Underestimated and Ignored, Growing Ebola Epidemic Requires Unprecedented Global Mobilization

September 15, 2014
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Laurie Garrett

senior fellow for Global Health at the Council on Foreign Relations. She won a Pulitzer Prize in 1996 for her coverage of an Ebola outbreak in what was then Zaire, now the Democratic Republic of Congo. She is the author of two bestselling books, The Coming Plague: Newly Emerging Diseases in a World Out of Balance and Betrayal of Trust: The Collapse of Global Public Health.

The World Health Organization is warning that the number of new Ebola cases in West Africa is growing faster than relief workers can manage. The organization says that thousands are at risk of contracting the virus in the coming weeks and more medical professionals are urgently needed to help contain the outbreak. So far, Ebola has claimed some 2,400 lives and continues to ravage Liberia, Sierra Leone and Guinea. It is the worst outbreak since the virus was discovered in 1976. Meanwhile, Sierra Leone has lost a fourth doctor to Ebola after efforts to transfer her abroad for treatment failed. The loss is a major setback for the impoverished country, which is already suffering from a shortage of healthcare workers. Since the Ebola outbreak began, approximately 144 healthcare professionals have died while serving affected populations. We speak to Pulitzer Prize-winning journalist Laurie Garrett, senior fellow for Global Health at the Council on Foreign Relations.


TRANSCRIPT

This is a rush transcript. Copy may not be in its final form.

NERMEEN SHAIKH: The World Health Organization is warning that the number of new Ebola cases in West Africa is growing faster than relief workers can manage. The organization says that thousands are at risk of contracting the virus in the coming weeks, and more medical professionals are urgently needed to help contain the outbreak. So far, Ebola has claimed over 2,400 lives and continues to ravage Liberia, Sierra Leone and Guinea. It is the worst outbreak since the virus was discovered in 1976. At a press conference on Friday, the director-general of the World Health Organization, Margaret Chan, said the vast nature of the outbreak requires a massive emergency response.

DR. MARGARET CHAN: In the three hardest-hit countries—Guinea, Liberia and Sierra Leone—the number of new cases is moving far faster than the capacity to manage them in the Ebola-specific treatment centers.

AMY GOODMAN: Meanwhile, Sierra Leone has lost a fourth doctor to Ebola after efforts to transfer her abroad for treatment failed. Dr. Olivet Buck reportedly died late Saturday, hours after the World Health Organization said it could not facilitate her medical evacuation to Germany. The loss is a major setback for the impoverished country, which is already suffering from a shortage of healthcare workers. Since the Ebola outbreak began, approximately 144 healthcare professionals have died.

For more, we’re joined by Laurie Garrett, senior fellow for global health at the Council on Foreign Relations, won the Pulitzer Prize in 1996 for her coverage of an Ebola outbreak in what was then Zaire, now the Democratic Republic of Congo, author of the two best-selling books, The Coming Plague: Newly Emerging Diseases in a World Out of Balance and Betrayal of Trust: The Collapse of Global Public Health.

Laurie Garrett, welcome back to Democracy Now!

LAURIE GARRETT: Thank you.

We just had you on about a week ago, but talk about the numbers right now and what you feel needs to be done.

LAURIE GARRETT: Well, the numbers are really unknown. I mean, this is the big problem we have, is that because the hospitals are completely overfull, people are literally dying on the sidewalks and in the dirt roads outside the hospitals, not able to get admitted. We know that the majority of people are now keeping family members in their homes, not bringing them forward. And so, all the numbers you hear are a gross undercount, and they represent only laboratory-confirmed cases. So, most of the people on the ground are saying that it’s understated threefold, which would say that we have something in the neighborhood of 12,000 to 15,000 cumulative cases already.

The other thing to keep in mind is that while we’re focused on three nations that are really, really devastated—Liberia, Sierra Leone and Guinea—we also have cases in Senegal, in Nigeria, and then a completely separate and different strain of the virus is breaking out in Equator, Democratic Republic of Congo. And that epidemic is also proving more difficult to control than people had initially thought. So, I think we’re in a turning point, where—and I would say that everybody that I’ve spoken to on the ground and everybody in leadership on this would agree with me, that we’re at a turning point. And we either find a way to mobilize on a scale unprecedented in modern time for epidemic response, or we will be looking at something like a quarter-million cases by Christmas.

AMY GOODMAN: What would that mobilization look like?

