Why it’s hard to keep Ebola from spreading

Containing this year’s Ebola outbreak won’t be easy. Undeveloped governments in the three countries most affected by the current Ebola surge — Guinea, Liberia and Sierra Leone — are having trouble coordinating a response, and health care workers are overwhelmed, said John Campbell and Laurie Garrett, senior fellows with the Council on Foreign Relations, on a conference call Tuesday.

As the number of cases of Ebola in West Africa grows, the second of two American missionaries who contracted the disease while helping patients in Liberia, arrived in Atlanta for treatment on Tuesday.

The virus Ebola, which causes severe bleeding, has killed nearly 900 people in West Africa since the outbreak was detected in Guinea in March.

Campbell, who specializes in Africa policy studies and was ambassador to Nigeria from 2004-7, said the three main African countries have weak bureaucracies and are emerging from a protracted period of civil war. “There’s great suspicion of them,” which makes it difficult to address the disease, he said.

The governments have trouble controlling their borders, where people who have contracted the disease might travel. “There can be screening at airports, but movement tends to be on foot outside of any government control,” said Campbell.

Rapid urbanization also poses a challenge. “You have people of a village culture packing themselves into urban slums,” where the spread of the disease becomes easier than in lower density populations, he said.

The Ebola virus “is out of control. I don’t think it’s clear that it ever was in control since it first broke out in March,” said Garrett. Health care workers are burned out, she said, and populations are suspicious of their treatments and efforts to prevent the virus from spreading, because they interfere with the communities’ burial rituals.

The World Health Organization is meeting in Switzerland this week to assess the current situation and determine if it constitutes international mobilization, she said. (Read WHO’s Ebola response plan for the governments of Guinea, Liberia and Sierra Leone [PDF])

In addition to engaging the African governments, Garrett added, key leaders in the communities must be enlisted to help, “whether they’re religious, political, gangsters, whatever. … This has just reached levels where all the simple solutions have tried and failed,” so something new must be attempted, she said.