So the researchers found Ebola antibodies-in the 1980's. As far as we know--this was a country with not one, but two, horrible civil wars that lasted from the late 1980's until 2003--there were no outbreaks during this time. (If there were isolated ebola outbreaks, they were lost in the chaos.)
The writers say "Had the..findings been linked to long-term efforts to train Liberians to conduct research, to identify and stop epidemics, and to deliver quality medical care, the outcome might have been different."
So these efforts would've occurred in a safe third country somewhere while the wars were going on? For twenty years?
Liberia has made large strides in infant immunization and reducing neonatal mortality. Increased access to education means that now among males 15-24, the literacy rate is 63%, while for adults it is merely 42%. It appears that money has been spent on public health in ways that meant the most good for everyone, not on preparing for an epidemic that might or might not occur.
The Ebola epidemic in Liberia is horrible and tragic. The West needs to increase targeted assistance in ways that minimize corruption. But I am sorely disappointed that these Liberian medical officials are grasping at a 'woulda coulda' straw to blame the West and ignoring the facts of their history.
The writers say "Had the..findings been linked to long-term efforts to train Liberians to conduct research, to identify and stop epidemics, and to deliver quality medical care, the outcome might have been different."
So these efforts would've occurred in a safe third country somewhere while the wars were going on? For twenty years?
Liberia has made large strides in infant immunization and reducing neonatal mortality. Increased access to education means that now among males 15-24, the literacy rate is 63%, while for adults it is merely 42%. It appears that money has been spent on public health in ways that meant the most good for everyone, not on preparing for an epidemic that might or might not occur.
The Ebola epidemic in Liberia is horrible and tragic. The West needs to increase targeted assistance in ways that minimize corruption. But I am sorely disappointed that these Liberian medical officials are grasping at a 'woulda coulda' straw to blame the West and ignoring the facts of their history.
But for the fact that the victims of this disease were Black Africans this warning would not have been ignored. As the original home of modern humans with the most genetically diverse and ancient human populations on Earth, Africa is destined to be the infectious disease center of humanity.
HIV/AIDS turned out to have been at least a century old in Africa before it appeared outside of that continent. Africa is also home to our closest animal ape kin the bonobo and chimpanzee which share some of our disease vulnerabilities as a reservoir.
The world is shrinking with transportation and cyber increasing physical and speeding cyber contact. Information is accessible. But our morals, wisdom, socioeconomics and politics often lag behind our technological scientific prowess.
HIV/AIDS turned out to have been at least a century old in Africa before it appeared outside of that continent. Africa is also home to our closest animal ape kin the bonobo and chimpanzee which share some of our disease vulnerabilities as a reservoir.
The world is shrinking with transportation and cyber increasing physical and speeding cyber contact. Information is accessible. But our morals, wisdom, socioeconomics and politics often lag behind our technological scientific prowess.
1
What I don't understand is how the Ebola response model forecasts the CDC and WHO published in September 2014 could have been so wildly overstated.
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6303a1.htm
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6303a1.htm
Nobody downloaded an electronic version of a scientific paper in 1982. You consulted the hard copy of Index Medicus, and if your library did not have the journal subscription (and even if it did) you wrote a letter to the author who would then be delighted to send you a reprint. It was also common to send an unsolicited reprint to someone the author thought might be interested in the topic. Are we sure that the authors of these early reports did not directly share their results with their West African counterparts? Did anyone ask them?
Yes, we were warned about Ebola. Mostly during the recent outbreak. Over and over and over again, Endlessly and repeatedly. By every media possible, print and visual. So much so that most of us, as in the folk story of The Boy Who Cried Wolf!, tended to block it out and not even worry about it. If a true Ebola outbreak had occurred in this country, unfortunately it would have been ignored, until the bodies began piling up in the streets. There must be a better way..............
sadly we all live in a world in which we learn to show more concern for the outside in terms of clothing, jewelery, etc etc
and little concern for what we put into our bodies.
look how people have died from smoking?
and yet it remains legal to "abuse ourselves" so that people can reap billions in profit while the government takes a huge cut from the blood money.
since that is "the norm" in the world
should we be surprised to find that "unwanted diseases" like Ebola has spread?
if our attitude towards smoking is recklessly laid back
then we can only expect to have more than our fair share of aliments.
and little concern for what we put into our bodies.
look how people have died from smoking?
and yet it remains legal to "abuse ourselves" so that people can reap billions in profit while the government takes a huge cut from the blood money.
since that is "the norm" in the world
should we be surprised to find that "unwanted diseases" like Ebola has spread?
if our attitude towards smoking is recklessly laid back
then we can only expect to have more than our fair share of aliments.