LAURIE GARRETT: Well, look, a hell of a lot more than what we’re doing. I mean, first of all, let’s back up. You know, supposedly, the United States military is building a 25-bed hospital in Monrovia for the care of infected healthcare workers. Supposedly, the British government is building a 68-bed hospital in Freetown, Sierra Leone, for care of healthcare workers and the acutely infected. Supposedly, France is sending 40 people—we’re not even sure what exact skill set they have. But all of this, I say "supposedly," because a commitment on paper does not equal rapid action. I was at the Department of Defense last week, and it turns out, to mobilize a 25-bed facility—by the way, unstaffed; they’re not going to staff it, but they’ll be there, there will be beds—that takes 50 days—five-oh. So we’ll be well into October before that facility is even there. And as fast as hospital beds are being erected, whether it’s just a cot in a tent or what it may be, they’re overfull, and they’re turning people away outside. So, the nature of the response is so far behind the virus, so far behind the scale of need, that it’s almost impossible to quantify how we really do need to respond.

NERMEEN SHAIKH: And one of your recent pieces, in fact, is called "We Could Have Stopped This." So, could you explain what you say in that piece?

LAURIE GARRETT: Back, back, if we had had a response that was to scale in March, April, May, June, as this was growing and spreading and festering, but largely remained a rural epidemic in Sierra Leone, Guinea and Liberia, MSF, the Doctors Without Borders organization, and a handful of other nongovernmental responders were having a decent capacity to handle the caseload. What wasn’t going on was the local governments doing the case contacting, meaning identify—you have a person here in the hospital bed. Let’s find all their family members and test them. Let’s see where they were in prior days, who might have been exposed, and let’s get these people in quarantine and observe them, test them and make sure they don’t spread it. Nobody was doing that.

NERMEEN SHAIKH: And that didn’t happen because in these places they didn’t have the capacity? Or are you suggesting—

LAURIE GARRETT: They didn’t have capacity, and the international response was zippo. WHO was like, "Zzzz, excuse me, wait. Did somebody say there’s an epidemic? Uh, because we’re really busy over here, you know, talking about how to normalize care of heart disease."

AMY GOODMAN: Isn’t this a crisis of public health, both in the United States, funding, as well as at the level of the World Health Assembly, the World Health Organization?

LAURIE GARRETT: This is a screaming cry that—we couldn’t ask for a louder one—that says globalization is not working, we don’t have any system of global governance, and we don’t have anything called "global health" to speak of when it comes down to actually getting things done. And we already knew this, because in 2009 we had the H1N1 swine flu scare. And that globalized in a matter of weeks. Every country in the world was affected. And what we saw was a complete breakdown in global solidarity around that, because the meager supplies that were available and the vaccine that took more than six months to get online only went to the rich countries, and the poor countries, the middle-income countries were all left going, "Oh, what about us?" And it gave a clear indication this is what we will do in an epidemic: We’ll take care of the rich, and the rest of you, eh, maybe there’s some aspirin. Well, these folks in Liberia aren’t even getting the aspirin.

AMY GOODMAN: Cuba announced it’s sending 165 health workers to help address the Ebola outbreak in West Africa. A team of doctors, nurses, infection specialists will be stationed in Sierra Leone for six months. Cuba’s minister for public health, Roberto Morales Ojeda, made the announcement at a World Health Organization press conference on Friday in Geneva.

DR. ROBERTO MORALES OJEDA: [translated] We will cooperate with a brigade of 165 collaborators, made up of 62 doctors and 103 nurses, all of them with more than 15 years professional experience and who have worked in other countries facing natural and epidemic disasters, and who have also worked in medical cooperation missions, with 23 percent participating in more than one international mission.

AMY GOODMAN: Meanwhile, the Bill and Melinda Gates Foundation has donated $50 million to the relief effort. The Financial Times writes, quote, "Raúl Castro and Bill Gates may not be the most natural allies but the pair have emerged ... at the forefront of international efforts to combat the Ebola outbreak ravaging west Africa." Cuba putting the U.S. to shame, Laurie?

LAURIE GARRETT: Well, I don’t know about "to shame," but the one genuinely strong asset Cuba has is trained primary healthcare workers. And they have a long tradition of flying them into places of need and being available to respond. And, well, they’ll obviously be very well welcomed on the ground in Sierra Leone. Now, the problem is, where are they going to work? I mean, there aren’t enough hospital beds. There aren’t enough facilities. Exactly how will they be doing patient care?

And the one thing I would caution about with the Cubans is that they do not have experience working in PPE suits, under maximum protective care. And this is really tough. This is why people are getting infected. You know, it’s 120-plus degrees centigrade inside one of those suits. After about an hour in that kind of heat, coupled with the emotional tension of dealing with this disease, people start to get sloppy. You develop fatigue. You don’t quite notice where the syringe is vis–à–vis your fingers and your protective suit. And this is how accidents are occurring. It’s a sloppiness. It’s a fatigue. And it takes a special kind of skill set to be able to work under these conditions. It’s interesting to note, MSF has been the major responder, from day one. They still are the number one responder.

