Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, 3rd Floor, Ammapettai Village, Thiruporur- Guduvancherry Main Road, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
India

Full Text

Sir,

The 2014 outbreak of Ebola virus disease (EVD) has been declared as an international public health emergency.[1] Since its origin in March 2014 in Guinea, almost 15,935 cases of EVD (confirmed, probable and suspect) have been reported till the end of November 2014 in eight of the affected nations (viz. Guinea, Liberia, Mali, Sierra Leone, Nigeria, Senegal, Spain, and United States of America).[2],[3] Moreover, the worrisome factor is the ability of Ebola virus to claim the lives of a significant number of affected persons (viz. almost 5700 deaths have been reported), without sparing the health care professionals.[3],[4] Although, time and again multiple outbreaks/epidemics of infectious origin have been reported in the past, this current outbreak of Ebola virus was not expected to result in such a catastrophe (owing to moderately long incubation period, absence of airborne transmission and noninfectious asymptomatic patients).[5],[6] This was also presumed since almost 20 such EVD outbreaks have been reported till date (first outbreak in 1976), and all of them were successfully contained without any significant loss of human life (viz. the caseload and death rate of current outbreak has already exceeded the estimates of all previous 20 outbreaks combined).[3],[5]

Now, the question arises if the public health authorities and the health professionals are dealing with a known enemy, then what went wrong that they failed to contain the same?[1],[4],[6] The retrospective analysis of the outbreak provided valuable insights on how a common disease agent with a limited infectivity could maneuver the existing weaknesses in the public health care delivery system.[7] It was concluded that a wide range of factors such as lack of preparedness;[8] delayed initial response;[8] poverty;[9] shortcomings in the public health infrastructure (viz. limited number of laboratories well-equipped with diagnostic facilities, no isolation wards, human resource constraints, untrained health care personnel, shortage in logistics – personal protective equipments, etc.);[2],[4],[9] absence of clear roles and responsibilities of different cadres of health workers;[6] inadequate contact tracing;[9],[10] inability of the government authorities to involve community in their initiatives;[11] no trust of people in the public health sector;[4],[6] minimal awareness of the people about the different aspects of the disease (viz. reservoir species, mode of transmission of disease, clinical features, preventive measures, high-risk behavior which should be avoided, etc.);[10] traditional and ritual practices;[12] development of a sense of fear among the masses and thus they refrained themselves from availing the services of public health sector (instead approached traditional healers);[9],[12] no regulation on the movement of the people across the land borders (hot zone) in the affected adjoining nations;[6],[9] hot and humid environment in the affected regions, thus decreasing the work efficiency of staff;[9] empty-handed clinicians (no drug and no vaccine);[13] and dearth of research in the field;[9],[13] allowed the disease to grow to epidemic proportions.

Thus, the 2014 Ebola epidemic has highlighted the growing socioeconomic disparities in the world, where the richer sections of society access the best medical care and poor people are left to die.[9],[14] It further revealed that the existence of an effective public health care delivery system and involvement of the community is a must to successfully counter any such outbreak in the future.[4],[9],[10] The outbreak even exposed the wide gaps that are persisting in the research arena – as even after passage of 4 decades the health professionals have no effective drug or vaccine, which can be employed on a mass scale in affected nations for the benefit of people.[10],[13],[14] In addition, it has been realized that by not adhering to the basic preventive strategies (viz. use of personal protective equipment, maintaining hand hygiene, use of disinfectants, etc.), the disease eventually involved multiple districts, states, and countries.[8],[10],[15] Finally, the EVD outbreak emphasizes the need of development of an action plan (in unaffected nations), timely support from international agencies/countries, and contribution from the researchers to deny further expansion of the disease.[1],[4],[7],[16]

In conclusion, the 2014 outbreak of EVD has proved to be an eye-opener for the health professionals who advocate "health for all" and "millennium development goals," despite not achieving the basic health care services on a universal platform. The need of the hour is tofirst strengthen primary health care services so that future such outbreaks can be averted, and lives of thousands of people can be saved in years to come.

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