No
More Ebola Whac-A-Mole
By Nathan Wolfe in the
Wall Street Journal
Ebola
has killed more than 4,000 people, and the number of cases in Liberia and
Sierra Leone is growing rapidly. We don’t know how many will ultimately die.
But we do know that unless the world takes broader, more coordinated steps
aimed at anticipating outbreaks like Ebola and controlling them early, we’ll be
vulnerable to this and other devastating diseases.
This
vulnerability reflects a world that is increasingly interconnected and
susceptible to potentially pandemic viruses that are transmitted to humans from
wild animals. In the past year, for example, we’ve witnessed the emergence of
MERS and H7N9 as well as Ebola—and despite the understandable focus on Ebola,
the risk of a serious outbreak from these other viruses has not disappeared.
Guarding
against the threat means putting in place robust, resilient laboratory and
surveillance infrastructure in those parts of the world—Africa and elsewhere,
most notably Asia—most susceptible to viral epidemics, and we must support
regional scientists and health experts who will sustain this infrastructure at
all times. Local political leaders have to buy in to this effort, and countries
and governmental agencies in the region will need to coordinate their work.
The
growing international response to the West African epidemic is valiant, but it
is after the fact—a fire-brigade model. That has to change, or the world will
continue to be stuck in a dangerous game of pandemic Whac-A-Mole.
Pandemics
are generally not random, one-off events. Close viral cousins of HIV, for
example, were jumping for many years from chimpanzees to people in Central
Africa before a strain emerged that led to the AIDS pandemic. Ebola outbreaks
have been common in recent years. In August, while the world focused on West
Africa, a second outbreak of Ebola occurred in the Democratic Republic of
Congo. It emerged from an animal-to-human transmission that was unrelated to
the West African epidemic.
The
Ebola outbreak in Congo, unlike the one in West Africa, occurred in a rural
area without easy connections to large population centers. But the way it was
controlled shows what is possible regarding futures eruptions of infectious
disease.
Congo
has years of experience fighting this disease: It has world-class Ebola experts
who have responded to countless outbreaks, as well as multiple, national-level
laboratories that are devoted to the diagnosis of viruses. When people in Congo
began falling ill this summer, local labs within a week were able to determine
both that Ebola was the cause and that the virus was distinct from the West
African epidemic. The Congolese response included immediate site visits and the
deployment of a mobile lab for on-site diagnostics, reducing response time, and
the effective isolation of Ebola cases.
In
regions that are susceptible to pandemics, it will be crucial in the future to
coordinate the efforts of different branches of governments. A model for this
is Cameroon, where the government has a National Emergency Committee for
Pandemics & Epidemics and a National Program for Zoonosis Prevention and
Control, both aimed at infectious agents including Ebola and others that move
from animals to humans. These organizations, the product of efforts begun six
years ago, help to integrate the monitoring of animal and human diseases, and
have advocated this year for dedicated training and early shipment of critical
equipment in anticipation of the potential regional spread of Ebola. The
Cameroon emergency committee has also helped coordinate efforts this year to
fight against cholera and polio.
Even
when national and regional systems are in place, there will be times when the
developed-world cavalry will need to rush to the rescue, as it is now. But
ultimately there are more important ways that wealthy nations can assist.
For
example, the disease surveillance and diagnostic systems in Cameroon and Congo
have been facilitated for over a decade by financial and technical support from
American governmental agencies, groups within the Defense Department and United
States Agency for International Development (USAID), implemented in part by my
company. More work of this kind is needed, and it is vital that other countries
get more involved in this kind of effort.
Today,
the length of time needed for foreign aid to reach its destination, as well as
the ability of countries to rapidly and effectively use assistance, pose real
problems in need of solutions. Innovative financial tools such as parametric
catastrophe bonds—an insurance-like instrument—could at least improve the speed
of funding. Payment of these bonds is triggered based on the measurement of an
actual hazard, such as wind speed in the case of a hurricane, and so they are
paid immediately rather than waiting for a claim based on damages. In the case
of outbreaks, the bonds would require more standardized and widely distributed
measures of early detection, but since such measures are needed anyway, the
development of such financial instruments and the push for improved
surveillance systems could work hand in hand.
Ebola
is not the first virus to threaten the world, and it won’t be the last.
Stopping the current epidemic is vital, but the world can’t afford to go to
sleep after it is stopped. Unless we prepare for the next epidemic, we will
find ourselves forever nailing down outbreaks just in time to see the next ones
pop up.
Mr. Wolfe is the founder and CEO of Metabiota, which develops
systems for monitoring and managing disease spread.
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