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Business News/ Politics / Policy/  Tony Barnett | There is no sign of an Ebola pandemic
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Tony Barnett | There is no sign of an Ebola pandemic

Humans are ready for Ebola because our immune systems have evolved to defend us as individuals, says Barnett

Tony Barnett, professor of social sciences, infectious diseases at the London School of Hygiene and Tropical Medicine, says that WHO has taken a very brave decision in allowing the use of experimental drugs to treat Ebola. Premium
Tony Barnett, professor of social sciences, infectious diseases at the London School of Hygiene and Tropical Medicine, says that WHO has taken a very brave decision in allowing the use of experimental drugs to treat Ebola.

New Delhi: More than 1,400 people including 130 health workers have died in West Africa from the Ebola Virus Disease (EVD) between December 2013 and 20 August. With a fatality rate of between 50% and 90%, the disease has spread across the five African nations of Guinea, Liberia, Nigeria, Sierra Leone and the Democratic Republic of Congo. Many governments have taken precautions to prevent the infectious disease from entering their countries. Tony Barnett, professor of social sciences, infectious diseases at the London School of Hygiene and Tropical Medicine, spoke about the chances of the disease becoming a pandemic and the debate about experimental drugs to treat EVD. Edited excerpts from an email interview:

Realistically, what are the chances of Ebola becoming a pandemic?

The areas where the worst is occurring, it is already an epidemic. An epidemic occurs when new cases of a disease, in a given human (or other animal or plant) population during a particular period, markedly exceed what is expected based on recent experience.

What people are really worried about is whether there is going to be a pandemic of EVD. In other words, will it spread across the world, is it a threat to you and me now?

EVD kills infected people very rapidly, so they do not walk around spreading it widely. If you take the case of the one Liberian man who travelled to Lagos in Nigeria, he died there after he had infected some people who nursed him, and they also unfortunately died. So far, we have not seen an outbreak in Lagos—which is what you might expect if the rate of onward infection from each case was very high, as with a respiratory virus (like influenza). In other words, EVD is rather poor at transmitting from one human host to another.

So, the simple answer to your question is, on present evidence, there is no sign that this is going to become a pandemic. But, of course, viruses and other disease pathogens do try to evolve to maximize their population. With regard to Ebola, if I speculate—and that is all it is—I think it may have made a geographical leap (either via an animal host or via reduced virulence in the human host) because of changes in parts of Africa in the last 10-15 years. These include a long period of warfare and unrest, continuing poverty with some slightly raised living standards as warfare has come to an end in Sierra Leone and Liberia, better communications and some economic growth, often around environmentally disruptive processes such as mineral extraction and/or forestry. Therefore, people move about more easily. And so the pathogen has also been able to move along with people and perhaps because of destruction of rain forests. It has evidently increased its range, coming out of the Congo river basin forest belt and has moved to the remnant West African forest belt.

Has the virus mutated to become more infectious and deadly? How big a danger is the evolution of viruses as they attempt to survive and how can we prepare for it?

Leading experts in the field think it is unlikely that the virus has mutated and no evidence is available to suggest that this has happened. It does not mean it could not happen, but the evidence at present is against it having happened.

Second, how dangerous is it to us? Well, humans have survived and evolved over many tens of thousands of years in relation to various viruses, bacteria, parasites and prions, and other infectious agents. We have been co-evolving with malaria for about five million years. In other words, it has been and continues to be a constant battle between us and the pathogens that would like to use our bodies for their own purposes. But the evidence is that we have managed to survive rather successfully—there are a lot of us around. In other words, our immune systems constantly evolve, and so far, while there have been some spectacular pandemic events, we continue to survive as a species, and indeed to threaten our environment.

Finally, how to be ready for it? One, we are ready for it all the time because our immune systems have evolved to defend us as individuals; two, we can be ready by improving our healthcare systems, particularly the preventative aspects of those systems, and often this means relieving poverty: poor housing, poor diet, bad sanitation and water supply, anxiety, gross inequality.

What do you think about the World Health Organization’s (WHO) decision to allow the use of experimental drugs to treat the disease, particularly in the context of developing countries like India, where public health systems are not robust enough to monitor the patients?

This has been a very brave decision on the part of WHO in very unusual circumstances. It is, however, an emergency response and is restricted to the provision of very few courses of treatment because not many are available. And there are of course risks, particularly that (a) the treatment may not work or may only work for a small number of people; (b) it may have unknown short-, medium- or long-term adverse effects. But remember that development of a drug is usually a very long process.

But above all, we should ask ourselves the following question: why would any commercial company invest huge amounts of money to produce a drug to treat an obscure virus which kills a few people each decade in poor countries that cannot pay for the drug? I don’t think anybody is imagining very large-scale experimental use of such untried treatment and so monitoring will be quite easy given the very few uses.

But if an attempt is made to use an experimental treatment on anything other than a very small emergency scale, another protocol will have to be discussed.

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Published: 25 Aug 2014, 06:28 PM IST
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