It’s one of the deadliest diseases on Earth, with a fatality rate as high as 90 percent. It’s also grotesque, sometimes causing bleeding from the eyes, ears, mouth and rectum and a bloody rash leading to a quick demise. It’s Ebola, one of a handful of illnesses that are so deadly governments consider them a threat to national security. The latest epidemic has killed more people than all previous waves combined. For the first time Ebola infection occurred outside Africa.

The Situation

Ebola reappeared in Liberia in late June after the World Health Organization declared a month earlier that it had stopped spreading in the country. There were six new cases. In the other hard-hit countries, Guinea and Sierra Leone, new cases had dwindled to just a few by late July. Even as the epidemic wound down, it continued to inflict pain. More than 27,000 people have been infected since December 2013, according to the official count. About 11,000 have died, leaving behind an estimated 30,000 orphans. More will perish, given a fatality rate of 70 percent in this outbreak. The economic disruption caused by Ebola cost the three countries more than half a billion dollars in 2014, almost five percent of their combined GDPs, according to the World Bank. Aversion to medical facilities has wrecked malaria-control efforts. According to a study published in the Lancet, some 74,000 fewer cases of malaria were treated in medical centers in Guinea in 2014 than in 2013. Coping even with mundane medical needs is a challenge given the more than 500 health-care workers killed by Ebola. With better medical systems, Nigeria, Senegal and Mali contained Ebola when it spread there, and the Democratic Republic of Congo controlled an outbreak of a different strain of the virus. Two medical workers in the U.S. and one in Spain were infected after caring for people who had contracted Ebola in Africa; all three recovered.

The Background

Earlier Ebola outbreaks, which produced  a total of 2,387 cases and 1,590 deaths since 1976, were contained within months. Those occurred largely in remote rural areas. This epidemic, however, began at a crossroads where people move frequently across porous borders in search of work or food, and cities became centers of contagion. It was Ebola’s first appearance in western Africa, in three of the world’s poorest countries. Early on, the disease was transmitted by victims who avoided hospitals because of stigma and fear, as well as by unsafe burial practices. The countries’ relatively rare health workers — Liberia has just 1 doctor per 100,000 people — were unprepared to deal with the patients they saw. A few foreign volunteer groups pitched in, but the WHO was slow to recognize and respond to the threat. The U.S., beginning in September 2014, sent 2,800 military personnel to Liberia to help fight the outbreak; all but 100 had been withdrawn by April 2015. There are no drugs or vaccines approved to treat or prevent Ebola, although companies and government-funded labs have accelerated their development. In July, an experimental vaccine made by Merck was found to be 100 percent effective in an interim analysis of results in a continuing trial in Guinea. Ebola jumps to humans through contact with secretions from animals such as chimpanzees, gorillas and bats. It spreads among humans the same way, with medical workers and family members the most at risk.

The Argument

Ebola doesn’t travel through the air, making it harder to transmit than many other pathogens as long as proper health-care practices are followed. Thus, the disease’s tear through three impoverished countries raises questions about whether richer nations should focus their aid more on strengthening health-care systems. Assistance programs are often directed instead at combating a particular disease. Defenders of this approach say it gets quicker results, which are measurable. Critics say it creates a duplication of services for different diseases, and leaves few resources for primary care. For its part, the WHO, acknowledging criticisms of its performance, said it would create a special fund and an emergency workforce to react to crises such as the Ebola outbreak. That change, however, did not address the failure of WHO’s leaders to recognize the need to respond.

The Reference Shelf

  • Bloomberg News Q&A on the Ebola outbreak.
  • A WHO report examining the response to Ebola one year into the epidemic.
  • A report on ethics and Ebola by the U.S. Presidential Commission for the Study of Bioethical Issues.
  • Richard Preston’s 1994 best-selling book about Ebola, “The Hot Zone” and Laurie Garrett’s 1995 book “The Coming Plague: Newly Emerging Diseases in a World Out of Balance.”
  • A New York Times graphic tracing the latest epidemic.

First Published April 4, 2014

To contact the writer of this QuickTake:

Makiko Kitamura in London at mkitamura1@bloomberg.net

To contact the editor responsible for this QuickTake:

Lisa Beyer at lbeyer3@bloomberg.net