Why Is Ebola Outbreak In West Africa So Difficult To End?

The Ebola outbreak in West Africa dominated worldwide headlines for several months this year, peaking with the news that the deadly virus had seen its first cases in the U.S. and Spain. But media outlets soon appeared to lose interest as attention shifted to other concerns, even as Ebola continued to ravage Liberia, Sierra Leone and Guinea. Now, the epidemic has returned to global headlines this week as a Scottish nurse who had returned home from treating victims in Sierra Leone was diagnosed with the disease in Glasgow, making her Britain’s first Ebola patient and reigniting questions about why the outbreak has been so difficult to bring to an end.

As the outbreak nears its one-year anniversary, the inability to stomp it out can be chalked up to a shortage of immediacy, commitment and resources during its early stages, according to health experts. The disease’s global victim toll has topped 20,000, according to U.S. Centers for Disease Control and Prevention statistics released Saturday, and Liberia -- which had experienced success lowering transmission rates and had been perceived in recent weeks as being on the path to eliminating the disease -- is seeing a worrying uptick in new cases in areas near its border with Sierra Leone. The latter African nation is currently ground zero of the Ebola outbreak, seeing more new cases per week than Liberia or Guinea as health workers and nonprofits struggle to bring about an end to that tragic trajectory.

“I think we are still under-resourced to tackle the problem, we still don’t have enough beds to tackle the patients when they come in, and I think that’s a major problem to fully quelling the outbreak,” said John Lyon, CEO of World Hope International, a Christian international nonprofit based in the U.S. that is working to fight Ebola on the ground in Sierra Leone. “Then there’s ancillary things around that. For instance, we’re working on a program to move discharged patients from our Ebola treatment centers, to move more people in and make sure the beds are being used efficiently.”

The undersupply of resources and their mismanagement has been a severe hindrance to the eradication effort in Sierra Leone for several months. “It’s important to remember that there was a 21-day window back in May when there were virtually no new cases,” said Dr. Andrew Schroeder, director of research and analytics at Direct Relief, a U.S.-based humanitarian aid group. "There was this point at which people thought this was something where we would have the whole disease corralled, but one case can change the whole ballgame. That means you have to be very, very localized, you have to have the trust of the populations."

While there has been an influx of money, health care professionals and other resources into the countries struggling to eradicate Ebola, experts have been calling for more of all three for months. “There’s a whole range of resources that are needed other than just a company putting in beds,” Lyon said. “They need resources to be able to fight it effectively, and I think it’s just taking time to get the resources to the areas that need to be resources. Too much time, in my opinion. It needs to go faster. We need more people, more funding, more resources.”

Kurt Williamson, a viral ecologist and associate professor of biology at the College of William & Mary in Williamsburg, Virginia, said the Ebola outbreak should demand more attention. “[P]eople are caring for the sick in Africa as best they can, but a lack of proper equipment, isolation units, communications and transportation infrastructure, and in many cases lack of knowledge about how the disease is transmitted, are all inhibiting those efforts,” Williamson said in an email interview in October.

Part of the problem is that there still isn't a system in place to provide testing and care to those who may have contracted the virus, in order to avoid it spreading further throughout victims’ communities. “The reason it’s so hard to get under control is in every case, everyone who has been known or suspected to be in contact with them has to be contacted and they have to be willing to get treatment and you need to have a place to treat them,” Schroeder said. “It’s different than other kinds of outbreaks because you have to get down to literally zero cases.”

Until that time, Ebola’s threat to the world remains real, albeit fairly minor, Dr. Amesh Adalja, a senior associate at the University of Pittsburgh Center for Health Security, said via email. “The Scottish case is not unexpected and should reinforce, in the minds of the general public, that though Ebola may not be in the headlines as much as it was a few months ago, the outbreak rages on at its source, and until it is extinguished, the world has to be prepared to identify, isolate, and care for infected health care workers and travelers,” he said.