Ebola: A public health infrastructure crisis. Not the next pandemic


Tonya Villafana, Ph.D, MPH

Many of us have been tapped into the growing developments behind the Ebola outbreaks in four West African nations, including Sierra Leone, Guinea, Liberia and, now, Nigeria.

The World Health Organization (WHO) is calling this a “public health emergency of international concern.” This is an official label, which essentially means that the current epidemic meets certain conditions, including that it constitutes an “extraordinary event,” that the consequences for further international spread are serious, and that a coordinated international response is essential to stop and reverse its effects.

The facts about Ebola and ZMapp
Amidst the deluge of information in the news and elsewhere, it’s important to separate fact from misinformation. First, Ebola is not a respiratory disease. It spreads through direct contact with blood or bodily fluids from an infected person or exposure to contaminated objects (like needles contaminated with infected secretions). You can read more about Ebola transmission on the Centers for Disease Control website here. And, there is no approved prophylactic vaccine or treatment for Ebola.

Second, the two American aid workers who contracted the Ebola virus in Liberia and were subsequently transferred back to the United States are receiving an experimental drug called ZMapp, a cocktail of three monoclonal antibodies (mAb). This was authorized for use under emergency conditions, and the two aid workers consented to take this experimental therapy.

The drug can’t be widely administered for several reasons. There are less than a handful of doses available, plus ZMapp is currently manufactured in tobacco plants, and the ability to scale up production is unclear. The drug also has not been tested in the clinic, which means that we don’t know anything about its therapeutic efficacy. And, even if ZMapp were available for use today, the delivery logistics in the countries most affected would be extremely challenging.

Finally, there are numerous ethical issues around delivery of experimental therapies to vulnerable populations. To this end, the WHO convened a panel and issued this statement on August 12 regarding the delivery of unregistered interventions for Ebola. There are many questions—among them how fair distribution of these experimental therapies would be addressed between countries and within communities.

While concerns about the spread of Ebola are causing a public din for prophylaxis and treatment, and there is global urgency at this moment to respond, the stark truth is that this has not been a priority in the past, and it will take time.

Addressing public health infrastructure
But we do have an opportunity. And, that is to look closer at the Ebola outbreak for what it is: a public health infrastructure crisis that has not been adequately addressed. Many of us within the infectious disease and public health community have been calling for such action for years, and have consistently advocated the need for infrastructure and resources to address zoonotic diseases and pandemic threats. This includes the World Bank, which published its public health policy note in December 2012.

So, what does this mean? It’s no surprise that the outbreak is occurring in some of the world’s poorest countries where there is weak public health infrastructure. Guinea, Liberia and Sierra Leone are defined as low-income countries with gross national income (GNI) per capita of less than $1,045 dollars. These countries need trained medical personnel, basic medical supplies, surveillance capabilities and infrastructure—including laboratory capacity, epidemiologists, and social mobilization experts to stop transmission and prevent the spread. Sadly, many of the deaths have been among health care personnel caring for the sick. Knowledge of infection control and dissemination of this information are critical.

In order to address the current crisis and to prevent future outbreaks of Ebola, we need changes to a public health infrastructure that are sustainable. That it takes such a crisis to produce the necessary momentum is unfortunate. But, the good news is that the international community seems to recognize this, and we will hopefully be able to work together to develop the right long-term solutions. That includes organizations like the WHO and the World Bank, which has released $200 million in funding specifically for the Ebola crisis, as well as American, European and other international governments, organizations and private companies who understand that health is a global issue inextricably linked to economic development.

And, our own industry—which includes the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) and many of its members—is involved in partnerships with other key players to develop new and improved medicines and vaccines. These may help to tackle Ebola and other health challenges that disproportionately affect developing countries.

My hope is that as we’re all wading through the enormous volume of information about Ebola, we’re realistic about what’s possible in the short term and that we remember to think about it within the context of long-term public health solutions. That’s the best—and healthiest—strategy for the future.