Fighting against Ebola is not enough.
It is not Ebola … it’s the systems.“ (Barbiero 2014)
As soon as an Ebola outbreak is defeated by ever better control measures, the next one breaks out, and then all the worse:
Health authorities already expect the Ebola epidemic to become a permanent (endemic) problem in Congo (CDC 06.11.2019)
Ebola is a social problem
Ebola is caused by a virus (family Filoviridae). It is transmitted from wild animals to humans. Infected people then spread the virus via body fluids to other people. This often happens in health care facilities. 30-90% of infected people die, depending on the quality of their general care.
Rainforest ecosystems are teeming with microorganisms and viruses. Humans enter this habitat slashing, or burning or hunting, injure themselves with bites, or come into contact with the blood and saliva of the animals on markets.
If such a poacher is bitten by a bat becomes infected with Ebola viruses, he may infect some family members who care for his corpse. Then a few people die in the village, but the epidemic quickly comes to a standstill. Mostly the patient is transported to the nearest ailing infirmary. There „fever“ is nothing special. Often one then erroneously fights a supposed „malaria or bacterial infection“ with injections or pills that do not help Ebola patients, but offer the viruses ample opportunity to be carried on.
The spread of the Ebola virus is therefore favoured by human behaviour: Advance into the jungle, slash-and-burn, small animal hunting, poverty, war, unhygienic misconduct, dangerous health services.
The first still small Ebola epidemic was observed in 1976 in the Congo. Since then there have been sporadic outbreaks.
In 2014, numerous cases were reported from West Africa (Guinea, Liberia, Sierra Leone, Nigeria). About 11,000 people died. In 2018, another outbreak occurred in the Democratic Republic of Congo. By the beginning of July 2018, 53 infected persons had been reported, 29 of whom died.
By August 16, 2019, more than 2,800 Ebola cases had been reported in the civil war provinces of Kivu and Ituri in the Democratic Republic of Congo by August 16, 2019, most of them laboratory-confirmed. Well over 1,900 of these patients died.
„Weak, underfunded, understaffed and fragmented health systems are unable to cope with a major outbreak of an infectious disease and may even have contributed to its spread“. Peter Piot 2015 „… The cumulative number of confirmed/probable cases among health workers is 153 (5% of all confirmed/probable cases), including 41 deaths. (ProMED, Congo 20.08.2019)
In 2015, a special issue of Nature asked whether we had learned from the epidemic in West Africa. The answer was no. In 2018 the same questions had to be asked again:
… health facilities with inadequate infection control procedures can amplify outbreaks of Ebola virus disease, and serves as a reminder of the importance of providing sufficient training and equipment for health-care workers to protect themselves. Ahmadou 2018
In 2019, Ebola experts with many years of experience are again writing down demands that have actually been known for years, including the need to secure the general health services in the long run (and not only when an outbreak has just been revived). And that one should take care of the general needs of the population within the framework of a peaceful regional development. (Piot 2019, Kittelsen 2019)
Ebola epidemics are announced disasters
The preconditions for epidemics are poverty, wars, social instability, lack of education and miserable living and nutrition conditions. The occurrence of epidemics is therefore due to the neglect of causes that inevitably lead to epidemics in the long term.
If an epidemic threatens once again, the most common approach is to try to kill an enemy as simply as possible, possibly with „heroic“ volunteer missions, using problem-fighting actionism. Nobody then likes to think of system connections, including a world economic order that is disadvantageous for many countries.
What should actually happen?
In order to prevent the outbreak of epidemics in Africa (and elsewhere) from flareing-up in the long term, the complex system of relationships and interrelationships that favour the spread of Ebola, yellow fever, Lassa, malaria, HIV and many others should be better understood and influenced. (Barbiero 2014, Azuine 2014).
It is not enough to revive basic health care, which has collapsed in many regions (UNDP 2015, Difäm 2016). And vaccines will not solve the problem either unless general living conditions improve at the same time. (Davis 2013)
In particular, the focus should be on ensuring hygienic, healthy, stable and peaceful living conditions. This includes, for example, securing sufficient food and eliminating the causes of war and terror. In the context of long-term development of community-based structures in rural and urban areas, investment would also have to be made in integrated, high-quality basic health systems. And this at the expense of the current, isolated eradication programmes for individual infectious diseases (Kieny 2014). In addition, highly dangerous and largely uncontrolled medical facilities would have to be completely rehabilitated or closed down.
For good reason, the then President of Liberia, Ellen Johnson Sirleaf, therefore called for a Marshall Plan for West Africa in 2015 that would influence the overall situation of the countries affected.
