Good news at last from West Africa, where the outbreak of ebola finally seems to be tailing off. According to a situation report by the World Health Organisation (WHO) on 28 January: ‘For the first time since the week ending 29 June 2014, there have been fewer than 100 new confirmed cases reported in a week in the three most affected countries. A combined total of 99 confirmed cases were reported from the three countries in the week to 25 January: 30 in Guinea, four in Liberia, and 65 in Sierra Leone.’
This has still been by a very long way the worst-ever outbreak of ebola. Since WHO was notified of the first case, in March 2014 in Guinea, there have been 22,000 confirmed, probable and suspected cases of the disease reported, almost all in Guinea (2,917 cases), Liberia (8,622) and Sierra Leone (10,518), resulting in almost 9,000 deaths. (It is now thought that ‘Patient Zero’ was a two-year-old boy who died in Guinea in December 2013.) The situation has placed enormous strain on the very limited healthcare resources of these three countries.
The turnaround has been dramatic. Cases peaked in September in Liberia, but only peaked in Guinea and Sierra Leone in December; the number of cases in Sierra Leone alone was over 500 per week at the end of 2014. This decline is no doubt due to the way resources are finally being applied to the problem, with new infrastructure being put in place and better tracing of contacts of known sufferers. The allocation of resources may still be ineffective, however. There are reports of treatment centres built by the US military in Liberia that have received no patients at all.
This is all a far cry from the wild claims being made last year. In September, the US Centers for Disease Control (CDC) suggested that, by January 2015, 1.4million people could be infected. WHO’s assistant director, Bruce Aylward, told a press conference in Geneva: ‘Quite frankly, ladies and gentlemen, this health crisis we’re facing is unparalleled in modern times. We don’t know where the numbers are going on this.’ US President Barack Obama ordered a ‘surge’ in West Africa, with 3,000 military personnel on the ground. But the real problem was that it took so long for global health agencies like WHO to realise the gravity of the situation and start taking measures to tackle it. Budget cuts meant that WHO had only two ebola specialists out of over 6,000 permanent staff. As ebola started to get out of hand, WHO chief Margaret Chan was in Moscow, promoting conspiracy theories about the tobacco industry. That’s a good illustration of where public-health leaders see their priorities: manipulating our behaviour and lambasting big corporations rather than doing the one thing they might have some actual expertise in – tackling infectious disease. That complacency, combined with wrongheaded priorities and the political failings of both local governments and the governments of major donors, meant that a small outbreak was allowed to escalate into a much bigger one.
While the ebola death toll overall has been smaller than those from much more common diseases in Africa, like malaria, the emergency will undoubtedly have meant that treatment for such endemic diseases has been made much harder. In effect, the death toll caused by the failure to nip ebola in the bud is considerably higher than those actually killed by the disease itself. And the economies of the three most affected countries have been hit hard in various ways, from the closure of bars and cafes and the banning of public gatherings through to the closure of schools. According to The Economist: ‘The drop in household incomes is estimated to be 35 per cent in Liberia, 30 per cent in Sierra Leone and 13 per cent in Guinea.’ There is a serious risk that many children have seen the last of formal education as they are prematurely pulled into doing work at home after months away from school.