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Epidemic ethics: four lessons from the current Ebola outbreak

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EbolaEpidemic ethics: four lessons from the current Ebola outbreak

By Ian Kerridge

Published 26 August 2014

The extent of the current Ebola virus outbreak in West Africa has belatedly focused the attention of non-governmental organizations, local and Western governments, and international media. What we haven’t caught up with though, is the extent to which these outbreaks and their devastating effects are predictable and preventable. The spread of Ebola virus occurs because health infrastructure in the region is fragmented, under-resourced, or non-existent. And the therapeutic response to the illness is constrained by failure of markets to drive drug and vaccine development that would help the world’s poorest people.

The extent of the current Ebola virus outbreak in West Africa has belatedly focused the attention of non-governmental organizations, local and Western governments, and international media. What we haven’t caught up with though, is the extent to which these outbreaks and their devastating effects are predictable and preventable.

The spread of Ebola virus occurs because health infrastructure in the region is fragmented, under-resourced, or non-existent. And the therapeutic response to the illness is constrained by failure of markets to drive drug and vaccine development that would help the world’s poorest people.

Resource constraints
This is the largest known Ebola virus outbreak, with more than 1,800 cases and 1,000 deaths so far. But the actual number of people affected and mortality rates are uncertain because laboratory diagnosis is limited and only severe cases are admitted to hospitals.

Apart from its longevity and extent, what distinguishes this outbreak is that, for the first time, there’s a prospect of drugs and vaccines to treat and prevent the disease. But these important therapeutic milestones don’t alter the fact that the outbreak will not be controlled by drugs. Rather, what’s required is strict infection control and quarantine.

Person-to-person spread of Ebola virus, by contact with blood, body fluids, or tissues of an infected person (mainly in the late stages of disease or after death) is not particularly difficult to prevent by well-established infection prevention measures that should be routine practice in any modern hospital.

Unlike influenza, for instance, Ebola virus doesn’t spread by coughing or during the incubation period. So the current hospital outbreaks are related to inadequate health-care resources rather than a particularly high level of infectiousness.

Nor can we escape the fact that future outbreaks are more likely to be prevented by sociopolitical and environmental reform than vaccination. That’s because identifying target populations and delivering vaccines rapidly requires infrastructure and sociopolitical stability, both of which can be difficult to ensure during an outbreak.

A moral failure
But drugs and a vaccine are being sent to the region, after a ruling from an ethics panel convened by the World Health Organization decided their use was acceptable even though they haven’t been definitively shown to be safe or effective.

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