The world has finally got serious about Ebola. In a first for a public health threat, the United Nations has launched the kind of response it normally reserves for war zones. Meanwhile, the US, UK and France are sending troops to build treatment units, train health workers and keep order.
It's not a moment too soon: the US Centers for Disease Control warns that without a massive effort to slow the epidemic, a million people in west Africa could have Ebola by January. Some will carry it elsewhere, and the virus may circulate non-stop in Africa for the foreseeable future.
In the clearest sign yet that world leaders are worried, the US has earmarked $500 million to fight Ebola, rising to $1 billion if necessary. Whoever pays, the UN says $1 billion will be needed to stop the epidemic, an order of magnitude greater than the World Health Organization estimated in July.
The increase reflects the epidemic's exponential growth: known cases now top 5800, and are doubling every 16 to 30 days. Epidemiologists have known this was coming for months. What has changed is the realisation at the upper levels of the political establishment that Ebola could now have a global impact.
International response
In a reflection of this, the UN Security Council last week called its first-ever emergency meeting on a health threat. It passed a resolution that declared the epidemic "a threat to international peace and security... which unless contained, may lead to further instances of civil unrest, social tensions and a deterioration of the political and security climate". Margaret Chan, director-general of the WHO, drove the point home, telling the Council: "This is a threat to national security, beyond the outbreak countries."
At the Security Council's behest, UN disaster relief experts this week set up a base in Accra, Ghana from which to coordinate international efforts. The UN Mission for Ebola Emergency Response will field military and civilian response teams from China, Cuba, the US, France, the UK and other countries.
Part of the threat if the epidemic continues to grow is the risk to global trade and the integrated financial system. The World Bank estimates that if the epidemic is not substantially slowed, trade and financial disruption could cost West Africa several billion dollars by the end of 2015. "Containment and mitigation expenditures in excess of $1 billion would be cost-effective," the Bank says, if they stop that happening.
The epidemic has already halved economic growth in Guinea, Liberia and Sierra Leone, the three countries most affected. The hardest-hit parts of Liberia and Sierra Leone are key producers of rice, the region's staple food. Quarantining infected people has interfered with harvests and planting, causing a spike in food prices. In hard-hit Kailahun province in Sierra Leone, 40 per cent of farmers have died or fled.
Worldwide spread
The financial toll, the Bank estimates, will kick in big time if Ebola gets loose in more countries. There are precedents. A resurgence of polio in Nigeria in 2003 was carried to Sudan, Saudi Arabia and Indonesia, even though many people are immunised to polio, unlike Ebola.
"If it grows as some models predict to hundreds of thousands of cases by the end of 2014, cases could reach other countries," says Thomas Inglesby, head of the Center for Health Security at the University of Pittsburgh in the US. "Cities with weak health systems and high populations could have Ebola epidemics that get out of control." Nearby cities such as Lagos in Nigeria or Kinshasa in the Democratic Republic of Congo fit the bill, but epidemiologists worry that infected travellers could get much further, as the virus can sometimes take three weeks to produce symptoms. An infected person who develops symptoms in Calcutta or Mexico City might infect many more people before anyone recognises the disease.
Ian Goldin of the University of Oxford says the US and other rich countries fear Ebola will weaken their trading and strategic partners such as India, Brazil – or Nigeria, also home to Africa's largest oil reserves, and violent Islamic jihadists. "Threats include extremist takeover, and extremists getting hold of the virus," says Peter Walsh at the University of Cambridge.
That alone, says Inglesby, warrants calling in the armies of other countries. "For a crisis this big, only the militaries of the world have the logistical, administrative and hospital building expertise to meet the challenge."
Permanent problem
But even the military may not be thinking big enough. The US plan includes training 500 health workers per week to manage Ebola cases safely. "But this linear increase in the number of workers may be overcome by an exponentially growing number of cases," says Matthew Hardcastle of the New England Complex Systems Institute. Some of the trainees must become trainers themselves so the number of workers can keep pace.
If efforts to control the epidemic slow, but do not stop its spread, the threat could become permanent. "There is now a high risk that Ebola becomes endemic in West Africa," says Peter Piot, head of the London School of Hygiene and Tropical Medicine, a co-discoverer of Ebola. This means the virus is always present in people somewhere.
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