Epidemic ethics: four lessons from the current Ebola outbreak

Abstract

The extent of the current Ebolavirus outbreak in West Africa has belatedly focused the attention of non-governmental organisations, local and Western governments, and international media. What we haven’t caught up with though, is the extent to which these outbreaks and their devastating effects are predictable and preventable. The spread of Ebola virus occurs because health infrastructure in the region is fragmented, under-resourced, or non-existent. And the therapeutic response to the illness is constrained by failure of markets to drive drug and vaccine development that would help the world’s poorest people. Resource constraints This is the largest known Ebola virus outbreak, with more than 1,800 cases and 1,000 deaths so far. But the actual number of people affected and mortality rates are uncertain because laboratory diagnosis is limited and only severe cases are admitted to hospitals. Apart from its longevity and extent, what distinguishes this outbreak is that, for the first time, there’s a prospect of drugs and vaccines to treat and prevent the disease. But these important therapeutic milestones don’t alter the fact that the outbreak will not be controlled by drugs. Rather, what’s required is strict infection control and quarantine. Person-to-person spread of Ebola virus, by contact with blood, body fluids or tissues of an infected person (mainly in the late stages of disease or after death) is not particularly difficult to prevent by well-established infection prevention measures that should be routine practice in any modern hospital. Unlike influenza, for instance, Ebola virus doesn’t spread by coughing or during the incubation period. So the current hospital outbreaks are related to inadequate health-care resources rather than a particularly high level of infectiousness.