Can we prevent the next pandemic caused by the virus of unfettered capitalism? Some commenters take umbrage at the implication that the "West" and its "brief" colonization of Africa and the resulting "plantation" socio-economic athrophy may have anything to do with health crises. They correctly point out the civil wars and endemic political corruption in those countries. But what were those wars about and who supplied the weapons? If exploitation of natural resources, colonization, and corruption ended in the U.S. long ago, why do we have poverty, disease, soaring infant mortality, and despair in places like Appalachia? Remember Robert Kennedy?
The key words are in the last paragraph, "local capacity". The strength of any health system is its knowledge and know-how on the ground--and who is involved. That is true for health professionals and the communities where they live and work. Public health requires both health care systems and the rest of the community to keep an eye on things. The #Ebola outbreak vividly demonstrated how important these local networks, social mobilizers, and community groups are in responding. Join the webinars about supporting community mobilization efforts for preparedness planning http://bit.ly/1CgRYqB
1
"The conventional wisdom among public health authorities is that the Ebola virus, which killed at least 10,000 people in Liberia, Sierra Leone and Guinea, was a new phenomenon, not seen in West Africa before 2013. "
This kind of shocks me. I've known about Ebola virus for years and I'm not in public health or a medical field at all. I just read and pay attention.
This kind of shocks me. I've known about Ebola virus for years and I'm not in public health or a medical field at all. I just read and pay attention.
2
I am not surprised by this article at all. Being in the United States, we do not know everything that is happening in other countries. Although we should reach out a hand to help, it should be a cautious hand and our prevention plans need to be flawless.
"cautious"? "flawless"? C'mon. This is the USA we are talking about. That is not how we do things, is it.........
Recently scientists announced that men who survive Ebola should practice safe sex indefinitely after a woman died after being infected by her boyfriend who recovered from Ebola more than six months previously. Perhaps the Ebola reservoir is not just in bats...but also in male human testes.
1
Tragic as the Ebola epidemic was its destruction is trivial in comparison to the pandemics raging through the none human species in most nations due to our global 1%s greed fueled Russian roulette of unnecessary transfer of biological material between continents. Major airports in the US receive 100's thousands of questionable shipments of wild animals and frivolous items like flowers,potted plants & exotic fruits every day and there are only a few inspectors at each point of entry.And it is impossible to find viruses, bacteria, fungus spores, insect eggs no matter how hard anyone looks.American chestnut & green elm have been annihilated.Now ash and hemlock are facing possible extinction. Wild sheep, our deer, and trout suffer recurrent pandemics of diseases imported here and now American bats are facing extinction from an imported fungus. But our merchants of death are making too much money to stop, and successive "fast track" trade agreements have further weakened needed import controls via dismantling what exists by charging that is subsidizing domestic producers.The 1% importers internalize profits and externalize the ecological and economic costs onto the 99%. Is it really going to take the import of a disease or insect that wipes out our entire wheat or corn crop to force our society to stop the insane flood of exotic animals and plants and needless produce.Garlic and tilapia from China when whirling disease devastating our trout came from Asia?Give us a break!
2
Let us not interpret this as another global vs. country level, developed vs. underdeveloped, point-the-finger game. Successful disease prevention and control depend on a whole set of factors, from citizen trust in local government to global leadership, from sufficient investments in health systems to sound research and evidence. Fail to have any of these and the chances of a lasting outbreak become that much greater. Unfortunately in the latest outbreak, Liberia had few of these things. What role the global actors could have played in the interim period between 1986 and the 2000s was overshadowed by the country's long civil war and immediate rebuilding efforts. Moving forward, efforts can and should be made to strengthen each of these interrelated components, rather than endlessly repeating the blame game.
5
This sort of discovery is not unheard of in Africa: 13.2% of Aka Pygmies tested in Central African Republic also had antibodies that bound to EBOV despite no outbreaks on record. During the 1995 outbreak in the of Democratic Republic of the Congo, researchers measured 9.3% seroprevalence in villages that dodged the outbreak. These aren't far from 6.0%, 10.6%, 13.4%, 14% of the sampled Liberian population with antibodies that showed capability of binding to ebola virus.
