You Are Not Nearly Scared Enough About Ebola

Experimental drugs and airport screenings will do nothing to stop this plague. If Ebola hits Lagos, we're in real trouble.

Attention, World: You just don't get it.

You think there are magic bullets in some rich country's freezers that will instantly stop the relentless spread of the Ebola virus in West Africa? You think airport security guards in Los Angeles can look a traveler in the eyes and see infection, blocking that jet passenger's entry into La-la-land? You believe novelist Dan Brown's utterly absurd description of a World Health Organization that has a private C5-A military transport jet and disease SWAT team that can swoop into outbreaks, saving the world from contagion?

Wake up, fools. What's going on in West Africa now isn't Brown's silly Inferno scenario -- it's Steven Soderbergh's movie Contagion, though without a modicum of its high-tech capacity.

Last week, my brilliant Council on Foreign Relations colleague John Campbell, former U.S. ambassador to Nigeria, warned that spread of the virus inside Lagos -- which has a population of 22 million -- would instantly transform this situation into a worldwide crisis, thanks to the chaos, size, density, and mobility of not only that city but dozens of others in the enormous, oil-rich nation. Add to the Nigerian scenario civil war, national elections, Boko Haram terrorists, and a countrywide doctors' strike -- all of which are real and current -- and you have a scenario so overwrought and frightening that I could not have concocted it even when I advised screenwriter Scott Burns on his Contagion script.

Inside the United States, politicians, gadflies, and much of the media are focused on wildly experimental drugs and vaccines, and equally wild notions of "keeping the virus out" by barring travelers and "screening at airports."

Let's be clear: Absolutely no drug or vaccine has been proven effective against the Ebola virus in human beings. To date, only one person -- Dr. Kent Brantly -- has apparently recovered after receiving one of the three prominent putative drugs, and there is no proof that the drug was key to his improvement. None of the potential vaccines has even undergone Phase One safety trials in humans, though at least two are scheduled to enter that stage before December of this year. And Phase One is the swiftest, easiest part of new vaccine trials -- the two stages of clinical trials aimed at proving that vaccines actually work will be difficult, if not impossible, to ethically and safely execute. If one of the vaccines is ready to be used in Africa sometime in 2015, the measure will be executed without prior evidence that it can work, which in turn will require massive public education to ensure that people who receive the vaccination do not change their behaviors in ways that might put them in contact with Ebola -- because they mistakenly believe they are immune to the virus.

We are in for a very long haul with this extremely deadly disease -- it has killed more than 50 percent of those laboratory-confirmed infections, and possibly more than 70 percent of the infected populations of Liberia, Sierra Leone, and Guinea. Nigeria is struggling to ensure that no secondary spread of Ebola comes from one of the people already infected by Liberian traveler Patrick Sawyer -- two of whom have died so far. That effort was expanded on Wednesday, when Nigerian health authorities announced that a nurse who had treated Sawyer had escaped her quarantine confinement in Lagos and traveled to Enugu, a state that, as of 2006, has a population of about 3 million. Though the nurse has not shown symptoms of the disease, the incubation time for infection, which is up to 21 days, hasn't elapsed.

Since the Ebola outbreak began in March there have been many reports of isolated cases of the disease in travelers to other countries. None has resulted, so far, in secondary spread, i.e., establishing new epidemic focuses of the disease. As I write this, one such isolated case is thought to have occurred in Johannesburg, South Africa's largest city, and another suspected case reportedly died in isolation in Jeddah, Saudi Arabia, prompting the kingdom to issue special Ebola warnings for the upcoming hajj. It's only a matter of time before one of these isolated cases spreads, possibly in a chaotic urban center far larger than the ones in which it is now claiming lives: Conakry, Guinea; Monrovia, Liberia; and Freetown, Sierra Leone.

So what does "getting it" mean for understanding what we, as a global community, must now do?

First of all, we must appreciate the scale of need on the ground in the three Ebola-plagued nations. While the people may pray for magic bullets, their health providers are not working in Hollywood, but rather in some of the most impoverished places on Earth. Before Ebola, these countries spent less than $100 per year per capita on health care. Most Americans spend more than that annually on aspirin and ibuprofen.

We must collectively listen to the pleading and anguish coming from those courageous health providers who have seen Ebola claim more than 80 of their colleagues since the crisis began. What do they want?

On Aug. 8, the World Health Organization (WHO) declared the Ebola epidemic a "public health emergency of international concern." In its pronouncement, the agency noted the urgent need for local government actions, such as the recently erected cordons sanitaires, and for global mobilization of medical resources. The WHO has repeatedly warned that this epidemic could persist for a minimum of six months, perhaps a year. The director of the U.S. Centers for Disease Control and Prevention, Dr. Tom Frieden, has concurred with that grim forecast.

