The Economist – WHAT should the world do about Ebola? A rationalist might say: nothing. Rich countries with decent health infrastructure are not at risk because—unlike airborne viruses, such as influenza, or mosquito-borne ones, such as yellow fever—the disease can be isolated if treated with sufficient care. In the poor countries that are infected (see article), the thousand-or-so lives this irruption is believed to have taken so far are fewer than the slaughter inflicted every single day by malaria, by AIDS, by tuberculosis or even by diarrhoea. In a world of limited resources, then, it is arguably best to concentrate on those big killers, whose treatment and prevention are well understood, rather than chase after an illness that is incurable and, on a global scale, trivial.
Yet looking at the problem from a different angle produces a different answer. Though its pathology, symptoms and means of transmission are different, Ebola has certain similarities to AIDS. Both were new diseases that came out of African jungles. Both took hold in countries without decent health infrastructure. Had AIDS been spotted in 1959, the year (as was subsequently realised) when the earliest blood sample known to contain HIV was taken from a man living in the Belgian Congo, the chances are that the epidemic which began to ravage the world two decades later would have been nipped in the bud. Some 39m lives—not to mention the countless dollars spent fighting the disease, and the countless more forgone by the decimation of many African countries’ workforces—would have been saved.
The story of AIDS argues for tackling such potential plagues early. Yet their spread is not easy to stop. In the case of Ebola and similar diseases, such as Lassa and Marburg fevers, early detection is crucial, for the best way to stop an epidemic from developing is to quarantine those infected. That means having a network which can report strange symptoms presented at local clinics to those best able to interpret them, such as America’s Centres for Disease Control and Prevention. This, in turn, means having clinics in the first place. It is no coincidence that the countries now affected by Ebola are some of the worst governed in the world. Public health is not a priority there, which is why it took months to notice what was happening.
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Fortunately, the trend in many poor countries is more encouraging. One lesson learned from recent successes against AIDS, malaria and TB is that victory comes only when the whole infrastructure of health, including the active involvement of local people, is promoted. As places get richer (as many African nations now are), more money for public health becomes available. With luck, then, outbreaks such as the current one will get rarer in the future.
Building decent health infrastructure everywhere will take a very long time. But there are quicker, targeted approaches that could help lessen the danger meanwhile. The main source of new infectious diseases is animals. Ebola, which was identified only in 1976, is thought to be spread by fruit bats. HIV was originally a chimpanzee virus. Boosting efforts to monitor wild animals, and those who routinely come into contact with them, such as hunters and butchers of “bush meat”, to see which viruses are jumping species, might help stop further plagues before they get started. The American government’s Emerging Pandemic Threats programme is already doing this, in collaboration with independent groups such as Metabiota—but the scale of the challenge is such that more resources are needed. In epidemics, even more than in individual cases of disease, prevention is far, far better than cure.