Why are we finding people with antibodies that bind to ebola-virus in places without outbreaks of ebola? The authors of this piece strongly imply that today's ebola virus has been hidden in some local sanctuary site in Liberia since at least 1978. Why an epidemic now, after 35+ years? A recent introduction is plausible. Are there similar viruses quietly bouncing around the region that create cross-reactive antibodies? Are these historical percentages due to travel from endemic areas? These various explanations have serious implications for control strategies. Does West Africa have the budget to throw money at interventions that could be weak or irrelevant?
Denigrating research as inaction doesn't move us closer to understanding ebola virus. To prevent the next outbreak, we'll need to understand the dynamics of long-distance transmission and find animal reservoirs. That means basic research funding for boots on the ground and finding a way to create a reliable cold chain for samples in Africa.
Why are we finding people with antibodies that bind to ebola-virus in places without outbreaks of ebola? The authors of this piece strongly imply that today's ebola virus has been hidden in some local sanctuary site in Liberia since at least 1978. Why an epidemic now, after 35+ years? A recent introduction is plausible. Are there similar viruses quietly bouncing around the region that create cross-reactive antibodies? Are these historical percentages due to travel from endemic areas? These various explanations have serious implications for control strategies. Does West Africa have the budget to throw money at interventions that could be weak or irrelevant?
Denigrating research as inaction doesn't move us closer to understanding ebola virus. To prevent the next outbreak, we'll need to understand the dynamics of long-distance transmission and find animal reservoirs. That means basic research funding for boots on the ground and finding a way to create a reliable cold chain for samples in Africa.
10
Complete and total self-serving nonsense. The country's Chief Medical Officer and the Director of County Health Services say they did not know anything about Liberian data published in Europe - on behalf of all their citizens they had the duty to know and should have had the access to stay up to date on publications that describe their own country's health profile. If even they do not have access to the world's literature because of lack of internet infrastructure (and it's disingenuous to say it costs too much as the majority of journals actually offered free access to people in the developing world several years ago and abstracts are always free), then the presence of such knowledge is irrelevant anyway as the resources to act on it are clearly not there either. You cannot have your own brutal civil wars that destroy any semblance of functioning society and then blame rubber plantation culture as the source of the problem.
7
Ebola has been known since 1976. But most westerners cared or knew little about it since it was happening to black people in Africa, and western pharmaceutical companies cared even less since there wasn't a lot of money to be made from it.
6
I don't know why anybody should be surprised at the contents of the article. Africa has been and is a medical catastrophe, just as it is a political and social catastrophe as well. I have lived and worked in Africa during the 20th century and today Africa is worse off than before. Just as diseases are endemic to Africa (ebola and AIDS come to mind) so is corruption. But what most people totally disregard is the human cost of corruption. Corruption, the plain and ugly stealing of public funds, means less doctors, less hospitals, less schools, less supplies, etc., etc. So while medical specialists complain that scientific studies produced in the West are not reaching the medical establishment in Africa, they should also worry about excising the cancer of corruption in their countries. Let us remember that a cancer that is not excised promptly, kills the patient.
17
I have known about and been interested in Ebola since I attended medical school in the late 1980's. What doctor wouldn't be interested in the deadliest pathogens know to mankind-kuru, Ebola, various strains of e. coli, Marburg virus, etc.? A literature search and dedicating yourself to continuing education is absolutely mandatory for all physicians, but they cease, most of them, after graduating. Medical education isn't just foundering in Liberia, but in the US as well. Just as there were a few people who understood the big short while it was going on; the outbreak of Ebola in Liberia was not a surprise to some. What bothers me is how unprepared the CDC has become. They are no longer the "go to people" for important medical knowledge,but just another politically driven agency. All hospitals have the ability to respond to Ebola-you can just default to radiation contamination illness methodology. Cultures can be changed. Thank you for this opinion.
11
I suspect public health & public health research isn't "sexy." Years ago, my mom worked as a Lab Assistant for the then NYS Dept. of Health Division of Laboratories & Research, then the Wadsworth Institute, now, I believe the Axelrod Institute after the late great Commissioner, Dr. David Axelrod. She was often surprised at the lackadaisical approach to a lot of research.
Proper protective gear, procedures, etc. never became a major priority, it seemed, till one of their own was infected w/the rabies virus. .
Just so, what we came to call AIDS was not much of a priority as long as it primarily affected Gay men & IV drug users. (Dr. Fauci of the NIH seems to have forgotten the lessons he SHOULD have learned from the AIDS pandemic espec. being frank with people, not dissembling.) I give great credit to Dr. Lloyd Novick, then Director of the DOH Office of Public Health, who worked w/the Gay community in developing responses to AIDS. We cared because our own were dying by the hundreds.
