In late July of 2014, I received an email from someone who had just started her medical residency. Why, she wanted to know, was the United States allowing American Dr. Kent Brantly to return to be treated for Ebola, which he had contracted while caring for patients in the exploding West African outbreak?
Why bring it here, she asked, expressing deep concern that his return could create an opportunity for Ebola to escape from Atlanta’s Emory University Hospital — where he was to be cared for in a special high containment unit — and spread on a continent where the virus is not typically found.
The email was a testament to a palpable sense of fear around Ebola among many at the time. And I’ve been thinking about it lately as I’ve struggled to understand why the current Ebola outbreak in the Democratic Republic of the Congo isn’t getting much attention or much funding.
Sure, there’s a lot vying for headlines. In the United States, two dozen candidates are contending to be the Democratic nominee in the 2020 election, and the president is still tweeting. Iran is flexing its muscles in the Strait of Hormuz, Boris Johnson is actually Britain’s prime minister, and of course, Brexit looms.
In terms of funding, the long-running war in Syria, the cholera outbreak in Yemen, a massive measles epidemic in DRC, and the never-ending effort to eradicate polio are just a few of the competing priorities.
But this is Ebola. Since Richard Preston’s “The Hot Zone” was published in 1994, people have been petrified of a disease they thought made those infected gush blood from every orifice and even their eye sockets. (That’s not generally the case; Ebola outbreaks would be spotted a lot quicker if it were true.)
Historically, Ebola epidemics have been major news. This one, which is approaching its first anniversary and still going strong, less so. That’s despite the fact that it is the second largest on record, already six times bigger than No. 3. Most outbreaks have involved well under 100 people; in the North Kivu-Ituri outbreak, nearly 2,600 people have been infected and over 1,700 — 67% — have died.
Why isn’t this one getting more attention?
Part of the answer may be the setting, in a part of DRC that has been riven by conflict for more than two decades. Few journalists from outside the region have traveled to the outbreak zone to report on the ground. (I am not one of them.) Conflict zones are dangerous — and expensive — places to report from.
But there are other ways to cover the outbreak. While it’s best to be on the ground, to tell the stories of the people affected and the people trying to help, it’s possible to report on an Ebola outbreak from a distance. Along with others, I’m doing that from the United States. Still, the swell of coverage that I would have expected to see from an Ebola outbreak that has lasted this long and killed this many people simply hasn’t materialized. #Ebola doesn’t ever seem to trend on Twitter anymore.
For a while, my theory was that the West African outbreak of 2014-2016 — the one during which Brantly got infected — completely reset expectations of Ebola.
It was the first where the disease spread in cities, where the world saw what urban Ebola could do. By the time the epidemic was finally extinguished, more than 28,600 people had been infected and more than 11,300 had died.
Throughout last fall and through the spring, when people asked me about the North Kivu outbreak and why it wasn’t getting more attention, I said I thought the West African outbreak may have made people conclude that an outbreak of only hundreds or even a few thousand cases wasn’t such a big deal.
But I’m not sure, anymore, if that’s what’s going on. I’m wondering, instead, whether the West African outbreak may have simply reshaped the wider world’s thinking about Ebola in a different way.
In addition to the three main countries affected by the outbreak — Guinea, Sierra Leone, and Liberia — seven others reported Ebola cases. Three were African countries — Nigeria, Senegal, and Mali — which fortunately managed to contain the virus quickly.
Italy, Spain, Britain, and the United States also had Ebola cases; most were health workers who had volunteered in West Africa and got sick shortly after traveling home. Germany, France, the Netherlands, Norway, and Switzerland also accepted infected health workers evacuated for care.
Spain and the United States actually saw a tiny amount of local transmission.
In one case, a man who lived in Dallas visited his native Liberia. When he traveled home, he brought the virus with him. When symptoms started he went to hospital, where staff didn’t initially realize what they were facing. Two nurses involved in his care contracted Ebola. The man died but the nurses survived.
That event, along with the case of an American doctor who developed Ebola a few days after returning to New York, sparked the type of fear that my email correspondent had expressed — that Ebola might be on the verge of spreading in a real way in the United States. That didn’t happen. It didn’t happen in any of the other countries either.
Now I wonder if the West African outbreak taught citizens of the U.S. and other countries that typically help out in an Ebola outbreak a different lesson. Maybe the idea that eventually took root was that Ebola wasn’t the threat to us that we thought it was.
What if, ironically, the worst Ebola outbreak ever de-fanged Ebola?
That definitely shouldn’t be the lesson anyone took from that horrible outbreak. What West Africa and northeastern DRC should teach us is that struggling states with weak health systems are fertile ground for hard-to-contain disease outbreaks that will be massively expensive to stop if they aren’t addressed quickly and aggressively.
I’m not a social scientist. I have zero data on which to lean here. Someone who actually does this sort of research may conclude that donor fatigue, or the financial straits some countries and most media outlets currently face, or the turning inward that has accompanied the rise of populism can explain why this Ebola outbreak isn’t as front burner an issue as it would have been a decade ago, why organizations struggling to stop it are finding fewer donors writing smaller checks.
But in the meantime I am left wondering if we have learned to fear this virus less. And in the process, if we have let Ebola drift toward the column of bad diseases — things like cholera and yellow fever, Guinea worm and malaria — that we’re not so concerned about. Sure, they sicken and kill lots of people. But they don’t do it here.