The panic surrounding the Ebola epidemic reached new heights this week with its spread into Mali and the news that the virus has now claimed over 10,000 lives worldwide. In recent months, media hyperbole has led many to believe that Ebola is little more than an elaborate government concoction, or that it could lead to the rise of vast zombie hordes. But what do experts have to say about the prospects for this epidemic and the probability of Ebola spreading to the UK?
Last Thursday, Professor Peter Piot – a member of the team who first discovered and characterised the virus in West Africa in the late 1970s – shared his thoughts with an audience at the Oxford Martin School. Now the Director of the London School of Hygiene and Tropical Medicine, and a major driving force behind the development of the antiretroviral therapy which has revolutionised the prognosis of HIV, Professor Piot offered unique insight into the state of the current epidemic. The talk is available to watch here.
One of the first topics addressed by Professor Piot was the significant media interest in the source of the epidemic. After all, humans are not the natural hosts for the virus. The only goal that any virus has is replication – perpetuating its genetic material ad infinitum. As such, they succeed most in conditions where they can establish chronic disease; HIV and hepatitis C infection in humans, for example. Killing off your host prematurely simply complicates matters, and the imperfect, accidental relationship seen between the Ebola virus and man lies behind the extraordinary mortality – exceeding 50% – that makes this particular epidemic so frightening.
Research recently performed by Professor Simon Hay and colleagues in Oxford suggests that bats are the major animal reservoir for the virus, particularly in Ebola’s traditional West African heartlands. The various local outbreaks of Ebola infection in the Democratic Republic of Congo and neighbouring countries that have occurred since the late 1970s may therefore stem from the consumption of illegal, infected bushmeat. Many media outlets have reported that the family of the first victim of the current outbreak – a 2 year old child who died in Guinea in December last year – hunted and ate bats regularly. European food safety experts are now evaluating the safety of bushmeat and trade sanctions may follow in the coming months.
In contrast, an issue that few newspaper articles have highlighted is the low death rate seen in previous epidemics. In the 35 years since Ebola was discovered, outbreaks have claimed just 1500 lives in West Africa – an average of around 40 a year. Dwarfed by deaths due to cancer, heart disease and stroke in the West, and a range of common bacterial and viral infections in developing countries – this figure may offer real comfort. Unfortunately, the picture has changed dramatically in recent months. Professor Piot believes that a combination of widespread mistrust of federal decrees, pernicious disease myths and above all a shortage of health workers and resources have created a “perfect storm” for an epidemic in West African countries ravaged by decades of war. In his eyes, a comprehensive international aid and intervention program could have everted this crisis if implemented several months ago. We have now reached a point where, as he puts it, “there is no time to lose”. Despite these pressing concerns, the risk of a worldwide pandemic remains low, given the rich medical resources and watertight isolation protocols seen in developed countries.
One of the saddest aspects of this epidemic has been the dynamics of the international response to Ebola. Professor Piot himself noted that “it took until 8th August, when the WHO declared that Ebola was a public health emergency of international concern. And what did it take? It took around 1000 Africans dying, and two Americans repatriated. So that’s about the equation and value of life, and what triggers an international response.” He went on to heap deserved praise upon Médecins sans Frontières, the international consortium of healthcare workers who have volunteered to care for Ebola sufferers at great personal risk. With a large-scale injection of international resources and adequate medical assistance now on its way, Piot believes that tackling this epidemic on the ground will require huge social and cultural upheaval in the countries affected. Changes in burial practices for example, could markedly reduce the spread of disease, as infected corpses are important sources of infection. As he puts it, “this is not something that can be fixed by foreigners – it must come from within?”. It will be interesting to see how resources are targeted in West Africa to overcome these profound social and cultural challenges.
So, what does the future hold for Ebola? The high mortality associated with this outbreak ultimately stems from our lack of a suitable vaccine and our inability to treat infection once it has become established. The World Health Organization has made an unprecedented move in fast-tracking vaccine development, and now estimate that nearly 1,000,000 effective doses will be available, primarily for healthcare workers, by mid-2015. With this massive drive, Piot hopes, on a final optimistic note, “this will be the last Ebola outbreak where all we have is isolation”.
This term, Bang! will be running a regular series on topical science talks held in and around Oxford, in collaboration with the Oxford Martin School and several collegiate societies. Please contact the Editors at email@example.com to find out more.