If we fund medical research properly, appropriately, we will be prepared for the next medical emergency. If we keep cutting funding, dismantling government as the Republicans desperately wish, allow anti-vaccine people to have their sway, EVERYONE will be at risk for the next major infectious disease outbreak, whatever that will be. We will be caught w/our pants down, UNABLE to respond. We have only ourselves to blame.
Proper protective gear, procedures, etc. never became a major priority, it seemed, till one of their own was infected w/the rabies virus. .
Just so, what we came to call AIDS was not much of a priority as long as it primarily affected Gay men & IV drug users. (Dr. Fauci of the NIH seems to have forgotten the lessons he SHOULD have learned from the AIDS pandemic espec. being frank with people, not dissembling.) I give great credit to Dr. Lloyd Novick, then Director of the DOH Office of Public Health, who worked w/the Gay community in developing responses to AIDS. We cared because our own were dying by the hundreds.
If we fund medical research properly, appropriately, we will be prepared for the next medical emergency. If we keep cutting funding, dismantling government as the Republicans desperately wish, allow anti-vaccine people to have their sway, EVERYONE will be at risk for the next major infectious disease outbreak, whatever that will be. We will be caught w/our pants down, UNABLE to respond. We have only ourselves to blame.
2
The assumptions regarding local infrastructure I see in this section are astonishing. An illustration: I worked for an NGO in Cameroon in the late 80s. As I tried to clear my personal effects from the local airport, a process that took well over 2 weeks, I noted an enormous container, emblazoned with bright red “Vaccines” “Urgent” “Keep refrigerated.” The enormous container was composed of a wooden frame, as I recall, with a visible styrofoam lining, and clearly had been carefully packed to ensure the survival of the vaccines of the air shipment, probably 72 hours.
I was gratified to see the container as I waited for hours each day to fill out my paperwork, and glad to know the precious contents would be delivered to those who desperately needed vaccines.
My gratitude turned to despair over the next two weeks, as I watch the carton rest on the tarmac under the blazing sun. That container was packed to survive transit for probably a week. I had zero conviction any material inside was viable after two weeks in the full sun. When I asked, I received a shrug, well know to any old Africa hand.
I shudder at our collective ignorance, thinking that just because we have the capacity to buy and ship vaccines, means that the vaccines will get to their intended recipients intact.
Let us all temper our expectations for a reality most of us have no conception of.
I was gratified to see the container as I waited for hours each day to fill out my paperwork, and glad to know the precious contents would be delivered to those who desperately needed vaccines.
My gratitude turned to despair over the next two weeks, as I watch the carton rest on the tarmac under the blazing sun. That container was packed to survive transit for probably a week. I had zero conviction any material inside was viable after two weeks in the full sun. When I asked, I received a shrug, well know to any old Africa hand.
I shudder at our collective ignorance, thinking that just because we have the capacity to buy and ship vaccines, means that the vaccines will get to their intended recipients intact.
Let us all temper our expectations for a reality most of us have no conception of.
25
Lest the scientific mystery here get lost among the complex politics: Understanding the widespread presence of antibodies to Ebola virus prior to the latest outbreak might lead to some important findings, perhaps with implications for treatment and/or prevention. Is there a non-lethal form of the virus that is infecting some people and immunizing them, as cowpox did for smallpos? Do people who did not catch Ebola during the recent outrbreak tend to have the antibodies? If there is funding for research as there was funding for emergency treatment, perhaps these puzzles will get solved and the disease will be brought under control.
14
Ebola or not, we must invest, with some urgency, in a much stronger international public health infrastructure. It is not "their" problem.
Such an infrastructure might have prevented the breakout of AIDS, confining it to a small number of cases, with all contacts traced and monitored. It would have prevented the tragedy of the current Ebola epidemic.
And it is needed to protect us against, as Laurie Garret put it 2 decades ago in her compelling book, The Coming Plague.
Such an infrastructure might have prevented the breakout of AIDS, confining it to a small number of cases, with all contacts traced and monitored. It would have prevented the tragedy of the current Ebola epidemic.
And it is needed to protect us against, as Laurie Garret put it 2 decades ago in her compelling book, The Coming Plague.
6
While I am heartened that Liberian public health officials are actively perusing scientific literature about Ebola and the best ways of combating it, this op-ed piece puts the burden of Ebola response on the rest of the world instead of on the country where the outbreak is taking place. In countries such as Liberia and Sierra Leone, where basic public infrastructure of any kind is lacking in many areas, public health infrastructure has no hope of effectively dealing with virulently infectious diseases.
