Aug 27, 2018
Reading the news, it feels as if only bad things ever happen in the world. Yet there are a lot of ways the world is getting gradually better. Not hearing about those is likely to give us a skewed view of the world, and prevent us realising we should learn about what caused those improvements. I also find it easier to stay motivated when I think about the fact that people around the world are getting better off, and how that’s often down to the hard work of others. For example, it’s not news when another month goes by without a case of guinea worm in South Sudan. So we only hear about guinea worm when there is a new case. But in fact, in 2017, there were only 20 villages with cases of Guinea worm disease in two countries, both in Africa, compared to 23,735 villages in 21 countries on two continents in 1991. That’s a really incredible feat for humanity to have pulled off. I’d love for there to be more content on the overall positive trends in the world and what’s causing them. That could give me a more accurate and more inspiring picture of the world than the news provides. So I thought I’d have a go at writing the kind of thing I have in mind. The post was inspired by Zach Groff suggesting we share good news.
Tragically, another Ebola outbreak has begun in the Democratic Republic of the Congo. That has overshadowed the fact that the WHO has declared the April Ebola outbreak successfully extinguished. The end of any Ebola outbreak is excellent news: the disease has an average death toll of 50%, and in some cases as high as 90%. In this case there were over 50 infected, of whom 33 died. That is actually a much smaller number than some predicted. The reason for high predicted death tolls is that the outbreak spread to a large city (Mbandaka). That’s in contrast with other outbreaks in DRC which have been in very isolated areas, and therefore burned themselves out comparatively swiftly. In addition to the danger of such a disease in a dense urban area, the Mbandaka is a port on the river Congo with strong transport links with the capital, Kinshasa. This proximity to such large populations means that the 2014-2016 West African outbreak is very much on people’s minds, which killed over 11,000. But in this case, the outbreak was contained mercifully swiftly.
It’s impossible to know how the outbreak would have progressed had it been treated differently, and which parts of the response to the outbreak had most and least effect. But it is clear that the response to the outbreak was swift and impressive, and it’s likely that had a major effect on limiting the death toll. Unlike the 2014 epidemic, Ebola was diagnosed fairly quickly and a state of emergency was called early, with the WHO sending some of its most experienced personnel into the field. This response seems to show how much the international community has learned from the West African outbreak.
A key intervention employed to curb this outbreak was ring vaccinations. This is the first Ebola outbreak for which a vaccination has been immediately available. It was tested using a randomised controlled trial in West Africa in 2016. Although that epidemic was contained too early for the trial to be completed, the results of the trial seemed promising. In considering this scientific achievement, we should consider not just that we have found a vaccine that works against the world’s deadliest disease, but also the important strides we’ve made that allow its use. Most obviously impressive is the fact that we are able to administer the vaccine successfully in areas with hot climates and which are difficult to reach despite it needing to be stored and transported at temperatures less than -60 degrees C. The vaccine was also strategically administered, using ‘ring vaccination’ – the same method as was used to successfully eradicate smallpox. That involves, for each case of Ebola, finding all the people that person has been in contact with and vaccinating them, and then doing the same for each of the people those contacts have been in contact with. Tracking all those people down is no mean feat, particularly given the historic difficulty of producing accurate maps. Strides in cartography are starting to improve this situation: satellite imagery can be used to mark the positions of buildings, rivers and roads, and then people on the ground can use smartphones or GPS receivers to label the map accurately.
Our responses to Ebola take advantage of many other improvements in our understanding of diseases and ways of fighting them. That includes things we might think of as simple but are extremely important, like effective disinfectants. It includes using the latest technology to build health bots which search the web for mentions of Ebola, meaning that potential outbreaks can be discovered fast, even if there is a delay in official announcements. And it includes using anthropology to allow people from one side of the world to understand those on the other well enough to make themselves useful at times when everyone needs to come together.
Just one family of children being prevented from growing up without a parent, or just one mother being spared the grief of losing a child, is a truly wonderful thing. It’s hard to know exactly how significant the tools I’ve described were in halting the spread of Ebola. But it’s genuinely possible that the response mounted to this outbreak avoided such pain for thousands of families. That’s an absolutely incredible feat.