"It's like fighting a forest fire: leave behind one burning ember, one case undetected, and the epidemic could re-ignite," Frieden recently told Congress. "Ending this outbreak will take time, at least three to six months in a best case scenario, but this is very far from a best case scenario."

At the same congressional hearing, Dr. Frank Glover, a medical missionary who partners with SIM, a Christian missions organization, and the president of SHIELD, a U.S.-based NGO in Africa, warned that Liberia had fewer than 200 doctors struggling to meet the health needs of 4 million people before the epidemic. "After the outbreak that number went down to about 50 doctors involved in clinical care," said Glover.

I myself have received emails from physicians in these countries, describing the complete collapse of all non-Ebola care, from unassisted deliveries to untended auto accident injuries. People aren't just dying of the virus, but from every imaginable medical issue a system of care usually faces.

Ken Isaacs, vice president of international programs and government relations at Samaritan's Purse, the aid organization that has two of its members fighting for their lives in Ebola quarantine in Atlanta, told Congress, "It took two Americans getting the disease in order for the international community and United States to take serious notice of the largest outbreak of the disease in history. That the world would allow two relief agencies to shoulder this burden along with the overwhelmed Ministries of Health in these countries, testifies to the lack of serious attention the epidemic was given."

Despite current response mechanisms, this Ebola outbreak, Isaacs said as he closed his remarks, "is uncontained and out of control in West Africa."

Even if the world dodges a viral bullet and Ebola fails to take hold in a metropolis in a different country (such as Lagos, Johannesburg, Delhi, or Sao Paulo), controlling the disease and saving lives in Liberia, Sierra Leone, and Guinea will require resources on a scale nobody has delineated. The emotionally distraught doctors and nurses on the front lines are screaming for help.

Let's start with simple, on-the-ground manpower. All three countries desperately need doctors, nurses, medical technicians, ambulance drivers, Red Cross volunteers, epidemiologists, and health logistics experts. They do not need novice do-gooders from the wealthy world, but people experienced in working under the stifling conditions of tropical heat, the desperation of supplies deficits, and the fearfulness of epidemics. The lion's share of care to date has been provided by one group -- Médecins Sans Frontières -- which is pleading for others to relieve their exhausted ranks: 600 people who have been fighting for months on the front lines in this war.

Nothing could be clearer than this MSF press release, dated Aug. 8:

Dr. Bart Janssens, MSF Director of Operations

"Declaring Ebola an international public health emergency shows how seriously WHO is taking the current outbreak; but statements won't save lives. Now we need this statement to translate into immediate action on the ground. For weeks, MSF has been repeating that a massive medical, epidemiological and public health response is desperately needed to saves lives and reverse the course of the epidemic. Lives are being lost because the response is too slow.

Countries possessing necessary capacities must immediately dispatch available infectious disease experts and disaster relief assets to the region. It is clear the epidemic will not be contained without a massive deployment on the ground from these states.

In concrete terms, all of the following need to be radically scaled up: medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems, community mobilisation and education.

MSF currently has 66 international and 610 national staff responding to the crisis in the three affected countries. All our Ebola experts are mobilized, we simply cannot do more." 

Here is the list of supplies Emmet A. Dennis, president of the University of Liberia, emailed that he needs for his medical school personnel now fighting cases in Monrovia:

Gowns -- Isolation
Underpads -- Disposable
Gloves, Examination -- All Sizes
Body Bags -- Adult & Children
Infectious Waste Bag -- Red
Face Mask -- Duckbilled
Face Shield -- Disposable
Eye Shields -- Disposable
Shoe Covers
Aprons -- Disposable
Sanitizer Wipes
Plastic Boots
Surgical Caps -- Disposable
Scrubs (L & XL)
Thermometer: Infrared -- Thermofocus
Disinfectant Soap
Chlorinated Disinfectant
Rehydration Fluids
R/L Solution
N/S Solution

It simply does not get more basic. As there are no miracle drugs for Ebola, the needs include few medicines, though other local responders tell me that they wish they had sterile syringes, saline drips, and fever modulators such as aspirin.

"Getting it," in this epidemic, means realizing that over the next six to 12 months, these countries will needs millions of dollars' worth of basic supplies, hundreds of highly skilled health care workers, including logistics supplies officers, and self-sufficiency for all foreigners (food, water, personal supplies). As the border blockades ending trade to these nations persist, food supplies for the population will also become acutely short, probably necessitating World Food Program assistance. Exhausted, frightened young soldiers and police will need their ranks replaced slowly with United Nations Peacekeepers or soldiers from the African Union.

And of course this list assumes Ebola remains confined in terms of secondary spread to Liberia, Sierra Leone, and Guinea. If the virus takes hold in another, more populous nation, the needs will grow exponentially, and swiftly.

John Moore


5 Things to Know About the Global Economy Right Now

Why Japan is a wildcard, the Eurozone's in trouble, and the BRICS are a bust.

