What Is the Deal with the Ebola Outbreak?

This week I caught some of The Diane Rehm Show on NPR, which had a very interesting discussion about the current Ebola outbreak. (Audio and transcript here; also available as a free podcast on iTunes.) Panelists included Dr. Anthony Fauci and Laurie Garrett.

As a brief side note, Ebola helped launch me onto my career path in microbiology and immunology. During my senior year as an undergraduate I took a virology course that, along with some outside reading, led me to pursue microbiology in graduate school. Ebola was the exotic virus of the day. One of the books I (mostly) read as part of my extra-curricular reading was The Coming Plague by none other than Laurie Garrett. (For some reason I never did read The Hot Zone, though.)

Anyway, I thought that Garrett said some of the most interesting things in the discussion. For example, one surprising feature of the outbreak is that it is exacerbated by the resistance of the very people that need help. Why?

GARRETT
...first of all, these countries have an average adult illiteracy rate of 50 percent. Then you take in what's functional literacy versus the ability to read anything that actually tries to describe what a virus is, you're talking about a very small percentage of these populations.

And for most people, the germ theory of disease is not a real concept....

In the case of Ebola, we're really up against cultural beliefs that when a disease hits a given family, it's because your ancestors committed some sin against some other family and they have leveled evil spirits against you. It's a kind of sense of an endless set of circles of retribution and revenge for deeds committed by someone against someone else. Well, now add to it, they just came out of these heinous civil wars where indeed evil deeds were done on almost every single family by somebody during the course of the 1985 to 2003 outbreak of violence.

And so you have a situation where outsiders are trying to say to people, there's a virus. And this virus causes this disease. And we are outsiders dressed in space suits and we don't look like you and you should believe us. And meanwhile the average person doesn't even have a concept of what a virus is....

FAUCI
This is nothing new. It's not new to HIV, it's not new to Ebola. History is replete with examples of when there are major outbreaks and plagues. The fear, the terror that is stricken into people has people almost intuitively look to someone to blame, someone, some group, some class, some religion, some country. There always needs to be a reason for things. And if you don't understand, as Laurie was saying correctly, the subtleties of the germ theory of infection, then you're looking to blame people and blame nations and blame groups that have nothing to do with it. So you're absolutely correct, it's a very difficult situation.

This next part gets at something I have felt deeply for quite a while, which is the importance of public health to our prosperity and standard of living. I don't think people in first-world countries appreciate what they have, which is why things like the anti-vaccine movement, slashing of budgets for programs that undergird our medical knowledge and capabilities, or cultural forces that disparage or twist science make me angry.

GARRETT
Quick thing is the average per capita spending, according to the World Bank on health care per person in these countries is a high of $18 a year, a low of $7. So there's not a lot of health care delivery available if you're spending $7 per person per year on all health services combined. And as far as the question -- I'm very glad the caller brought this up -- from Ann Arbor. Thank you. Funding and WHO -- WHO is in severe budget crisis. Has been now for almost four years.

They've laid off 20 percent of total personnel of the institution. And their disease response capacity has seen its budget slashed. I know that the average listener imagines that there's this huge SWAT Team of health providers sitting in WHO Headquarters in Geneva. And at the snap of a finger the director general deploys them where needed. This is absolutely untrue. In fact, WHO goes around begging for people like Dr. Fischer to -- at the expense of somebody else, the U.S. government, for example -- to go in under the WHO flag where needed.

And our own CDC has seen our budget cut for international response capacity, pandemic response and surveillance. So actually we're less prepared today then we were perhaps 10 years ago, in terms of the budgetary constraints of the major responders.

For more on the virus and what kinds of conditions the doctors treating infected people labor under, listen to or read the whole thing.

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