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Ebola Threat: Global Challenge and India’s Preparedness

Reshmi Kazi was Associate Fellow at the Institute for Defence Studies and Analyses, New Delhi. Click here for profile
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  • July-December 2014
    Special Focus

    Ebola virus has been spreading exponentially. As of October 23, 2014, the total number of confirmed, probable, and suspected cases of Ebola infection stood at 10,141 including 4,922 reported deaths.1 With the number of new reported cases continuing to increase rapidly, the situation remains worrisome in Guinea, Liberia, and Sierra Leone. Though the epicenter of the ongoing Ebola crisis is placed in West Africa, Ebola virus has been spreading its tentacles outside of West Africa. It has claimed its victims in the US and Spain. In India, there have been close calls after a frequent traveler to Nigeria exhibited several Ebola-like symptoms, including hemorrhagic fever but eventually tested negative.2 Although India has been more fortunate than the Ebola-affected West African nations, the risk of India seeing an Ebola patient is “very, very high,” and India could have “at least a few cases before the calendar year is over”.3 According to Ashish Jha, Professor of International Health at Harvard’s School of Public Health and Director of Harvard Global Health Institute, as long as the Ebola epidemic poses an international health emergency, “the chances that someone will end up in India and then develop symptoms are very high.” At this juncture it needs to be asked whether India is prepared to combat the epidemic.

    What is Ebola?

    Ebola virus disease (EVD) is a severe and highly fatal illness with a fatality rate of up to 90 percent. There are five identified Ebola virus species, four of which are known to cause disease in humans.4 Among human population, the Ebola virus spreads through human transmission chains driven by direct contact with blood, body fluids, or skin of EVD patients or person’s broken skin or mucous membranes (eyes, nose, or mouth) who have died of EVD.5 Healthcare providers treating Ebola patients and the family and friends in close contact are at the highest risk of getting infected. Personnel handling burial of Ebola affected bodies also run a high risk of getting contaminated with the Ebola virus. Ebola can also get transmitted through objects (like needles and syringes) that have been contaminated with the virus. The usual incubation period of Ebola is from 2 to 21 days after exposure, but the average is 8 to 10 days. The symptoms of EVD include fever, severe headache, muscle pain, weakness, diarrhea, vomiting, abdominal (stomach) pain and untoppable hemorrhage (bleeding or bruising).

    At present, there is no specific vaccine or treatment available for EVD treatment though a few preventative vaccines are in development and three to five are seen to be able to completely protect nonhuman primates against Ebola.6 Accoding to the World Health Organisation (WHO), “Hundreds of thousands of doses will be available by mid-2015.”7 It is important to note that since EVD care is a relatively small global market, it is not a lucrative option for any pharmaceitical company to conduct research and develop vaccine. Hence government support and financial help are indispensible for any breakthrough in Ebola vaccination. Despite the grim situation, the good news is that it is not an air-borne disease at present. It is not a mysterious virus that spreads randomly through the air. Ebola is an infectious disease that can be contained.

    Ebola: risk to human security

    WHO has declared the EVD pandemic a “public health emergency of international concern”. The rapid spread of Ebola in West Africa shows that the deadly virus can pose serious risk to human security unless timely contained. Ebola is much less deadly in the developed countries than it is in Africa simply because of the medical care available in the developed countries is much better equipped. The medical treatment administered to EVD infected patients in the US has shown almost 90 percent success rate. Seven out of the eight Ebola patients have been discharged after being declared Ebola-free. The only patient that succumbed to the virus was not diagnosed early, like the others. Comparatively, the results have been starkly different in the African nations. The mortality rate in the Ebola-affected African nations has been approximately 70 percent. While the Ebola strain found in patients in the US is the same fatal strain, what is different is the quick response in terms of diagnosis, technique and training and drugs availability and advanced infection containment approaches. Lack of adequate staffing is another factor that heightened the fatality level in West Africa. Adequate medical staffing is a crucial requirement for Ebola-affected patients who need continuous care and attention. In the absence of specific medication, constant monitoring and intensive nursing are prerequisites for rapid response to clinical changes in Ebola-affected patients. This is simply impossible in West Africa. Consider the fact that there are 245 doctors per 100,000 US population. In Liberia, the number is 1.4, in Sierra Leone, it is 2.2, and in Guinea, it is 10.8 In the absence of any specific treatment and vaccination, the best way to contain Ebola is to have well-prepared modern medical facility system that can provide quick diagnoses, is equipped with life sustainining medicines and observes effective infection-control practices.

    India and the Ebola Risk

    Nearly 45,000 Indian nationals live and work in Guinea, Liberia, Sierra Leone and Nigeria, the worst Ebola virus affected places. In case of further deterioration of the Ebola situation in the affected countries, Indians nationals there will most certainly travel back to India. Therefore, India is at a high risk of EVD as even a single case can spell disaster for human security and seriously affect the environment. The risk is even higher since the patient is likely to travel back by air to one of India’s megacities like Delhi, Mumbai or Chennai.

