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| This digitally-colorized scanning electron microsgraph depicts filamentous Ebola virus particles. Image: CDC/ NIAID |
On September 30, the first case of Ebola virus disease diagnosed outside of Africa during the current outbreak was reported in Dallas, Texas. With more than 3,000 already dead and estimates that as many as 1.4 million may become infected by January, the outbreak, centered in the West African nations of Liberia and Sierra Leone, has the potential to be a massive public health crisis with lasting implications across the global community.
As members of the Harvard community respond to the epidemic, Michael VanRooyen, HMS professor of medicine at Brigham and Women’s Hospital, professor in the department of global health and population in the Harvard School of Public Health and director of the Harvard Humanitarian Initiative, highlights what we need to know now about the disease.
HMN: With news of this recent case in Texas, what do Americans need to know?
MVR: The U.S. has excellent resources to detect and manage an outbreak and to prevent epidemic spread of Ebola. U.S. hospitals are generally well prepared (or will be). I think there is still work to be done for routine questioning and screening of travelers from West Africa by airlines and travel security to identify high-risk travelers. This is the same in U.S. hospitals caring for recent travelers from Ebola-endemic areas.
HMN: What are the breakdowns in global public health that got us to this point?
MVR: Ebola is a disease of poverty. Liberia and Sierra Leone have very little true public health capacity and limited public health literacy, which makes epidemic detection, investigation and management very challenging. It is important to note, however, that early in the epidemic, organizations that were working on containing the epidemic, including Doctors Without Borders and Samaritan’s Purse, were calling for help and indicating that this was an extraordinary event with explosive potential. One breakdown in the system was the lack of ability to listen to such advice and to mobilize international resources earlier.
It was an important moment when the President declared Ebola as a national security issue and mobilized resources. There is still little understanding, however, of the economic and security threats to West Africa. The effects of Ebola will be measured not only in those infected with the virus but in the economic slowdown and collapse of the health system.
HMN: Many entities, such as the World Health Organization, are urging the global community to step up efforts, and organizations like Partners In Health are acting. But what still needs to be done that isn't being done? What can academic institutions like ours do that isn't being done yet?
MVR: Many organizations are scaling up efforts, and there are new Ebola Treatment Centers planned; most are not familiar with the management of this type of emergency, so the time to operational readiness is slow. While treatment centers are important, it is also important to note that this war will be won not in the hospital but in educating communities, increasing public awareness and advancing new models like home-based care. This is not as high profile, but public health will be the answer to stopping the epidemic.
HMN: Are there any plans yet to send people from the Harvard Humanitarian Initiative to Africa?
MVR: We are working with several NGOs and the U.N., WHO, etc., to identify personnel needs. HHI-affiliated physicians and technical experts are being deployed on behalf of their home hospitals and will work within existing NGOs. HHI is also coordinating data collection and sharing for Doctors Without Borders and others running Ebola treatment centers and assisting African leaders to advocate for logical policy and increased resources.
HMN: What lessons must the global community draw from this outbreak?
MVR: Listen to the field. As with many major humanitarian emergencies, this epidemic could have been controlled far earlier and with far fewer resources if we would have 1) understood the need to prepare for these crises, and 2) listened to field organizations who see the crisis expanding. Now we have to play catch up.
