THE BLOG

The Link With Islamic State, and Why the Politics Behind Ebola Could Kill You

10/10/2014 14:36 BST | Updated 09/12/2014 10:59 GMT

Reports of Ebola symptoms across the planet is spreading global panic, leading to an aeroplane cleaner strike in New York, a temporary quarantine in a French town, and a nurse who developed a fever having worked in Sierra Leone, has been admitted to a hospital Australia after quarantining herself.

Is it possible that we could suffer a world-wide Ebola epidemic, killing hundreds of thousands, because our government has been distracted by Islamic State, which in fact poses less threat to the citizens of this country, than a contagious infection with a previous case fatality rate of 79%?

The 79% figure is quoted from a study about to be published in the journal 'Epidemics' (discussed further below), and refers to previous outbreaks of Ebola. That figure may come as a shock to you because the current case fatality rate figure being spread on news sites is 70.8% and refers to the current outbreak; quoted from a recent study published in the New England Journal of Medicine entitled 'Ebola Virus Disease in West Africa -- The First 9 Months of the Epidemic and Forward Projections', published September 23.

Headlined: 'Ebola: an open letter to European governments', 44 senior Public Health experts from across Europe have just published a plea in 'The Lancet', of October 4th, that the world wakes up to the Ebola crisis.

Their opening paragraph declares: 'After months of inaction and neglect from the international community, the Ebola epidemic in west Africa has now spiralled utterly out of control. Today, the virus is a threat not only to the countries where the outbreak has overwhelmed the capacity of national health systems, but also to the entire world.'

One problem appears to be that health budgets have been slashed, such as for the World Health Organisation (WHO), perhaps as resources elsewhere have been diverted to military adventures?

There is deadly politics behind the scenes because a 'war on terror' means a raid on budgets.

Writing in 'The Lancet' edition of October 11th, Lawrence Gostin, The Director of the World Health Organization Collaborating Center for Public Health Law and Human Rights, and Eric Friedman from Georgetown University USA, point out that the current Ebola epidemic will take 'hundreds of thousands of lives if the current trajectory is not reversed'.

Yet the authors point out that the international organisation which would normally take charge of this worldwide predicament, the WHO, after a 2011 funding shortfall, had an already inadequate budget cut by nearly US$600 million.

With the WHO side-lined, Lawrence Gostin and Eric Friedman point out that in the leadership vacuum that was created, high-income countries sent in military assets, while the UN Security Council declared Ebola a threat to international peace and security.

In a paper just about to be published entitled, 'Potential for large outbreaks of Ebola virus disease', a team of academics from the London School of Hygiene and Tropical Medicine, and the Fogarty International Center, National Institutes of Health, United States, had deployed mathematical modelling to better understand the spread of Ebola.

Before the current epidemic there have been 25 outbreaks of Ebola, all limited to a few hundreds of cases, so extrapolating from the past is more difficult than the public might appreciate, as it was rather different from today's predicament.

The team, led by Dr Anton Camacho and Dr Adam Kucharski, focused on the first ever reported Ebola outbreak in Yambuku (Democratic Republic of Congo) during 1976. They suggest one of the reasons epidemics before were more limited is because each time the transmission chain was stopped quite early in the epidemic (change of person-to-person contact, change of burial practice, isolation of potential cases, contact tracing). Change in contact in the community was essential to control the spread.

But in the current outbreak we have not seen this big trend in changing behaviour in communities; the response has been slower, allowing the outbreak to affect different geographical areas and urban centres as well as rural communities.

The authors of this new research published in the academic journal 'Epidemics', point out that a number of mathematical modelling studies of Ebola focused on two historical outbreaks, but the authors of the current study argue it remains unclear to what extent person-to-person transmission contributed to past Ebola outbreaks, and how community and hospital-specific control measures influenced the spread in each setting.

Their new results, suggests that if the reduction in community transmission had been smaller, then the1976 outbreak in Yambuku they specifically studied, could have persisted for much longer, potentially leading to thousands of cases, as in the current one. Their analysis appears to suggest that Ebola may have been teetering on the brink of being more catastrophic than the past experience may have suggested.

In a sense this research demonstrates just how difficult it is to assess how dangerous a particular threat is, and how much probability and uncertainty plays a larger role than perhaps our leaders and politicians are comfortable admitting to us.

Perhaps they understand our psyche better than we do? Maybe we prefer to be lied to with a false certainty, rather than confront a darker truth that no one really knows with confidence just how dangerous many of the contrasting threats we face are.

There is a sense of miscalculation in the way this current epidemic is being handled and this may be partly why, 'WHO has been constantly catching up in mobilising resources for Ebola', according to, Lawrence Gostin and Eric Friedman in their Lancet commentary. They argue that in preparing its budget, WHO demonstrated misplaced confidence that it could mobilise funds rapidly in the face of the Ebola crisis.

They point out that in April 2014, the WHO sought $4•8 million additional funds to deal with Ebola, by July 31 it set a $71 million goal; and in August made a $490 million appeal, with the UN launching a $988 million appeal weeks later.

The trouble is this might be too little too late given the historical under-funding of the WHO.

Worldwide, the amount spent on waging war, so creating death and destruction, as compared to global health, is very asymmetric.

In being so distracted by Islamic State, have we become more vulnerable to Ebola?