Additionally, when many of these same countries's citizens ignore the rules their public health officials tell them to follow, and choose instead to believe in ignorant and dangerous mixtures of rumor, paranoid politics and native medical cures, I see almost no real hope of changing how Ebola is spread in these countries.
The rest of the world can pour all the resources it wants to into fighting diseases such as Ebola, but these resources will mostly go for naught if these underdeveloped nations and their indigenous populations remain unchanging in their responses to these scourges. Even enormous sums of foreign aid cannot offset bad government, lack of infrastructure and ignorant, superstitious locals. That is what this recent crisis really showed the rest of the world. First things first has to be Liberia's approach to these matters. The rest of the world can't effectively govern Liberia. This is Liberia's job.
19
@K Henderson in NYC: this isn't about money, this is about underdeveloped countries with crummy government which doesn't understand that basic infrastructure must be built, maintained and supported before much of anything else worthwhile can happen in the country. Go back and read the series of depressing Ebola stories since Ebola began re-infecting West Africa in the past year and half. These countries got plenty of outside help and money. Virulent infectious diseases cannot be effectively fought if health teams, regardless of where they are from, cannot traverse the country to help the local populations due to lack of passable roads.
Ebola can't be fought effectively if the local people believe it is the U.S. and European health organization agencies which have purposely infected them in order to take their natural resources, this sort of paranoid belief system is only going to work against any sort of assistance these agencies can deliver.
Ebola can't be effectively fought if the locals keep re-infecting themselves because they don't believe in quarantining, population segregation, and basic hygiene practices.
Fighting Ebola is difficult enough without all the impediments found in many West African nations. It is nearly impossible with them. This isn't about lack of money. These countries are their own worst enemies when it comes to helping themselves. Until they govern themselves better, very little can be done long term to help them from the outside.
1
The translation from research to practice is difficult even under the best of circumstances. Yes, full, open access to research publications is nice but doctors and public health professional have to have the time to read these journals. Findings in journals need to be turned into clinical practice, clinical practice needs to be modified to account for this new knowledge, laboratories need to be prepared (staff hired & trained, equipment and supplies purchased, etc.) to perform these new tests, and all of these need to be sustained.
This was an article from 1982 hence over 30 years of investment in screening for Ebolavirus. 30 years of investment in training people, in maintaining equipment, and purchasing supplies.
Sadly, we know that in the midst of competing interests, including civil wars, low probability problems are going to be given low priority.
In an environment in which common problems, e.g. malaria, childhood diarrhea, are overwhelming, how is a robust health delivery system going to cope with EBOV?
This was an article from 1982 hence over 30 years of investment in screening for Ebolavirus. 30 years of investment in training people, in maintaining equipment, and purchasing supplies.
Sadly, we know that in the midst of competing interests, including civil wars, low probability problems are going to be given low priority.
In an environment in which common problems, e.g. malaria, childhood diarrhea, are overwhelming, how is a robust health delivery system going to cope with EBOV?
11
On a practical note - had the research team decided to "share" their results instead of "hoarding" them, had they recruited a local scientist to participate on the team – was there infrastructure in place to disseminate the information? To make and implement recommendations? Was there a qualified Liberian scientist at the ready in 1982? Or today? While improvements can and must be made, this supposition assumes far too much about basic public health care and research infrastructure.
14
I come away from reading this article with an acute reminder of the disparity of wealth around the globe. Ironically, pictured just to the right of this piece was a blurb about another entry with an account of Leonardo Dicaprio's new "eco resort" project. I had read that article recently and thought that the only thing not mentioned in it was how it could only be accessed and experienced by the ultra elite classes, or maybe, the eco elites.
The phenomenon of wealth inequality, which is a hot topic, even among the johnny-come-latelies in the GOP, manifests itself in numerous strange ways, from the inaccessibility of medical journals to poor physicians in countries like Liberia, to the unlikelihood that most of us poor mortals will ever sip cocktails overlooking the coral reefs on Dicaprio's new island.
Priorities take a back seat to profit in a growing global anti-regulatory economy. We have also been warned of the killer that is rampant, unstoppable capitalism.
The phenomenon of wealth inequality, which is a hot topic, even among the johnny-come-latelies in the GOP, manifests itself in numerous strange ways, from the inaccessibility of medical journals to poor physicians in countries like Liberia, to the unlikelihood that most of us poor mortals will ever sip cocktails overlooking the coral reefs on Dicaprio's new island.
Priorities take a back seat to profit in a growing global anti-regulatory economy. We have also been warned of the killer that is rampant, unstoppable capitalism.
