The Ebola epidemic is horrible. But it's more than that: it's a warning that what comes next could be devastating — unless we learn its lessons now.
Ebola, while a gruesome, lethal illness, is not especially contagious. It isn't airborne. It only infects patients when it slips beneath the skin. Historically Ebola outbreaks have been small: the largest prior to this year killed 280 people. This year's outbreak has so far killed 3,865 — and it's still raging.
The lesson here is simple, and it needs to be heeded: our international health systems are far too weak for an increasingly interconnected, urbanized world. The failures of public-health infrastructure in Liberia quickly become the problems of hospitals in Dallas. But what happens when it's not Ebola? What happens when the disease is airborne, when it travels through coughs and sneezes — and when contagion can occur before symptoms emerge?
"Germs have always traveled," Howard Merkel, a medical historian, recently told the New York Times. "The problem now is that they can travel with the speed of a jet plane."
We've known about these weaknesses for years
Ebola isn't our first warning. There was the SARS outbreak in 2003 when — much like Ebola — poor reporting and a lack of basic resources hampered the initial response. One account of how the response went wrong, published more than a decade ago in the Journal of the Royal Society of Medicine, reads as if it could be written about the current Ebola outbreak:
There was an acute shortage of masks and protective clothing for the medical and health personnel, who were hard hit by the disease. Lack of epidemiological information about the disease hampered the prompt application of effective control measures. Because of inadequate communication, panic developed in the community and weakened cooperation and support from the public.
Reflecting afterwards, top public health officials saw how it could have gone worse. "We got lucky," Centers for Disease Control and Prevention director Tom Frieden later said of the SARS outbreak, "that none of the cases in the U.S. came from a super-spreader."
There was the H1N1 influenza outbreak in 2009, which killed at least 150,000 people in dozens of countries. Five years ago, that outbreak showed that the World Health Organization, which coordinates international responses, was too cash-strapped and disorganized to contain the disease.
During that outbreak, there were 78 million vaccines sent to 77 countries — but only after it was "long after they would have done the most good," Harvey Fineberg recently wrote in a New England Journal of Medicine review of the H1N1 outbreak.
"The budget of the WHO is incommensurate with the scope of its responsibilities," Fineberg writes. "Only approximately one quarter of the budget comes from member-state assessments, and the rest depends on specific project support from countries and foundations."
Officials were surprised that, given the missteps, the outbreak wasn't even worse. And some, once again, chalked it up to good fortune: unlike many other flu vaccines, H1N1 did not mutate into a different virus as many influenza strains do. "We are just plain lucky," WHO secretary Margaret Chan said in 2010, after the pandemic ended.
Luck does not prevent world-wide pandemics
Our luck ran out with Ebola. The virus turned up in a small village in southeastern Guinea that shares a porous border with Sierra Leone and Liberia. This made it easy, even expected, that the disease would cross the border too. The virus in the outbreak is also the most deadly strain of Ebola we know, the Zaire strain, which has historically killed 80 percent of patients.
Ebola can be a difficult disease to detect, too, giving it another advantage in a highly connected world. Infected patients can be symptom-free for as long as three weeks. This helps explain how Thomas Eric Duncan, the now deceased Ebola patient treated in Texas, successfully boarded a plan from Liberia to the United States. He was asymptomatic.
We've had bad luck with Ebola, and that exposed the weakness of our public health system. Countries mobilize too slowly and are unable to get basic resources to the areas of the world that need them most. West African nations, chronically impoverished and ravaged by years of civil war, have severely underfunded health care systems.
They don't have the right labs to analyze diseases and catch disease sooner — nor did wealthier nations step in to provide that.
"We need to build the capacity of countries to find, stop, and prevent global health crises," Frieden told my colleague Ezra Klein in a recent interview ."We are all vulnerable to the weakest link in the chain."
The world ignored other warning bells in the past, with SARS and H1N1 and the outbreaks before them. That's how we ended up with the weak public health system we have today, the one that has allowed Ebola to spread across oceans, traveling to eight countries in three continents.
As bad as the current Ebola outbreak is, it could be worse with another, more contagious disease. If we can't contain a disease that is difficult to transmit — one that has to make its way under each patient's skin — how will we contain a disease that spreads more swiftly, easily and discreetly?
A luck-based public health system isn't a way to prevent pandemics. There is a lesson in this Ebola outbreak, and we may not get another chance to learn it.