Yellow fever’s coming back, and Ebola never left.
If the West Africa Ebola epidemic follows the history of past outbreaks, it is highly likely that it will become endemic to the subregion and subsequent outbreaks can begin at any time. In fact, errant cases of Ebola have continued into 2016. And we do not want a redux of the 2014 epidemic. Which is why it is troubling that Congress is debating whether to reallocate $350 million in funds designated for Ebola to contribute to the Zika fund.
Zika isn’t entirely benign, of course. We are right to take note of Zika’s global spread. The disease has been a known threat since it was first identified in 1947. It has since spread through many African and Asian countries, but the attention it’s currently garnering is due to the Asian strand, which is currently spreading throughout the Americas at a rapid rate—Zika-bearing mosquitoes are predicted to reach the U.S. this summer, and the Olympics will take place in one of the hotbeds, Rio de Janeiro, this August(though it will be winter there). The public’s reaction is understandable: Zika’s propensity to cause brain damage in babies is, to say the very least, troubling. And while most adults who contract Zika exhibit mild symptoms, infant microcephaly, coupled with Zika’s presence in nearby Latin America, brings it to the fore in both the media and in personal conversations on public health. There is fear of Zika, so coverage is understandable—and laudable when it serves to appropriately contextualize that fear.
But despite the outsized media attention, we must not pretend Zika is the only public health concern. Zika is getting coverage now because it’s here now. But it is not the only deadly disease in the world, nor are the others necessarily going to stay remote. And while coverage of disease shouldn’t be thought of as a zero-sum game, the reality is that all of the attention on Zika has meant that other global public health crises are being ignored, by the media and by public health experts. At the time of writing, Zika had 95 million hits on Google; by comparison, Ebola had 49 million—despite the fact that Ebola has proved to be a much more deadly threat.
And even though it’s gotten much less media attention in the U.S., Angola is currently battling a yellow fever outbreak (Google hits: 6.3 million) with the propensity to spread throughout the region, and a Lassa fever outbreak has been ongoing in Nigeria, Togo, and Benin since last fall. As we saw with the West African Ebola outbreak, a disease can spread rapidly if the response is slow, health facilities are inadequate, and public health and human resources are lacking. More significantly, West Africa had never had an Ebola epidemic prior to 2014. The lack of global attention in the early part of the Ebola epidemic was one of the primary factors for its swift and wide proliferation.
Responding to epidemics in new or underserved areas requires many kinds of resources. In the case of Ebola in West Africa, several factors were in play. The hardest hit countries—Guinea, Sierra Leone, and Liberia—lacked sufficient medical staff and facilities to respond to Ebola. In this case, these countries needed additional monetary aid as well as human resources. As Ebola progressed and supplies started to reach West Africa during the summer of 2014, additional medical professionals were still desperately needed. It was several months after the outbreak began that medical professionals from around the world, including Uganda, Cuba, Ethiopia, Nigeria, China, the United Kingdom, and the United States, started showing up in considerable numbers—and only then was the situation was contained.
Guinea, Liberia, and Sierra Leone were also overwhelmed because they did not have sufficient warning. Ebola was first identified in 1976, but only one errant case of animal-human transmission of Ebola had ever taken place in West Africa. It would take a few months before medical personnel knew what they were dealing with. In contrast, Senegal and Nigeria were able to respond more effectively because they had more developed public health systems, more medical professionals, and advanced warning and planning. If we ignore public health crises at the outset, we end up paying more to respond and contain the crisis.
The ideal way to respond to a traveling disease like Zika—and rapidly growing Chagas, Chikungunya, and Ebola—is to do so quickly, wherever it first occurs. That diseases can travel and should be stopped at the source is nothing new, but history shows us that it is a lesson we continuously ignore. If we continue focusing our attention on the biggest perceived threat, we will be forever chasing our tails rather than more effectively stopping problems at their sources. We can learn from the past—for example, it was the epidemics of yellow fever and bubonic plague that prompted the creation of the first medical school in French West Africa in 1918, as I show in Pharmacy in Senegal. While the colonial “medical mission” was not perfect, one result was the sowing of seeds of biomedical training and expansion in the region, which allowed them to be better prepared in the face of subsequent threats. Our efforts today could be more effective if they were concentrated at improving medical resources at Ebola’s source.
Diseases can travel, and can travel quickly, and must be dealt with early on and continuously—these are all lessons we should be learning from Ebola. But we are not. Instead, we are talking of diverting funds from the Ebola emergency fund to combat Zika. Even if public attention is limited, global outbreaks are not a zero-sum game—nothing that happens with Zika will play a role in whether or when Ebola emerges as a serious outbreak again. Instead, we are forcing ourselves into a corner of having to settle for too little, too late. Like Dr. Anthony Fauci, I believe that these funds should not be diverted to fight Zika. Instead, Zika deserves its own war chest as other epidemics and emerging epidemics do. And as governments and medical professionals respond to these infections, we cannot lose sight of developing sound infrastructure and staff to respond to current and future health crises.
To lessen the impact of future epidemics, it is crucial to look beyond the disease in the headlines and prepare a broad response strategy. Countries and communities with inadequate health facilities, wherever they are in the world, should be targeted for improvements. Medical personnel in developing countries and rural regions of developed countries should be incentivized to stay in the areas and not become part of a growing trend of “brain drain” in areas that need doctors, nurses, and midwives the most. As the world continues to get smaller via international travel and exchange, it is important to remember that borders are porous and global health security in remote areas is as significant as it is in major cities. In any event, not fighting for health security in more remote locations may end up costing us more in the long run—a lesson we should have learned by now. The disease that doesn’t make the headlines is no less deadly than the one playing on loop on your television.