8
As far as I can tell, the article referred to can be freely downloaded on-line at http://ac.els-cdn.com/S0769261782800282/1-s2.0-S0769261782800282-main.pd...
Today, abstracts of most biomedical research articles in English are registered in the PubMed database, which anyone can query at http://www.ncbi.nlm.nih.gov/PubMed/. PubMed is less complete for older articles, and I don't see this one from 1982. In recent years, NIH policies have required that electronic copies of all articles whose research had NIH funding be made publically available at no cost on a new archive called PubMed Central (although availability on PubMed Central may lag 6 months to a year after publication in the original journal due to copyright restrictions). These steps represent significant progress towards making biomedical research funded by public dollars available to everyone at no cost. Coverage of older literature is much spottier -- presumably in part because of the costs and effort involved in creating and electronically archiving old literature that was never in electronic form. This had very unfortunate consequences in the case described here, but at least we should now be better prepared for the future.
Today, abstracts of most biomedical research articles in English are registered in the PubMed database, which anyone can query at http://www.ncbi.nlm.nih.gov/PubMed/. PubMed is less complete for older articles, and I don't see this one from 1982. In recent years, NIH policies have required that electronic copies of all articles whose research had NIH funding be made publically available at no cost on a new archive called PubMed Central (although availability on PubMed Central may lag 6 months to a year after publication in the original journal due to copyright restrictions). These steps represent significant progress towards making biomedical research funded by public dollars available to everyone at no cost. Coverage of older literature is much spottier -- presumably in part because of the costs and effort involved in creating and electronically archiving old literature that was never in electronic form. This had very unfortunate consequences in the case described here, but at least we should now be better prepared for the future.
4
That link leads to a request for $31.50. Another button says "get text elsewhere" but seems to circle back to the request for money. "Free" also assumes an internet connection, which is of course not free, much the less so in remote areas.
5
A few points:
The article is not available for free, but is behind a paywall, as is most published biomedical literature.
The article is not findable in PubMed, because the journal (erroneously noted to be Annals of Virology, it is actually Annales de l'Institut Pasteur. Virology) is not indexed in Medline, which is the major source of citations in PubMed.
The article was published in 1982, and on that alone falls outside the scope of the NIH Public Access Policy you mentioned. That policy made it mandatory that NIH-funded research published on or after April 7, 2008 be made available freely to the public no later than 12 months after publication. As wonderful as the NIH policy is for dissemination of information, it still allows a great deal of peer-reviewed literature to fall behind paywalls.
Also, the lag time you mention is not due to copyright restrictions per se. The policy stipulates it be implemented "in a manner consistent with copyright law" and articles made available in PubMed Central still are under copyright law, and all the restrictions therein.
You note that coverage in older literature is spottier, which is true, and that is in part because of the costs and effort associated with making it available. I would also argue that there is a prevailing attitude that "newer equals better" and little effort is given to searching and discovering older literature. Also, as I noted, that discovery can be hampered by limitations in the tools we have.
The article is not available for free, but is behind a paywall, as is most published biomedical literature.
The article is not findable in PubMed, because the journal (erroneously noted to be Annals of Virology, it is actually Annales de l'Institut Pasteur. Virology) is not indexed in Medline, which is the major source of citations in PubMed.
The article was published in 1982, and on that alone falls outside the scope of the NIH Public Access Policy you mentioned. That policy made it mandatory that NIH-funded research published on or after April 7, 2008 be made available freely to the public no later than 12 months after publication. As wonderful as the NIH policy is for dissemination of information, it still allows a great deal of peer-reviewed literature to fall behind paywalls.
Also, the lag time you mention is not due to copyright restrictions per se. The policy stipulates it be implemented "in a manner consistent with copyright law" and articles made available in PubMed Central still are under copyright law, and all the restrictions therein.
You note that coverage in older literature is spottier, which is true, and that is in part because of the costs and effort associated with making it available. I would also argue that there is a prevailing attitude that "newer equals better" and little effort is given to searching and discovering older literature. Also, as I noted, that discovery can be hampered by limitations in the tools we have.
The West should not be blamed for the failures of a sovereign nation in Africa.
Don't forget that between 1982 and 2014, Liberia underwent at least one decade and more of intense civil war, dictatorships, and social disintegration. They live with the results of their own failures; the West does not carry the burden of Liberia's dysfunctions.
Don't forget that between 1982 and 2014, Liberia underwent at least one decade and more of intense civil war, dictatorships, and social disintegration. They live with the results of their own failures; the West does not carry the burden of Liberia's dysfunctions.
