Alex van Tulleken, M.D., the Helen Hamlyn senior fellow at Fordham’s Institute of International Humanitarian Affairs, is a physician who specializes in tropical diseases. He recently sat down to talk about the Ebola epidemic currently affecting West Africa.
What’s the biggest misconception about the Ebola virus?
In New York, the biggest misconception is that we’re likely to have an epidemic of Ebola here, or that you can catch it easily. People worry about Ebola because it has a very high case fatality rate. If you catch it, the chances of you dying are about 50 percent. That makes it pretty terrifying. The fact that it spread rapidly in West Africa also makes people think it could spread anywhere. It just isn’t the right kind of virus to do that. It’s actually not very contagious at all. It isn’t spread in an airborne mechanism, like flu. You really need contact with bodily fluids containing the virus.
This outbreak has been confined to Africa and is not expected to present a threat to U.S. citizens. Why should Americans pay attention?
This is killing a lot of people, but it is also destroying health systems. Which means that many more people are going to die of things other than Ebola. If we can’t contain a disease like Ebola, which isn’t that contagious, then it shows how hard it might be to contain something like flu. And if we were talking about flu, I would be saying that New Yorkers should be worried.
Why was it a greater threat to the populations of places like Sierra Leone to begin with, as opposed to the United States?
We’re talking about some of the poorest countries in the world. They’re different from America in almost every way. Many people can’t read and are poorly educated about health. There are a number of other cultural practices that are not helpful. One is the cultural practice of making contact with, and washing, the dead bodies; this sort of thing spreads disease.
Then there are the measures needed to control Ebola, like contact tracing. If we know you’ve got Ebola, we need to get in touch with everyone you’ve been in touch with. In New York, that’s pretty easy. But in West Africa it’s much, much harder. People are afraid of the health services. And many don’t have addresses and don’t have phones.
Does globalization make us more vulnerable to viral outbreaks?
Globalization is an important part of this conversation. We take more planes, there are higher densities of populations, and people move around more. But globalization is also one of the forces in which certain parts of the world have been excluded. We think of globalization as a force for good, and that as certain countries have become richer a rising tide has lifted all boats. In fact, in West Africa that has not been true. There hasn’t been consistent economic growth there for many decades. What we’re seeing now is a disease that’s really a hallmark of poverty and neglect.
Do you think this will serve as a wakeup call for the international community to provide more resources to prevention measures?
This will be a wakeup call in the short term, but the international community has a real problem when it comes to epidemic prevention, because no one ever won a medal for preventing an epidemic. You lose your job if you’re in the business of epidemic prevention, because people say well, there are no epidemics; we don’t need you.
How are relief agencies coping with the different crises around the world, such as Gaza, Syria, the Sudan, Ukraine, and now this?
The timing of the Ebola epidemic is really bad because ordinarily this would have been in the headlines months ago. When people started to say to the media that they’ve been reporting on this very poorly, they could for once reasonably say, ‘Look, there have been other things that have been really important. There are wars in Gaza, South Sudan, Syria,’ on and on it goes….
Is there room for optimism about these subjects?
The good news from the Ebola epidemic is that there is an incentive to develop vaccines and treatments, which in the long term will help—I don’t think we’re going to see a useful vaccine in this epidemic though, which I think will run for several months.
What we’re seeing are a group of aid organizations that are struggling to cope, that are poorly funded, and that are increasingly co-opted into political projects. Aid workers have been kidnapped or killed. So humanitarianism as it exists now is in a dangerous position. In the long run, to deal with humanitarian crises will require more training, more professionalism, and more money, and humanitarian organizations [will]require more room to work in a safe way.
