The Ebola Epidemic Is About to Get Worse. Much Worse.
As in: We need to order 500 million vaccines. Now.
By MICHAEL T. OSTERHOLM
September 30, 2014
We know how the disease will likely spread in the months ahead. Each year, thousands of young West African men and boys are part of a migratory work population not too dissimilar from U.S. migrant farm workers. Crop-friendly rains wash over West Africa from May to October, forming the growing season. These young men typically help with harvesting in their home villages from August to early October, but afterward head off for temporary jobs in artisanal gold mines in Burkina Faso, Mali, Niger and Ghana; cocoa nut and palm oil plantations in Ghana and Cote d’Ivoire; palm date harvesting and fishing in Mauritania and Senegal; and illicit charcoal production in Senegal, Mali, Cote d’Ivoire, Ghana, Burkina Faso and Niger.
This migration is about to begin, even for young men whose villages have been recently hit by EVD. These workers find daily laborer jobs at $5 per day, half of which they remit to their families back home. Like their ancestors before them, they use little-known routes and layovers through forests to avoid frontier checkpoints. They usually have ECOWAS ID cards, providing free passage to all the member states of the Economic Community of West Africa States. It takes one to three days to travel from the EVD-affected countries to these work destinations. There is no need for Ebola to hop a ride on an airplane to move across Africa: It can travel by foot.
Densely populated African cities such as Dakar, Abidjan, Lagos and Kinshasa—teeming with jam-packed slums as far as the eye can see—could be most at risk. This is the nightmare scenario. It is all too real, and yet no international, coordinated plan exists for how to respond to what would likely be an even more catastrophic event. Ask the world's intelligence and security experts what an Ebola epidemic unleashed on Africa’s megacities could mean for the continent’s stability. We need a Plan B, or hundreds of thousands of people may die.
And what of Plan C? The use of effective, safe vaccines has been a foundation of modern public health. We even eradicated one of the Lion Kings of infectious disease—smallpox—with an effective vaccine. Unfortunately, not all infectious agents can be relegated to the history books through vaccination. We are still searching for effective and safe vaccines for diseases such as AIDS, malaria and TB. But I feel certain that a safe and effective Ebola vaccine is on it way.
Will it come soon enough? On virus time? And on the scale that the disease demands? Only a month ago, the primary discussion around developing, approving, manufacturing and distributing an effective and safe Ebola vaccine was to protect a few thousand health-care workers and prevent the few remaining community-acquired Ebola cases that continued to occur. But it’s now a different ballgame. This epidemic could grow much, much larger and become what we call an endemic disease—one that doesn't go away. Science recently published two must-read articles, by Jon Cohen and Kai Kupferschmidt, about the grim reality of trying to find and produce an effective vaccine: Their conclusion was that government bureaucracy, a lack of adequate funding and battles between government and private-sector companies have prevented progress.
The first critical mistake public-health officials often make amid such outbreaks is failing to consider another black-swan scenario. At the moment, they are focused only on meeting the vaccine need in the three affected countries. If this virus makes it to the slums of other cities, the epidemic to date will just be an opening chapter. Africa contains more than a billion people, and is growing faster than anywhere else in the world. If world leaders don’t make it a priority now to secure up to 500 million doses of an effective Ebola virus vaccine, we may live to regret our inaction. It’s that serious.
Securing 500 million doses of an effective Ebola virus vaccine is going to require a partnership between government and vaccine manufacturers that puts it on the same footing as our response to an emerging global influenza pandemic. This will require mobilizing people and resources on a massive scale—it has to be the international community’s top priority.
In the words of Sir Winston Churchill, “It’s no use saying, ‘We’re doing our best.’ You have got to succeed in doing what is necessary.” It’s time to do what is necessary to stop Ebola. Now.
Michael T. Osterholm is director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
Many governments have been the victims of the pharmaceutical industry in the recent past with regards to the - then - 'impending' SARS epidemic. All those vaccines ended up being completely unnecessary. Would these very same governments have the political capital to acquire these vaccines now? And will they invest in vaccines on behalf of African civilian populations?
One of the Microsoft founders recently donated 100 million to help stop the spread of ebola. How will the Chinese, Russian, Brazilian and Indian elites respond to the globalization of the ebola epidemic? Will they donate money? Or will they act as their usual nouveau riche.
Forum-autist, coming through!