11
It is not politically acceptable to hold Africans responsible for any of the ills that plague their continent. Everything must be blamed on the West, either the brief period of colonialism that ended fifty years ago, or current failure to pump in enough aid money to combat ubiquitous massive corruption and neglect by African governments.
4
Come to think of it, I can synopsize things a lot more efficiently as follows.
Ebola affects poor African people. The world doesn't particularly care about poor African people because they don't purchase many things and are not a military threat. So nothing was done about Ebola the last several times after it died out on its own, and nothing will be done this time either.
Ebola affects poor African people. The world doesn't particularly care about poor African people because they don't purchase many things and are not a military threat. So nothing was done about Ebola the last several times after it died out on its own, and nothing will be done this time either.
6
What is frightening about this is how little attention the rest of the world paid to the paper in 1982. While the Annals of Virology is hardly a mainstream publication, it is known in the world of epidemiology and available in many medical libraries. I'm sure that our CDC had access to this journal. So did other European countries even if Liberia did not. That means that Liberia and the other affected countries did not fail; the Western world with all its sophisticated technology and medical knowledge and drugs failed. Money that could have been put towards preventing an outbreak of this size was not spent or invested in helping these countries to build better health care systems, to gain the trust of the population. This is truly a case of losing for want of a nail, not want of something expensive. Shame on us.
And what is being done for the next outbreak? Will we just wait for it to happen or will we see some proactive steps taken and followed through to completion? Perhaps we ought to put it in these terms so that people living in Europe and the US understand it: our good health depends upon helping the rest of the world stay healthy.
And what is being done for the next outbreak? Will we just wait for it to happen or will we see some proactive steps taken and followed through to completion? Perhaps we ought to put it in these terms so that people living in Europe and the US understand it: our good health depends upon helping the rest of the world stay healthy.
5
I "rediscovered" the 1982 Knobloch et al. study while putting together teaching materials on Ebola in August and September 2014. Notice of the study, and its implications for the current outbreak, has been openly available on the Internet since 09/03/2014: https://www.academia.edu/8188683/Global_History_of_Health_-_Teaching_Not.... The study mentions Ebola only in passing, and I wouldn't have discovered it myself had I not been reading systematically through other literature on hemorrhagic fever virology. Other early mentions of the presence of Ebola antibodies in serology studies in West Africa have since come to light. Yet commentators have persisted in describing Ebola as "new" in West Africa. What is missing is a sense that we need to investigate not only Ebola's present and future, but also its past.
Mind-bogglingly ironic. And yet instructive- if any are paying attention. Here is what this article says; translated for general comprehension:
"Academic studies were performed, and published, making a deadly danger clear. The result: nothing happened. No urgency was conveyed; no government agencies were activated."
So; after thousands of deaths; we have here a nice retrospective academic dissection of the academic knowledge. The result:
"We academics are advising the world: we really should do better than this."
Are any government agencies going to be activated by this nice statement?
Not one. Changes made? No.
The Religion of Academia is Reason. Academia believes, fervently, that if they illuminate a problem; it is, therefore, solved; and the World will, of course, change in the light of the newly uncovered Truth.
Reason, however, is a false god. History shows repeatedly, and into remotest antiquity, that humans do not change their behavior because of Reason; but for all the myriad other forces that drive us. You can provide your own list, from your own experiences.
There is no evidence- to support the fantasy that our species will change in response to rational, clear, arguments backed up by abundant evidence. None.
"Academic studies were performed, and published, making a deadly danger clear. The result: nothing happened. No urgency was conveyed; no government agencies were activated."
So; after thousands of deaths; we have here a nice retrospective academic dissection of the academic knowledge. The result:
"We academics are advising the world: we really should do better than this."
Are any government agencies going to be activated by this nice statement?
Not one. Changes made? No.
The Religion of Academia is Reason. Academia believes, fervently, that if they illuminate a problem; it is, therefore, solved; and the World will, of course, change in the light of the newly uncovered Truth.
Reason, however, is a false god. History shows repeatedly, and into remotest antiquity, that humans do not change their behavior because of Reason; but for all the myriad other forces that drive us. You can provide your own list, from your own experiences.
There is no evidence- to support the fantasy that our species will change in response to rational, clear, arguments backed up by abundant evidence. None.
18
I get it now. John Oliver asked Ed Snowden whether NSA collected pictures of penises. Of course they do. People on the street were outraged. Next time an academic wants to present data and analysis on a forthcoming killer disease, simply imply that this will cause genitalia to swell up and die. Case closed.
