From Africa, Ebola could become a pandemic

SOME FACTS ABOUT Ebola virus disease in Africa can be unsettling.  This disease, which was known to have affected many people in the Democratic Republic of Congo (DRC), suddenly became an albatross in West Africa some years ago. Its spread then and the possibility of its further spread now need be taken very seriously because of the danger it poses. For Africa not to become an epicentre of a global Ebola pandemic, much groundwork needs to be done in a world characterised by rapidly occurring events and increasing frequency of human traffic across the globe.

Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans. The virus is thought to have African fruit bats as the source animal (reservoir host), as scientists have discovered Ebola virus in West African bat. In humans, the average EVD case fatality rate has been estimated at 50 per cent, but varying from 25 per cent to 90 per cent in past outbreaks. The first reported EVD outbreaks occurred in remote villages in Central Africa, near tropical rainforests, but recent outbreak in West Africa between 2014 and 2016 recorded in major urban as well as rural areas.

West Africa’ has experienced unprecedented cases. The risk of re-emergence of the disease due to viral persistence in some survivors is real. A biomedical research report stated that “due to the lack of Ebola outbreak early warning alert, preparedness, surveillance and response systems, the most deadly, complex and largest ever seen Ebola war has been devastating West African communities.” Guinea, in 2015, had one terrifying epidemic, leaving behind a devastating trail in form of 11,300 deaths and 28,000 infected people, taking a toll on the health systems and economies of a region that struggled to surmount its hurdles. In a space of about two years, between 2014 and 2016, a total of 28,616 cases of EVD and 11,310 deaths were reported in Guinea, Liberia, and Sierra Leone.

Ebola’s spread puts Africa a crossroads. At a time when the leaders are pushing the continent towards borderless trade, this may come at a significant cost if a delicate balance is not ensured. While a strong case has been made for the African Continental Free Trade Agreement (AfCFTA), which came into effect only recently, a counterbalance might have to be ensured to prevent trans-border transfer of diseases. This is more so as cross-border movement between North and South Kivu provinces in Congo and neighbouring countries on foot has played a part in the spread of EVD. It underscores the difficulty in stopping the international spread of the infectious diseases.

Although an argument could be made in favour of free movement of people and goods, the downside in such vulnerable areas is that this will increase the risk of cross-border transmission of disease and heighten the potential risks for regional disease spread in West and Central Africa, with prospects of continental spread. Although quarantine is an impediment to free trade, public health arguments can justify trade barriers or border controls – for people as well as for goods – to reduce the importation of communicable diseases. It is unfortunate, however, that governments and communities tend to prevent, detect and respond to health threats after epidemics have been established. In the cases of Ebola,

In Ebola as well as many other humanitarian crises, we are well aware that the international community’s response has been too little and too late. The efficiency of national, regional and international community’s responses also appears inadequate. The late humanitarian and local non-governmental organisations (NGOs) emergency responses and challenges to stop the spread of Ebola outbreak in West Africa allowed unprecedented toll of 14,413 reported Ebola cases in eight countries since the outbreak began, with 5,177 reported deaths including 571 health-care workers and 325 died as at November 14, 2014. The sustenance of the Ebola scourge is compounded by people’s attitude, particularly in the Central Africa.

This is 21st century. But, believe this: that health workers in the DRC have run into an invisible but powerful hurdle—a belief system that deems the disease to be a curse or the result of evil spirits. Superstition and doubts about genuineness of claims on Ebola have created a fertile land for rejection of medical interventions. Ignorance is at the core of this needless resistance. In spite of recorded cases of deaths and infections, those who presume that Ebola needed no modern treatment missed the point. A report from the World Health Organisation (WHO) states, as at June 12, 2019, that the DRC has recorded 2,888 total cases. The confirmed cases were 2,794 and probable cases were 94. Deaths stood at 1,938, with three cases of deaths confirmed in Uganda.  Personnel safety has come under jeopardy with the killing of health workers, thus enhancing the spread of in-contact persons.

