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Ebola: Lessons from earlier pandemic scares

Ebola: Lessons from earlier pandemic scares

In July 2014, Australia's Chief Medical Officer, Dr Chris Baggoley, assured us that the risk of the deadly Ebola virus spreading to Australia from West Africa was very low. At that stage, cases of this most recent outbreak of the disease had been confined to West African countries and in particular, Guinea, Sierra Leone and Liberia.

Two months later, the US Centers for Disease Control and Prevention (CDC) confirmed that the first case outside of West Africa had been reported in Texas, where Thomas Duncan had become ill after arriving from Liberia. The Dallas hospital where he'd been admitted didn't recognise the symptoms and sent him home with antibiotics. He returned two days later in an ambulance, and died yesterday.

Earlier this week, the first case of Ebola contracted outside of Africa was reported in Spain.

These two cases don't necessarily herald the start of another global health scare or suggest that Australia's security is at risk from an imminent outbreak of the Ebola virus. But they do serve as a timely reminder of the international security aspects of global health and the need to be prepared. [fold]

Just over a decade ago, the SARS outbreak in 2003 created a level of global anxiety which ultimately went unfulfilled, as the confirmed cases totaled around 10,000 with less than 800 deaths. At the same time, the number of people dying from HIV across the world continued to rise, notably in the developing world. The security concern lay in the fear that the virus would decimate economies and further harm fragile struggling states, as HIV preyed on the most productive segment of a developing country's society – its workers. 

The next international pandemic scare was the avian influenza (H5N1) in the mid 2000s, which led to an international coalition of states working together to minimise the impact of what was being hailed as the next global killer. Fortunately, again, this forecast was not realised. Swine flu or H1N1 was identified as the next significant major potential pandemic. The first case was confirmed in April 2009 and by the time the WHO declared an end to its status as a pandemic in August 2010, more than 214 countries and overseas territories or communities had confirmed cases. Over 18,449 deaths were attributed to H1N1. In the wake of what turned out to be another unrealised pandemic scare, the WHO was criticised for over-reacting. This criticism was fueled by a comparison with normal flu mortality which annually kills somewhere between 250,000 to 500,000. 

So while the alarm bells which tolled for three of this century's four pandemic threats eventually rang hollow, the most important legacy of all four was the realisation of the need to be prepared and stay prepared, not just domestically, but also across borders. This consists of upgrading cooperative preparedness regimes, surveillance, vaccine development and distribution, and risk communication. 

Pandemics are both predictable and unpredictable. Predictable in the sense that there is a reasonably well-grounded and widespread expectation that a major viral pandemic will affect the world sooner than later. Unpredictable because as Margaret Chan, Director General of the WHO said at the height of the H1N1 fears, pandemics are prone to deliver surprises and no two are ever the same. 

Let's be clear. The Ebola virus hasn't led to a pandemic, yet. As of 30 September, CDC, in partnership with the WHO, estimated that Ebola has killed 3431 people out of the nearly 7470 cases reported. All deaths and almost all cases have occurred in the three West African countries. But returning to Margaret Chan's words, it is critical to remember that 'when an infectious agent causes a global public health emergency, health is not a peripheral issue. It moves straight to centre stage'. 

As earlier pandemic threats have showed, international collaboration is critical for an effective response, and developed nations lending support to developing ones so they can strengthen their health systems to prepare and respond is a vital international development lesson from the last decade. 

While Australia's Chief Medical Officer has assured us that we will be able to respond if Ebola reaches Australia, the lesson of the past two decades is that health is a global matter. So the strategic issue for Australia is how it is positioned to support our closest developing neighbours in their preparations.

The real limitations of developing-country health systems was reinforced earlier this month when Medecins Sans Frontieres rejected a A$2.5 million grant from the Australian Government to support its Ebola work in West Africa. Instead, it wants Australia to provide specialised civil and military personnel to the affected countries. Australia's Foreign Minister has countered that the Government will not put Australian health workers at risk when there is no safe evacuation plan in the case of infection. 

That's reassuring for Australia's health workers, but it reminds us of the importance of stopping a disease in its tracks by preparing through smart development investments. It is more than emergency aid and border control, and it is definitely in Australia's interests.

Photo courtesy of Flickr user UNICEF Guinea.

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