We have all been living with Ebola for the past year, and after more than 28000 reported cases, 11000 deaths, 17000 survivors, and a barrage of clinical research trials – the end of the epidemic is apparently in sight -but there is still no FDA-approved Ebola treatment or vaccine. Moreover, multiple studies have confirmed that the Ebola virus can persist in semen following recovery, rendering the male survivor a potential carrier and hence a source of the Ebola virus, which can be sexually transmitted. This implies that asymptomatic transmission of the Ebola virus can occur, as is the case for HIV/AIDS.As the epidemic (centered in West Africa) fades from the spotlight, the recent and seemingly mysterious resurgence of Ebola infection in Liberia is a stark reminder of the uncertainty surrounding this deadly virus, and that another wave of the Ebola epidemic could be imminent.
There is consensus among experts that the Ebola epidemic rapidly expanded due to initial gross mismanagement by the World Health Organization (WHO). And while the countries almost exclusively affected areLiberia, Sierra Leone, and Guinea, there was an associated epidemic of fear worldwide, especially in the US, and this is understandable, given the mishandling of the first Ebola case ever diagnosed in the US(Thomas Eric Duncan), the deadly nature of the virus, as well as the unpredictability and rapid growth of the epidemic in West Africa. Compounding this fear was the projection by the CDC (Centers for Disease Control and Prevention), that by January 2015, we could have had close to 1.5 million cases. With such a projection (reminiscent of devastating pandemics in history), it seems fair to say that the media coverage of the Ebola epidemic was commensurate with the magnitude of the problem, especially as characterized by the CDC, which is considered the world’s authority on diseases.
Given our limited knowledge and understanding of the deadly Ebola virus, I am disappointed by those healthcare professionals who visited, and were in direct contact with Ebola patients in West Africa, but were opposed to restricted movement and active monitoring upon their return to the US. Such precautionary measures are at the core of evidence-based public health practice for controlling the spread of major infectious diseases, not to mention, it is good old-fashioned commonsense to do so. While I applaud those healthcare workers for their service, they seem to have forgotten the fundamental principle of decision-making amidst uncertainty – err on the side of caution, act for the greater good.
Again, after almost 40 years, and at least 20 Ebola outbreaks, the world is still without a vaccine or specific treatment, but unlike previous outbreaks, the magnitude and severity of the current epidemic has created a huge economic incentive to pursue clinical research and pharmaceutical production. There is an unprecedented number of Ebola vaccine and therapeutic trials in progress; a few with early promising results. However, amidst the relief of a waning epidemic, we must settle for inconclusive evidence, at best, from these clinical trials, due to a lack of Ebola cases to enroll as research participants, and a significant reduction of the risk of infection, making it almost impossible to fully evaluate vaccine candidates. This dilemma could have been avoided, if not for barriers posed by international and local politics, and a lack of collaboration, leading to a delay in initiating clinical trials.
When the Ebola epidemic ends, the virus may lie dormant in male human survivors, and non-human animals (the likely natural reservoir) waiting for an opportunity to enter a susceptible human host, and reignite the epidemic. With appropriate and effective primary interventions in place, the risk of transmission and infection can be significantly decreased. Certainly, the preferred first line of defense is a vaccine, but absent that, the primary emphasis needs to be on health education and psychosocial interventions, in other words, behavioral medicine, which is aimed at facilitating lifestyle changes conducive to health. While we work to identify the primary reservoir of the Ebola virus, as well as an effective vaccine and treatment, let’s not lose sight of a confirmed source from which the Ebola virus can be transmitted -male survivors.
It is hoped that commonsense, collaboration, and evidence-based decision-making will prevail. In the words of CDC director Dr. Tom Frieden:”We have to work now so that this is not the world’s next AIDS”. We must act fast and decisively, void of political correctness.
Rossi A. Hassad, PhD, MPH, is an epidemiologist and professor at Mercy College, in Dobbs Ferry, N.Y. He is a member of the American College of Epidemiology, and a Fellow and Chartered Statistician of the Royal Statistical Society, [email protected]