AMY GOODMAN: Doctors Without Borders.

LAURIE GARRETT: Doctors Without—and they have not had any of their people infected. So they know what they’re doing. And everybody, the Cubans included, should go through huge training with MSF before they get in touch with patients.

AMY GOODMAN: This issue of public health and the crisis of public health also goes to the development of vaccines, because do companies really pour money into, for example, Ebola vaccines when they think they won’t be making money? Talk about the crisis of the drugs needed to deal with Ebola.

LAURIE GARRETT: Well, actually, Ebola was top of the list, in the top 10, for Project BioShield. So here we are, just a few days after the 9/11 anniversary, and of course one of the things that happened right after 9/11 were the anthrax mailings, which resulted in members of Congress getting exposed and saying, "All right, we want cures for these things. We want vaccines. We want more science." Billions and billions and billions of dollars have gone into Project BioShield I, Project BioShield II. Ebola vaccines were among the things on the list. There was money, a lot of money. And the NIH got a fair distance down the path on development of a potential vaccine. GSK, GlaxoSmithKline, got down the path on one, and so on. The problem is, where’s the marketplace for something that may not be able to survive refrigeration for very long? You have to wait for an epidemic to occur before you will mass-manufacture, because they can’t just sit on shelves. And trying to come up with proper market incentives for anything like this is proving elusive, at best.

NERMEEN SHAIKH: Well, in a recent New York Times piece by the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, Dr. Michael T. Osterholm, he warned of the possibility that the Ebola virus could someday mutate into an airborne strain. Do you agree with that? And if so, what would the implications of that be?

LAURIE GARRETT: Well, I know Mike very well, and I was a little surprised by that op-ed. There is documentation of more than 300 mutations have indeed occurred in the current circulating strain. It is unusual for Ebola to circulate through so many humans in one giant incident—this is the largest incident ever. And as a result, every time a virus goes through a different species—this is normally a bat virus—and as it comes into humans, it’s mutating, it’s picking up genetic material, and it’s a very sloppy virus, like many RNA viruses, like flu, makes lots of mistakes when it reproduces. So, it had a huge mutation rate. However, none of the mutations so far have functionally changed the virus at all. So, indeed, most of the mutations have resulted in something that just died out, because it didn’t improve functionality.

Could the virus turn into an airborne virus? Very, very unlikely. But it could be droplet-transmitted. And this is the real issue. The viruses that you think of as airborne—let’s take the flu as an example—the virus itself cannot exist without moisture. If you put it out on the tabletop and just let it sit there and put a blow dryer to it and you desiccate it, the virus falls apart, because it needs water, has to be in the presence of some kind of liquid. Now, in the case of flu, it’s able to remain—have sufficient fluid from your nasal or oral coughing; what you spit out, cough out and so on is how you transmit flu. Ebola, in contrast, infects blood. And people don’t spit out blood unless they’re really acutely ill with something, and so transmission right now is contact. If you touch the bleeding or the sweat, sweating fluids, of an individual who’s infected, and then rub your nose, rub your eyes, eat some food with those unwashed hands, that’s the nature of transmission. Could the virus mutate into one that could end up more airborne-transmissible? Well, potentially, but it would have to then take on a respiratory cycle similar to what we see with flu. And that would be huge, because the main target cells for this virus are what’s called the endothelial cells, which are the cells that line blood vessels, capillaries, arteries and so on. And the way it kills you is it pokes little holes in those blood linings and allows blood to leak and hemorrhage into the rest of your body.

AMY GOODMAN: Could you imagine if the world dealt with Ebola like it’s dealing with ISIS right now? Right now there’s an international global summit in France, every day headlines across the front pages of the paper. When you’re talking about the number of people killed, we’re talking in the thousands, at least, what—it looks like the number is around 5,000 right now, many more infected. What about that, Laurie Garrett, as we wrap up?

LAURIE GARRETT: Well, it’s interesting, because I have spent a lot of time talking with our military people about the Ebola response. And, of course, they’re wondering, "Well, what does the president want us to do with ISIS? You know, we’re also doing this, that and the other thing." And many people point out, "Well, there are more than 4,000 physicians working for the armed forces of the United States. Why can’t we deploy some of those into Liberia, Sierra Leone and so on?" And the response from the military leadership is, "Yes, and the majority of them work in the VA, and we will not put our veterans in greater risk than they already are. So we’re not going to deplete our veterans’ services." As you go around country by country—

AMY GOODMAN: Five seconds.

LAURIE GARRETT: —looking at potential responders, you see similar crises. We’re stretched thin, folks.

AMY GOODMAN: Laurie Garrett, thanks so much for being with us, now with the Council on Foreign Relations, Pulitzer Prize-winning journalist.


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