Magazine article Foreign Affairs

Ebola's Lessons: How the WHO Mishandled the Crisis

Magazine article Foreign Affairs

Ebola's Lessons: How the WHO Mishandled the Crisis

Article excerpt

In a biological sense, last year's Ebola epidemic, which struck West Africa, spilled over into the United States and Europe, and has to date led to more than 27,000 infections and more than 11,000 deaths, was a great surprise. Local health and political leaders did not know of the presence of the hemorrhagic fever virus in the 35,000-square-mile Guinea Forest Region, and no human cases had ever been identified in the region prior to the outbreak. Its appearance in the tiny Guinean village of Meliandou in December 2013 went unnoticed, save as a domestic tragedy for the Ouamouno family, who lost their toddler son Emile to a mysterious fever. Practically all the nonbiological aspects of the crisis, however, were entirely unsurprising, as the epidemic itself and the fumbling response to it played out with deeply frustrating predictability. The world has seen these mistakes before.

Humanity's first known encounter with Ebola occurred in 1976, with an outbreak in the village of Yambuku, Zaire (now the Democratic Republic of the Congo), and surrounding areas. A horrible unknown disease suddenly started causing internal bleeding, high fevers, sometimes hallucinations and deranged behavior, and often death; it was eventually named Ebola after a nearby river. Back then, science lacked today's tool kit for the rapid identification and genetic analysis of viruses, not to mention meaningful antivirus treatments, biotechnology, sophisticated hazmat suits, and cell phones. Considerable courage, combined with a fair amount of swagger and medical savvy, was the key trait of the couple of dozen foreigners who swooped in to assist the local disease fighters. Most were veterans of battles against other microbes, such as smallpox or yellow fever, but had not previously worked together. Karl Johnson, a virologist at the U.S. Centers for Disease Control and Prevention (cdc), took charge, and the multinational group operated as a team of rivals, jockeying for their respective institutional or national stature in the loosely governed investigation.

Conducting its work under the brutal dictatorship of Mobutu Sese Seko, the group's every small achievement, from corralling air transport to communicating with the cdc's headquarters in Atlanta, was a near miracle. But within a few months, the virus was identified, the Belgian Catholic mission hospital at the center of the outbreak was closed, quarantines were enacted, and the epidemic ended. Almost 300 people had died.

The world's second serious confrontation with Ebola came 19 years later, in 1995, when the disease again broke out in Zaire-this time in Kikwit, a community of nearly half a million people spread out along the edges of a vast rainforest in what amounted to a giant village of mud roads, with no running water, no electricity, no phones, no media of any kind, and only the crudest of medical facilities. I took up temporary residence in Kikwit during the epidemic, reporting on how it played out. There was (and still is) only one paved road out of town, the N1, heading around 300 miles due west to Kinshasa and 550 miles southeast to Mwene-Ditu. At the time, Mobutu held Zaire in his clutches and used its national treasury as his family's personal account; he would die two years later, and the nation would discover its bank vaults were empty. When the mysterious disease plaguing the community was finally confirmed as Ebola, the despot had his military cut off access to the highway, leaving the people of Kikwit to suffer on their own.

The global response boiled down to the Zairean doctor Jean-Jacques Muyembe-Tamfun and his medical team; three physicians from Médecins Sans Frontières (msf, or Doctors Without Borders); three World Health Organization (who) officials; and about two dozen clinicians and scientists from the cdc, France's Institut Pasteur, Belgium's Institute of Tropical Medicine, South Africa's National Institute for Virology (now the National Institute for Communicable Diseases), and other Western agencies and academic centers. …

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