Ebola Brings Salience to Global Health Issues

The spread of Ebola virus disease (EVD) has enthralled the United States. Major media publications, internet blogs (like this one!), experts and lay people alike tuned into the development of the conditions in west Africa and even more acutely to those here at home. This media attention provides an opportunity for global health issues discussed in this class to get more attention from the general public than they normally would. This attention from the general public, in turn, opens a window of opportunity for members of the global health community (or people who care enough to read this blog) to engage laypeople in discussion about global health issues. I would like to present some media articles that touch on topics discussed in this course, if only to provide evidence of how salient global health is at this particular date. Whether the attention is merited outside of instances when of endemic diseases spread beyond their border is a separate issue, and I do not plan on discussing that question.

Ebola Vaccine, Ready for Test, Sat on the Shelf, Denise Grady, New York Times, Oct. 23

An Ebola vaccine developed a decade ago and shown to be successful in primates never begins human testing. The market for a vaccine that prevents a disease endemic to resource-poor nations may not have a market to support sales of a drug that cost $1 billion to $1.5 billion to develop.

“There’s never been a big market for Ebola vaccines,” said Thomas W. Geisbert, an Ebola expert here at the University of Texas Medical Branch in Galveston, and one of the developers of the vaccine that worked so well in monkeys. “So big pharma, who are they going to sell it to?” Dr. Geisbert added: “It takes a crisis sometimes to get people talking. ‘O.K. We’ve got to do something here.’ ”

Now three vaccines are entering stages of human testing. Investment in completing the development of an EVD vaccine a decade ago would surely have saved much of the nearly $600 million spent thus far on attempting to control the spread of EVD, a number that will continue to rise as the year continues on. Monetary concerns aside, it would have prevented immeasurable human suffering and angst across the globe. Issues of pharmaceuticals and global health prioritization readily present themselves in the article.

Nurse quarantined in New Jersey after returning from Ebola mission is released, Abby Ohleiser and Cecilia Kang, The Washington Post, Oct. 27

Discussions of stigma and social determinants of health were prevalent in our Oct 27th seminar, including a discussion about the stigmas facing health care workers who treat infectious diseases such as EVD or HIV. A Doctors Without Borders nurse who had recently returned from treating symptomatic Ebola patients in Sierra Leone was detained by the State of New Jersey after arriving at Newark Liberty International Airport with a fever of 101 degrees F and held in quarantine until her symptoms had subsided for a full 24 hours. Since released, Kaci Hickox spoke to the media while in quarantine about her feelings on how she was treated and how other returning health care workers may be treated:

Still in isolation, Hickox fears colleagues will meet the same fate. “I had spent a month watching children die, alone. I had witnessed human tragedy unfold before my eyes. I had tried to help when much of the world has looked on and done nothing,” she wrote for the Dallas Morning News. “I sat alone in the isolation tent and thought of many colleagues who will return home to America and face the same ordeal. Will they be made to feel like criminals and prisoners?”

Although allowed to leave the state to travel to Maine, Hickox is still subject to quarantine if she returns to New Jersey. So what happens now? If more states with international airports adopt similar policies, could we expect a decline in volunteerism to travel to west Africa? The uncertainty of freely being allowed to travel home is, in my eyes, a possible outcome that any volunteers will have to take into consideration. In a country that believes in personal agency and widely approves of management by experts, how can a policy such as this even be enacted? How will this episode affect Kaci Hickox personally and professionally? Upon her return to her family and workplace, she may have to navigate through conversations about how she practices healthcare, risky behaviors, her political leanings (she directly challenged New Jersey Gov. Chris Christie) and potentially undesired media attention.

The protocol in New Jersey extends past people who are EVD symptomatic to anyone they have come into contact with as well. If you were faced with extended quarantine and public knowledge you may have come into contact with a deadly disease, would you report yourself to the state or seek medical care in your home state?

Ebola has brought the challenge of "health for all" into a new context and the obstacles to achieving that goal into focus here in the States. Perhaps we can leverage this attention to gain ground in the fight for "health for all" through asking ourselves and colleagues questions about global health issues and values, and participating in the Ebola discussion.