Is Ebola Over?

A headline in yesterday's Washington Post reported that "U.S.-built Ebola treatment centers in Liberia are nearly empty as outbreak fades." This is obviously very good news, although the map provided by the State Department's Humanitarian Information Unit shows that Liberia's next-door neighbor, Sierra Leone, actually had more cases as of last month than did Liberia. At the same time, Liberia led the count in terms of deaths. Their map also illustrates the fact that the only part of Guinea that was really affected was the portion closest to Liberia and Sierra Leone. WHO has put out a very extensive report  on Ebola that traces the origins of the disease, recaps the world's response, and suggests what steps need to be taken to make sure there is no resurgence of the disease. An important set of comments from the conclusion struck me, in particular:

The persistence of infections throughout 2014 had two causes. The first was a lethal, tenacious and unforgiving virus. The second was the fear and misunderstanding that fuelled high-risk behaviours. As long as these high-risk beliefs and behaviours continue, the virus will have an endless source of opportunities to exploit, blunting the power of control measures and deepening its grip. Like the populations in the three countries, the virus will remain constantly on the move. 

Getting to zero means fencing the virus into a shrinking number of places where all transmission chains are known and aggressively attacked until they break. It also means working within the existing context of cultural beliefs and practices and not against them. As culture always wins, it needs to be embraced, not aggravated, as WHO aimed to do with its protocol on safe and dignified burials.

Recognizing that there are cultural variables at play, rather than this being a simple health issue, is key to future success. Sadly, this reminds me of the rise in measles cases here in southern California, brought about by mothers who think they know more than health scientists and thus refuse to allow their children to be vaccinated, thus preventing us from being able to eliminate the disease.