Ebola’s Return Tests World's Ability to Control Outbreaks

Biggest Test

The unit was set up after a West African Ebola crisis that began in 2013 killed more than 11,000 people. The first deployment came in early 2017, when the group was summoned to Ethiopia amid an escalating outbreak of acute diarrhea. Later, they traveled to Nigeria to track cases of meningitis, Madagascar to combat pneumonic plague and Bangladesh for an epidemic of diphtheria.

In eastern Congo, they’re facing their biggest test yet.

Although the use of a Merck & Co. vaccine has helped contain infections, and health officials have reported progress in some areas, the number of cases and deaths continue to climb. Attacks on health centers and lingering mistrust have hindered the response, allowing the virus to advance, and the outbreak this month spilled into neighboring Uganda.

The World Health Organization hasn’t formally declared an international emergency. Still, the agency called the situation an “extraordinary event” and appealed for $54 million in global support to sustain its response.

“It’s a race against time,” Bausch said. “The longer we have this smoldering outbreak, the more risk we have of losing control.”

While others treat patients and knock on doors, the U.K. scientists are crunching data to understand how Ebola has spread and whether attempts to quell the disease have been effective. They’ve shown how children face increased infection risk when they’re exposed to the virus in health centers, studied where people travel when they get ill, and helped determine the best way to deploy vaccines.

Heart and Soul

As government health officials prepare for a meeting on vaccine strategies this week, the team is assisting in the potential introduction of an experimental shot from Johnson & Johnson that could provide immunity in a broader population, Bausch said.

They’re “the heart and soul of a lot of the decisions being made about where to expend resources,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “How to respond, where to respond and when to respond require an everyday review of what we hope is good intelligence, and the group is expert at that.”

The unit, run jointly by the London School of Hygiene and Tropical Medicine and Public Health England, also researches new ways to combat disease and help countries strengthen their health defenses, raising their level of independence.

Emerging diseases like Ebola are ratcheting up pressure on the U.K. group and others to put out fires on multiple fronts. Climate change, conflict, antibiotic resistance and large, increasingly mobile populations are conspiring to raise the threat level as a new phase of “high-impact” epidemics begins, according to Michael Ryan, head of the WHO’s emergencies program.

“A disease 50 years ago might have petered out and just run its own course,” Ryan said in an interview. “Now we’re offering these diseases opportunities for amplification.”

Fire Raging

Ebola is a particularly contagious and deadly foe; the virus can lead to massive internal bleeding from multi-organ failure and shock, and about half of infected people die. In the earlier epidemic, Ebola spread from Guinea, Liberia and Sierra Leone to Nigeria, Senegal and Mali; infection occurred outside Africa for the first time. That exposed holes in control efforts and sparked panic in the U.S. and Europe, where there were fewer than a dozen cases and one death.

“We tend to wake up when we see the blue lights flashing and we have a couple of Ebola cases imported into a developed country, and all of a sudden everyone goes crazy,” Ryan said. “We underestimate the vulnerability of developed economies.”

The public would like to believe there’s someone like Jack Bauer, the hero of the television series 24, out there to defeat lethal pathogens, but it’s not so simple, Gates said in a speech last year. A coordinated global approach focusing on early detection and better vaccines, drugs and diagnostics is needed to avert the next pandemic, he said.

Countries like the U.K. have strategic, as well as ethical, reasons to intervene before outbreaks become wider disasters, Bausch said.

“If you’re sitting in your house and you see a fire raging down the block,” he said, “even if you say it’s not my problem, probably the best way to protect your house is not to sit there with a bucket of water at your feet. It’s best to go put it out.”

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