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The Ebola Threat: A “new normal”?

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A couple months ago while stationed in Ghana, I was approached by colleagues and friends with questions on how to prevent contagion from the deadly Ebola virus. Their concern was stoked by reports in media outlets about the rising number of confirmed cases and deaths in neighboring countries. 

The alarm was justified. The current outbreak of Ebola in West Africa is the deadliest since it was first identified in 1976 in what was then Zaire (now the Democratic Republic of Congo) by Dr. Peter Piot, who later went on to lead the global fight against HIV,  and others.  The cumulative number of cases attributed to Ebola in Guinea, Liberia and Sierra Leone now stands at 982, including 539 deaths.
As described by Dr. Piot in his autobiography, No Time to Lose, and more recently in The Financial Times, the virus, which is assumed to circulate in bats, infects people through contact with blood or infected droplets.  Once in humans, the transmission between people results from contaminated injections, contact with blood and body fluids, sex, and possibly from mother to child.  About one week after infection, the patient develops severe fever, diarrhea and vomiting, starts to bleed and is affected by clots in the body’s blood vessels, which lead to generalized organ failure, shock and death.  The case fatality is staggeringly high: 90% in Zaire and 60% in West Africa.
While an uncontrolled outbreak of Ebola is frightening, in principle, as advised by Dr. Piot, it should be easy to contain if health workers and health facilities adopt simple, inexpensive and effective strategies that include the use of gloves, hand-washing, safe injection practices, isolation of patients, safe and rapid removal of corpses of those killed by Ebola, tracing of contacts, and follow-up observation of at-risk populations. Social mobilization and risk communication activities that focus on “at-risk groups” (e.g., people who consume bat meat, or who frequently travel across borders) and “at-risk behaviors and actions” (e.g., preparation/consumption of “bush meat”, treating the sick, or handling corpses of infected patients), help increase knowledge about causes, symptoms and modes of prevention among the population.

We should be mindful, however, that outbreaks of Ebola and other dangerous viruses such as the Middle East Respiratory Syndrome (MERS) in Saudi Arabia, are an ever-present danger in our interconnected world. The risk of animal-to-human transmission of lurking viruses will continue to be nurtured by close contact of people with wildlife, which is facilitated nowadays by the rapid spread of human settlements, aggressive mineral extraction practices, environmental degradation, the globalization of trade and services, mobility of people across borders, and poor, inadequate, and dysfunctional health systems in many countries.

The universal health coverage agenda offers countries and the international community a “window of opportunity” to move from ad hoc, short-term responses to the development of robust public health systems and service delivery platforms. Adopting ‘One Health’ approaches is also essential—that is, collaborative efforts between public health, veterinary and environmental services. This would facilitate the sharing of information, and enable holistic analysis of risks and joint responses to prevent and control outbreaks of diseases of animal origin, such as Ebola.  In doing so, countries would also be complying with WHO’s International Health Regulations that require governments to notify WHO of disease outbreaks.    
As international experience shows, strong national leadership is critical to make progress in this area.  And, sustained domestic funding, coupled by regional funding arrangements such as the one proposed by the Economic Community of West African States (ECOWAS) at the recent Presidential Summit to establish a Regional Pool Fund for Ebola, are necessary complements to political commitment.  International support, both technical and financial, is justified as it would contribute to reduce the global risk of the spread of viruses at their source. 
As recently described by Laurie Garrett of the Council of Foreign Relations, the Ebola virus in West Africa should be tackled the same way it was done in 1976:  with soap, clean water, protective gear, safe medical practices, and quarantine; technology and vaccines are of no use. Also community engagement and involvement, effective contact tracing, cross-border collaboration and effective coordination would be critical. But, I would add that in pursuing a broader development agenda to end poverty and enhance shared prosperity over the medium term, countries and the international community have the responsibility to act on the recognition that environmental factors can impact human health and support the development of sustainable ‘One Health’ platforms to deal with the emergence of new viruses or the reemergence of known pathogens that risk affecting all of us across the world.

Follow the World Bank health team on Twitter: @worldbankhealth


Audio: Ebola: Tackling The Outbreak in West Africa

Assessment Tools and Bridges Completed, Paving the Way to Reduction of Global Health Risks

“No Time to Lose: A Life in Pursuit of Deadly Viruses” (publication by Peter Piot)

Final Communique of 45th Session of the ECOWAS Summit of Heads of State and Government, Accra, Ghana, July 10, 2014

Bird Flu and Public Health Systems: Lessons of History

Crying wolf? Contagion is a real threat!

Fact Sheet: Emergency Financing for the Ebola Crisis


Patricio V. Marquez

Former World Bank Group (WBG) Lead Public Health Specialist

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