Things could be worse, right? Having shaken off the jitters that saw shares drop at the end of July, the major markets have been enjoying another period of relative stability. Apart from Argentina's comic default and a few geopolitical flare-ups, little has happened to raise fears of another crash. The unemployment rate has been falling steadily -- if slowly -- in the United States, Eurozone, and even Japan, where more people are also joining the labor force. Domestic demand has returned even as the fringes of the global economy have frayed. But is there a storm around the corner? Here are a few things to keep in mind as we look to the next couple of years:

1. The Federal Reserve is not out to surprise anyone. For years, the Fed has been saying that it will wait until 2015 to raise interest rates. Nothing has happened to change that plan. As the new year approaches, long-term interest rates -- the kind you pay on a mortgage or car loan -- are sure to rise in response to the coming increase in the short-term rates controlled by the central bank, which is likely to be sustained for some time. Before that happens, we may see a rush of house purchases in the United States as buyers scramble to lock in their loans. Continued strength in the labor market, which gives people faith in their future income, will likely reinforce this demand. Rising rates will be a signal that the Fed believes the economy is on a firm footing, and new inflows of foreign capital are likely to follow. The gap between rates of return in the major markets and frontier economies will shrink, which could be bad news for the latter group -- but more on that later. 

2. The Eurozone is still in trouble. At the moment, the Eurozone is in a race against itself. Households have been drawing down their wealth to pay their bills while waiting for jobs to return; young people have been kept afloat by their parents. The question is whether employment will increase before the wealth runs out. In the past few months, the unemployment rate has begun to fall in several of the countries most affected by fiscal and financial crises. Italy is still suffering, however, and is heading for last place. New rules for fiscal stability and banking, the two centerpieces of the European Union's recovery package, won't save the economy in Italy or anywhere else in the short term; it's a long road back even for countries like Spain, which has tried to revitalize its economy with extensive reforms of the public sector. Two summers ago, a group of graybeards suggested the Eurozone would not recover fully until 2018; that prediction may well be accurate.

3. Japan is a wildcard in global credit markets. The central banks of the United States, the Eurozone, and Britain are far more independent than Japan's, and their leaders coordinate policies more closely as well. But a shift in domestic political winds can change economic policies dramatically in Tokyo, as it did when Shinzo Abe led the Liberal Democrats to a huge victory in 2012. Within weeks, the Bank of Japan initiated a whatever-it-takes quest for inflation. The next general election is in 2016. If Abe's policies fail to yield growth by then, Japan could be under new management once again. A sudden disruption in the global economy's ample supply of liquidity is most likely to come from here. The Bank of Japan currently buys about $70 billion in securities every month as part of its credit easing program, which is only a bit less than the Fed bought at the height of its activities. The Fed has tapered its purchases slowly and with plenty of warning. Japan might not.

4. China has an enormous opportunity to grow. It hasn't been the best few years for China. Its dependence on exports, not to mention its internal struggles with credit markets and state-led investment, has led to big downgrades in expectations for growth. The shift from foreign to domestic demand sought by Beijing has not been easy. Between April 2011 and April 2014, the International Monetary Fund's forecasts for growth from 2012 through 2016 fell by a total of 14 percent of gross domestic product -- the equivalent of about two years of current growth going up in smoke. Since then, the forecasts have stabilized, and the ambitious package of economic reforms proposed last year may soon start to push them higher. Xi Jinping has consolidated his power. If he pushes the reforms through without causing too many dislocations in financial markets, particularly as the shadow banking system is formalized, then a new flood of foreign capital will be sure to follow. If it turns into a gold rush, then interest rates in other markets -- especially emerging markets -- could rise as the supply of credit dries up.

5. Emerging market acronyms are marketing tools. Remember the BRICs, or BRICS? Growth has petered out in all of them except China, and even there the numbers have disappointed. Then there were the Next Eleven. Of those countries, fewer than half -- Bangladesh, Indonesia, Nigeria, the Philippines, and Vietnam -- experienced the kind of expansion that would make investors' eyes sparkle. And who can forget the CIVETS? They were supposed to grow by 4.5 percent per year through 2030. That may still come to pass if we treat the group as one big economy, but for all of the individual countries it seems unlikely. With the Fed gradually decreasing the supply of easy money starting next year -- and more opportunities perhaps opening up in China -- investors will be a bit pickier in emerging markets; that means looking at them one by one rather than in arbitrary groupings.

* * * 

Despite sanctions on Russia, belligerence in East Asian waters, chaos in the Middle East, and other distractions, the biggest wheels in the global economy have continued to turn. Even as the companies that move markets have expanded around the world, investors and executives have become more adept at insulating themselves from temporary hotspots. Insurance, hedging using derivatives, the globalization of purchasing, and the proliferation of transport options have all helped. But geopolitical troubles still constrain growth and make it tougher to establish new business relationships. If things ever settle down, the world will be wealthier still.

Sean Gallup/Getty Images for Siemens