Ebola (similar to cholera) regarded this clever but little considered proposal only as an indicator of desolate conditions. Consequently, it could not only be a question of solving one (of many) individual problems. Instead, regions as a whole and in all areas must develop equally, sustainably and healthily. After all, impoverishment, filth and contamination in developing countries not only have local but also global consequences, such as migration.
The world community should therefore think and act long-term and not rely solely on technical measures such as the effectiveness of vaccination campaigns that have yet to be tested.
Instead of tinkering with individual problems, one should concentrate on developing entire regions (e.g. Ituri in the Congo) in a favourable and peaceful way in all areas at the same time. This would also reduce the risks of epidemics. (Dolin 1997)
Ebola is just one of many global disease signs
Industrial nations such as Germany would actually have to invest a large part of their wealth, which they have acquired at the expense of others, in „sustainable development goals“ out of self-interest.
They must act consistently and in the long term and ensure security, especially in regions in which proxy wars are waged over mineral resources. As long as this does not happen, well-meant, short-term epidemic control measures, which are limited to what is medically feasible, will remain a waste of time.
However, effective action in the face of a disease symptom such as Ebola would be very expensive and would therefore contradict the cross-party growth objectives of our societies. That is why it will not happen until an Ebola epidemic also threatens industrialised countries.
It is therefore not surprising that more and more people in Africa are heading north to escape their misery.
More about Ebola
- German Foreign Office „Ebola: Kongo & Uganda“, 19.06.2019
- Gesundes-Reisen 21.08.2019
- WHO Ebola Dashboard DRC, Aufgerufen am 23.08.2019
More about infections
- Ahmadou B et al. (2018): Outbreak of Ebola virus disease in the Democratic Republic of the Congo, April–May, 2018: an epidemiological study. The Lancet 2018 392 (10143), S. 213–221.
- Azuine R: Ebola Virus Disease Epidemic: What Can the World Learn and Not Learn from West Africa? Int J MCH & AIDS 2015, 3(1):1-6
- Barbeiro V (Editorial): It’s not Ebola … it’s the systems. Global Health Science and Practise, 31.10. 2014:
- Butler D: Six challenges to stamping out Ebola. Despite a recent sharp drop in the overall number of Ebola cases, the situation remains precarious in West Africa, Nature 24.02.2015
- Davies E: Health reform alone is pointless, BMJ 2013;346:f832
- Dolin PJ et al: Reduction of trachoma in a sub-Saharan village in absence of a disease control program, Lancet Volume 1997, 349 (9064):1511–1512
- Kieny MP et al.: Health-system resilience: reflections on the Ebola crisis in western Africa, Bull WHO 2014, 92:850
- Kittelsen SK et al: Rational trust in resilient health systems, Health Policy and Planning, czz066
- Nature: Did we learn? How to beat this epidemic an prepare for the next. Nature, 06.08.2015, 524: 7563
- Osterholm MT: Transmission of Ebola Viruses: What We Know and What We Do Not Know, Mbio, 09.02.2015
- Piot P et al.: Emergent threats: lessons learnt from Ebola, International Health, ihz062
- SCF, Save the Children Fund (2015): A Wake-up Call: Lessons from Ebola for the world’s health systems (pdf)
- Tomori O: Will Africa’s future epidemic ride on forgotten lessons from the Ebola epidemic?
BMC Medicine 2015, 13:116 (14 May 2015)
- UNDP-Report 2015: Recovering from the Ebola Crisis: A summary report as a contribution to the Formulation of National Ebola Recovery Strategies in Guinea, Liberia and Sierra Leone, 2015
- Virchow R: Die Noth im Spessart, 1852
- BMJ zu Ebola: Freier Zugang
- Bernhard-Nocht-Institut für Tropenmedizin Hamburg
- Ebola-Lessons: Foreign affairs 2015
- Ebola-Lessons: Oxfam 2015
- FAQ zu Ebola (www.gesundes-reisen.de)
- Journalistischer Artikel: Ebola Deepl
- Mansons Tropical Disease Zugang: Viral Haemorrhagic Fevers (Lucille Blumberg et al.) in Manson’s Tropical Diseases (Farrar J et al.) . 23rd edn. Elsevier; 2014; with permission from Elsevier (via GIZ).
- Sirleaf EJ: Marshallplan für Westafrika, März 2015: Aljazeera, BBC, Spiegel
- WHO: Ebola – Ebola Situation reports / WHO Ebola Response Team