Ebola is here again

Four years ago, the Ebola virus hit three impoverished west African countries. Initial cases were unrecognised, allowing unchecked person to person spread for several months.

Local health services collapsed and the virus reached all three capital cities where it spread uncontrollably in the cramped dwellings. There were no effective vaccines or antiviral drugs, and the World Health Organisation (WHO) – responsible for co-ordinating responses to such emergencies – responded with too little, too late. The virus infected some 28,000 people, killing more than 11,000 of them before it was eventually controlled.

Now Ebola has struck again, this time in a remote region of the Democratic Republic of Congo. So, is the world more prepared on this occasion? The answer to this question is yes, since the west African epidemic in 2014-16 was a wake-up call that initiated WHO restructuring and intense research and development.

First, the WHO now has a specific health emergency programme that responded rapidly this time around. Secondly, a rapid test is now available which diagnoses Ebola in a matter of hours rather than the four to six days’ time-lag in 2014-16.

This allows prompt isolation of cases and rapid tracing and monitoring of patients’ contacts. Third, an Ebola vaccine that proved effective in trials undertaken in the 2014-6 epidemic is now being used for ‘ring vaccination’. This involves vaccinating all close contacts of each new Ebola case to prevent the disease developing.

The present outbreak began in early April 2018, and so far there had been 65 confirmed cases and 29 deaths. In midMay, the virus jumped to Mbandaka, a city with more than one million inhabitants. But despite this workers on the ground are still optimistic that the epidemic can be controlled.

So far so good for Ebola, but what if the next epidemic to strike is caused by some unknown but equally deadly pathogen? Then we will be caught out yet again.

As founder of Microsoft and philanthropist Bill Gates says, ‘The world needs to prepare for pandemics in the same serious way it prepares for war. Unfortunately, in the case of biological threats, the sense of urgency is lacking.’*

* N Eng J Med 2018; 378: 2057-2060.

Health protection workers prepare to enter an area suspected to be infected with Ebola.

Photo: NIAID. An electron micrograph of Ebola virus particles (in blue) budding from an infected cell.