Analysis & Opinions - The Boston Globe

Ebola Outbreak is Quelled — This Time

| August 9, 2012

Uganda's President Yoweri Museveni meant no insult when he declined to shake Secretary of State Hillary Clinton's hand during her visit last week. It was a strategic slight. He was heeding his own advice that Ugandans should avoid handshakes, unnecessary public gatherings, and even kisses. By Wednesday, it appeared that this aggressive social distancing policy saved many lives. The World Health Organization confirmed that the quick and deadly Ebola outbreak there, which killed 16 people, is now under control.

While there is much talk in public policy circles about the need for diplomatic and international engagement to protect US national security, such efforts do not work on viral time. Sometimes, direct intervention is the sole option. But we have come to believe that when we do protect ourselves, the only options are kill or capture, and the only mechanism is military. But that doesn't help against a foe so deadly and so fast that its mortality rate can hover around 90 percent for those infected and there is no known cure. The only alternative is rapid containment. And however cruel it may sound for those who are already infected, containment may be the most powerful and cost-effective weapon of all.

While the immediate crisis has been averted with only 60 diagnosed patients so far, this was an outbreak that had many in the international public health community concerned. The problem was the long lag in determining whether the mysterious deaths were, indeed, part of an Ebola outbreak. In the western Kibaale district, the possibility that Ebola was responsible for the first victim's death was not immediately understood since the patient, and several others, did not have typical symptoms. They suffered from fevers and vomiting, but there was no sign of hemorrhaging.

Funerals for the victims, who appeared to die out of the blue, became large public events where exposed family members mingled with neighbors and friends, thereby increasing the likelihood that the virus would spread. (It passes through blood or other bodily fluid secretions.) An unsuspecting public health worker from the Kibaale district then travelled to the capital city of Kampala and died there. Kampala has about 1.5 million citizens.

At last tracking, the US Centers for Disease Control, the World Health Organization, and Uganda's ministry of health (which has increased both access and communication with support from the Gates Foundation) have all deployed resources. They now believe that they have identified the 400 or so people who came into contact with exposed patients. Monitoring of these patients will last another 21 days until the virus is contained. This means, sadly, until it has finally killed all its victims and has no other place to go.

Containment of a virus is no easy feat. The H1N1 virus made its way around the world in less than 30 days from its first identification in 2009. But in Uganda, the process of early identification was made easier by more sophisticated and rapid blood testing procedures that were quickly deployed by the US government, via the CDC. Uganda did not hide from the seriousness of the situation; it then launched a very public campaign to educate citizens. Hence, no kisses.

Global public health efforts tend to be be focused on reproductive and family issues. But health programs are very much a part of our security — hard security — apparatus. Even if the Ebola virus never makes it to American shores, a large outbreak in one or two countries in Africa would eventually have ripple effects leading to destabilization of governments, concerns about the global economy, refugee crises, and the end of immigration access to the United States for those in the impacted countries.

The containment strategy is the same name used for our Cold War efforts, suggesting just how much it is aligned with our national security. Such strategies tend to be little noticed and under-funded compared to guns and bombs. The CDC budget has suffered in the recent budgetary hard times.

But, as the nation continues to address essential security priorities, it is important to expand our hard security mantra to "kill, capture, or contain." The scary 10-day exercise in stopping the Ebola virus in Uganda from spreading elsewhere suggests that the much-maligned war mantra — "we're fighting them there so we don't have to fight them here" — may be apt after all.

For more information on this publication: Belfer Communications Office
For Academic Citation: Kayyem, Juliette.“Ebola Outbreak is Quelled — This Time.” The Boston Globe, August 9, 2012.

The Author

Juliette Kayyem