Infectious Disease Control Measures and Ebola

From its initial identification in 1976, there have been periodic outbreaks of Ebola Virus Disease (EVD) among the populations of Central Africa ^[1].  But the current West African outbreak is unprecedented both in its location and size.  And given the current rates of infection and transmission, as illustrated in Figure 1^[2], it can only be expected to get worse.  Many US politicians are calling for travel bans to the affected countries even now ^[3], despite the fact that no direct flights currently exist.  There may come a point where strict infection control measures become necessary, but people should be aware that these measures do not come without their own negative effects.

               The history of disease control intervention is filled with difficult choices to suppress individual rights in the name of the public good.  Some, like the Smallpox eradication campaign, essentially amounted to, “medicine by force.”^[4] And because disease is often directly related to income and education levels, the practical application is frequently an intervention of the wealthy and western forced upon the lives of the poor living in the global south.  The history of poverty and colonialism in West Africa must inform our decision making progress as we continue to combat Ebola.  The history of the HIV/AIDS epidemic in this country reminds us that social isolation can be a powerful ally of an epidemic.  Any intervention that fails to address the historic economic, cultural, and social underpinnings of disease is sure to be less effective and is likely doomed to fail.  The history of disease control intervention is filled with difficult choices to suppress individual rights in the name of the public good.  Some, like the Smallpox eradication campaign, essentially amounted to, “medicine by force.”

                It is too easy to drive people away from testing and treatment centers by failing to show adequate concern for their personal rights and dignity.  In 1985, the UN Economic and Social Council laid out the Siracusa Principles, a set of guiding principles against which the limitations of individual rights should be weighed in an emergency situation.  The declaration of Ebola as Public Health Emergency by the WHO ^[5] signals international expert consensus that we are indeed in such a situation.  The principles state that all interventions must be made within the scope of the affected nations’ laws, consistent with pursuing an end to the crisis, and constitute the least restrictive means possible for achieving that end. ^[6] Protecting health without protecting rights will only serve to incite further violence against aid and healthcare workers and limit the reach of their outreach to the affected communities.

                The dangers of Ebola are clear, and now is the time to be vigilant and attentive to the directives of public health officials at the WHO and CDC, but it is ill-advised and counter-productive for politicians to suggest additional isolation measures.  Such measures may only serve to increase the logistical burden on humanitarian workers trying to fight the disease and limit the rights of people around the world unnecessarily.  Any measures undertaken must carefully weigh the historical and human rights implications against the public good.  Suggestions for such measures are best left to those with expertise in public health and infectious disease.       

References:

1.       Fact sheet N°103: Ebola Virus Disease - Updated September 2014; http://www.who.int/mediacentre/factsheets/fs103/en/

2.       H Nishiura, G Chowell^{; “}EARLY TRANSMISSION DYNAMICS OF EBOLA VIRUS DISEASE (EVD), WEST AFRICA, MARCH TO AUGUST 2014” Eurosurveillance, Volume 19, Issue 36, 11 September 2014

3.       Nather, D. “GOP 2016ers on Ebola: Panic”; http://www.politico.com/story/2014/10/gop-republicans-elections-2016-ebola-panic-111597.html

4.       James Colgrove, “Between Persuasion and Compulsion: Smallpox Control in Brooklyn and New York, 1894-1902,” Bulletin of the History of Medicine 78 (2004): 349-378.

5.        “WHO Statement on the Meeting of the International Health Regulations Emergency Committee Regarding the 2014 Ebola Outbreak in West Africa”; http://www.who.int/mediacentre/news/statements/2014/ebola-20140808/en/

6.       UN Commission on Human Rights, The Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights, 28 September 1984, E/CN.4/1985/4, available at: http://www.refworld.org/docid/4672bc122.html [accessed 10 October 2014]