While some people are refusing medical care, international aid organisations are warning that the Ebola outbreak in DR Congo could worsen in the face of instability, public distrust and a critical shortfall in funds to contain the deadly virus. Over 1,000 people have reportedly died of Ebola since the outbreak was declared in August 2018. Treatment facilities and health workers have come under frequent attack by militia groups in the region, where local people are unwilling to accept help. The WHO has warned that the Ebola outbreak is “unlikely” to be contained in North Kivu and Ituri unless the militias are stopped. The two provinces are adjacent to the borders with Uganda and Rwanda. The Red Cross has also warned of possible cutback in scope of work in the affected area due to critical underfunding, receiving less than half of the $31.2 million (€28 million) it requested to fund its response in the DRC and neighbouring Burundi, Rwanda, Uganda and South Sudan.

The militia’s activities will have untold impact on DRC’s tourism industry as well as those of West Africa as they will affect migration and border management.  A lot of logistics constraints create peculiar problems at the border, hampering formal and informal cross-border trade, transnational communities, and exacerbating the porosity of borders. Travels and tourisms have also taken a hit. According to the World Travel and Tourism Council (WTTC), on some impacts in Sierra Leone, Guinea and Liberia are associated with paucity of data, on direct impacts of Ebola, aviation, border management and migration, with tourist arrivals down by 50 per cent while tourists were urged to avoid the Ebola zone in West Africa. Many considered the entire African continent as a risk.

The risk could be better understood in the case of a defiant Patrick Oliver Sawyer, a Liberian-American lawyer who travelled to Lagos after realising he had Ebola. He died in a Lagos hospital, exposing the hospital health workers to infections, in which case a doctor on duty died. Not all in-contact persons during his Monrovia-Lagos flight could be found.   

Inexplicable absence of political will among African leaders has also contributed in a way to sustain the Ebola crisis. A WHO report of 2011, reviewing the Abuja Declaration on health funding from national budgets over a period of ten years since 2001, noted that, in April 2001, “the African Union countries met and pledged to set a target of allocating at least 15 per cent of their annual budget to improve the health sector and urged donor countries to scale up support. Years later, only one African country reached this target. Twenty-six countries had increased the proportion of government expenditures allocated to health and 11 had reduced it. In the remaining nine countries there was no obvious trend up or down. Current donor spending varies dramatically.” The political will in DRC also took a different turn recently when Dr. Oly Ilunga resigned as DRC health minister, protesting what he criticised as pressure by unnamed “actors” called upon to deploy the second vaccine, manufactured by Johnson & Johnson and backed by the WHO. Ilunga’s resignation potentially paved the way for the introduction of a second vaccine to contain the spreading epidemic.

Measles disease resurgence has been reported recently in countries that claimed to have earlier eradicated it. With varying degrees of morbidity and mortality, measles have been ravaging the Philippines and the US. Before the latest round of outbreaks, measles was said to have been eliminated in the United States in 2000. According to the Centres for Disease Control and Prevention (CDC), outbreaks in close-knit communities accounted for 88 per cent of all cases. Of 44 cases directly imported from other countries, 34 were in U.S. residents traveling internationally; most were not vaccinated. Close-knit communities with low vaccination rates are at risk of sustained measles outbreaks. In the Philippines, based on the WHO’s report, it was stated that, as of February 26, 2019, “over 12,700 measles cases have been officially reported by The Department of Health (DOH) with 203 deaths from 1 January to 23 February 2019.”

Although there are signals that Ebola may soon be a “preventable and treatable” disease after a trial of two drugs showed significantly improved survival rates, according to some scientists, the aforementioned barriers still stand tall and remain daunting. More than 90 per cent of infected people can survive if treated early with the most effective drugs, the research showed. The drugs will now be used to treat all patients with the disease in DR Congo, according to health officials. It will be good news if all financial resources needed to purchase sufficient drugs are available. It will also be gladdening to know that African governments have decided to put allocate more money into the health sector; or if the traditional belief system that posed as barriers to interventions have been pulled down. But, with the increasingly connected world, Ebola could escape into countries outside Africa, making it a pandemic. Let’s hope this does not happen.