of research and large investments before you can find out which substances and chemicals you can combine to counteract a disease. Therefore, most medicines are made by pharmaceutical companies that can make money selling their medicine. In the global pharmaceutical market, life is only saved when there is something to be gained from it. Since Ebola outbreaks occur very rarely – and then only in poor countries where the population cannot afford expensive medicines – no one has wanted to develop Ebola medicines.

Global pharmaceutical companies are not alone in being uninterested in the world’s poorest countries. No one else cared when the Ebola crisis grew. Without medicine or a well-functioning healthcare system, the authorities in the West African countries were completely dependent on outside help to avoid thousands of deaths. But as long as Ebola did not receive any global media attention and was only a problem in small, poor countries far away, no other government wanted to get involved. The only help came from aid organizations, primarily MSF .

The Ebola Epidemic 1