    India is not adequately prepared to deal with the Ebola pandemic due to inadequate health care facilities to deal with a fast-spreading virus. There have been doubts on whether the public hospitals in India have trained health care workers to administer care and treatment even to the first cases. There also remains apprehension whether India has enough precautionary measures in place to contain sporadic cases leading to outbreaks. Given the dense population in large cities, there is every possibility that EVD could become a major epidemic. The risk of transmission might be intensified in the case of weak and strained medical facility systems. Intense poverty and lack of awareness might also prevent affected people from approaching appropriate medical authorities. India is a poor country with health care system that is already stretched in the season of disease.9 According to 2010 World Bank data, India has one nurse per 1,000 people compared to 1.6 nurses that Nigeria has or 10 per 1,000 in the US.10 In addition, India with a burgeoning population and overburdened medical response systems faces greater challenges of the inadequate ability to quarantine.

    Ebola – a bioweapon?

    EVD is rare but it can spread very fast unless affected people are diagnosed early. Ebola virus has compromised human security enormously by fatally affecting thousands of people in West Africa. Given its pandemic nature, it remains to be seen whether it is a potentially attractive biological weapon. There is significant divergence of opinion on the matter. While Scott Stewart believes that “Ebola is not an ideal biological warfare vector”, Marc A. Thiessen opines that terrorists could possibly “turn Ebola into a crude terror weapon”. 11 Aum Shinrikyo's team of trained scientists tried to acquire the Ebola virus for use as a potential biological weapon.12 Despite the differences on the possibility of Ebola being a potential terrorist weapon, it must be recognized that there is considerable concern among the international community that terrorists are indeed looking for bioweapons.

    India shares this concern as well. Warning against terrorists’ desire for acquiring biological weapons, India has called for stronger international action to contain their spread and has suggested a discussion of perceptions regarding the ongoing outbreak of Ebola virus.1313" name="_ftnref13" title="">13. Ambassador DB Venkatesh Varma said, “Improving the effectiveness of the Biological Weapons Convention (BWC) and strengthening its implementation and universalisation is necessary in view of the new challenges to international peace and security emanating from proliferation trends, including the threat posed by terrorists or other non-state actors seeking access to biological agents or toxins for terrorist purposes.”14 Given the concern, it would be a prudent approach to be sufficiently prepared to meet any prospect of biological threat. India’s disaster management mechanisms to deal with Ebola virus disease also simultaneously make it prepared to combat any similar bio-terror threat. Hospitals with modern medical facility systems well equipped with suitable tools and specific treatment methods can safeguard against any bio-terror attack on civilians. The health precautions and pandemic management process followed by India will eventually serve a dual purpose of ensuring human security against a pandemic and against a bio-terror threat. This is significant since hypothetically terrorists might take advantage of lack of vaccination and trade with any pharmaceutical company to create demand for Ebola virus antidote in return for suitable benefits. Hence, precautionary measures and quick responses are essential for a targeted state to deal with any bio-terror event involving Ebola virus.

    Way out

    Despite the challenges, effective and timely steps can prevent Ebola from becoming a pandemic. The first step in this regard would be to act rapidly in terms of spreading awareness. The Department of Health & Family Welfare, Ministry of Health & Family Welfare, Government of India has issued several guidelines for controlling any Ebola outbreak. These guidelines are primarily meant to raise awareness level of the risk factors for Ebola infection. The guidelines issues protective measures individuals can take as the only way to reduce human infection and death.15 The Health Ministry has also issued strict guidelines for hospital infection control while managing the suspect/case of EVD.16 Role of the National Institute of Virology, Pune and the National Centre for Disease Control, Delhi become critical in managing the Ebola threat.

    In addition, India has undertaken measures for effective environmental infection control. Environmental surfaces or objects contaminated with blood, other body fluids, secretions or excretions should be cleaned and disinfected using standard hospital detergents/disinfectants.17 India has also put in place safety measures for waste management and handling of human remains. The Indian Government has also issued advisories to disease surveillance units for early detection and management of travel-related cases. Families staying in and travellers visiting and returning from West African Countries affected by EVD have been issued specific advisory guidelines. Airline services, flight crew and the immigration and medical units at airports have also been issued advisories to distance other passengers if possible from the symptomatic passenger.

    At the international level, India has agreed to extend $12 million for countering the epidemic. In his summit talks with the US President Barack Obama, Prime Minister Narendra Modi expressed his commitment to strengthen international efforts against the Ebola crisis. Given the unpredented nature of the Ebola crisis, India shares global concern that Ebola could quickly evolve from a regional to an international crisis. In keeping with its tradition of fighting global pandemics like AIDS, India has urged the international community must support research and development of a vaccine to cure Ebola. Indian Ambassador to the UN, Asoke Kumar Mukerji, has told the UN General Assembly (UNGA) that “India will cooperate in the development of vaccines and drugs to fight the Ebola virus which must be made available especially to the poorest of the poor at realistic prices.”18 India’s pharmaceutical companies like Cipla and Ranbaxy have already produced cheap drugs for against AIDS. Given India’s long-term experience in developing affordable medicines, India can do its bit in developing affordable drugs and vaccines for treating and controlling EVD.

    Conclusion

    Ebola virus disease holds all the characteristic of wrecking havoc on humans and their environments. The risk factor gets multiplied enormously since there is no detailed antidote readily available. However, timely appropriate heath and preventive measures can go a long way to prevent the EVD outbreak. Additionally, it would also help build defence against any potential bio-terror attacks. Fortunately, Ebola can be contained. India and the rest of the international community must reinforce efforts and cooperation towards combating the deadly Ebola virus.

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