Do we see the important message here? My take away is the tragic obliviousness, narrow view, negligence of Western science, academia, foreign aide etc. to actually seeing what is going on in this part of the world. The failure to appropriately grasp and respond to the impact of poverty, lack medical and other infrastructure, culture on a region's capacity to mitigate the risks and medical crises. How about making sure local medical people are in a position to prevent and treat? All these problems are not easily resolved. But what's the point of the research if it is only published in the West and there's no mechanism to sound the alarm for those who will be most impacted? As we saw with AIDS, we won't be saved unless we all are.
4
Medical research, as well as other research involving living human beings, generally is overseen by an "institutional review board" (IRB) charged with insuring that minimum ethical standards are met, that subjects be made aware of the research and of the results, that there be participation of local scholars or professionals, and that the research provide some overall benefit to its subjects.
It would be a simple matter for American and international IRBs to require that resulting academic publications, as well as articles in which they are cited, be freely available to scholars and institutions in the countries and communities in which the research took place.
It would be a simple matter for American and international IRBs to require that resulting academic publications, as well as articles in which they are cited, be freely available to scholars and institutions in the countries and communities in which the research took place.
14
Exactly. Debrief the subjects and hospitals involved. But also tutor illiterate subjects so they can read the paper.
Rather than decry the "Rubber Plantation model" of international health, this sorry story better reflects "the Dead Frog model". No matter what the electrical voltage used to shock a frog, it will not twitch if it is dead. This self-flagellation over stripping countries of natural resources and not "giving back" reflects faulty ideological thinking. Why is it difficult to find a drinkable cup of coffee near an African coffee plantation? Why no latex gloves in a country that's the leading rubber exporter? Harvard academics will provide us with the proper answers.
3
Dear Charles,
Um, actually the whole deal with galvanic reactions is that if you run electric current through a frog's leg, it'll twitch even with no frog attached to it. That's the literal experiment we get the term galvanic reaction from.
Anyway the answers to your questions there are basically, corruption in government, and supply and demand. Demand for coffee is high in the U.S. but production is zilch (except in Hawaii), so the price is high. Thus people make a lot more money shipping coffee from Ethiopia than they could possibly get selling it next to the plantation. Corrupt government ensures that things do not work for the benefit of the nations' own people, and thus we see the inequities that we have today, all over the world. Lots of them go back to who developed ironworking first and so on, a good read on how we wound up this way is "Guns, Germs and Steel", by Jared Diamond.
Um, actually the whole deal with galvanic reactions is that if you run electric current through a frog's leg, it'll twitch even with no frog attached to it. That's the literal experiment we get the term galvanic reaction from.
Anyway the answers to your questions there are basically, corruption in government, and supply and demand. Demand for coffee is high in the U.S. but production is zilch (except in Hawaii), so the price is high. Thus people make a lot more money shipping coffee from Ethiopia than they could possibly get selling it next to the plantation. Corrupt government ensures that things do not work for the benefit of the nations' own people, and thus we see the inequities that we have today, all over the world. Lots of them go back to who developed ironworking first and so on, a good read on how we wound up this way is "Guns, Germs and Steel", by Jared Diamond.
5
"Even today, downloading one of the papers would cost a physician here $45, about half a week’s salary."
Professional journals have been monopolized, and as with all monopolies that has been abused.
The abuse produces the very evil that our philosophy of science and education warns us most against. It keeps knowledge secret and unavailable.
This example of something published but unknown, so killing vast numbers, is a wake up call to fix the system that enabled it.
Professional journals have been monopolized, and as with all monopolies that has been abused.
The abuse produces the very evil that our philosophy of science and education warns us most against. It keeps knowledge secret and unavailable.
This example of something published but unknown, so killing vast numbers, is a wake up call to fix the system that enabled it.
28
Very true. I work for a major city health department, emergency management - and that we have an agency account which allows us access to many publications we otherwise would need individual paid subscriptions to, is a luxury not lost on me. Many don't have the same access, but we all need it. Knowledge should never be inaccessible because of cost.
4
the only problem with these comments is that it does cost to make new knowledge and to promulgate existing knowledge. the economic model in use leads to the consumers and users of the promulgated knowledge bearing the cost so the producers can recoup their cost and continue making new knowledge and disseminating existing knowledge. otherwise we all lose.
a related topic is the effort it takes to absorb knowledge. not everyone can or is willing to make this effort .. which is why politicians and advertising succeeds.
a related topic is the effort it takes to absorb knowledge. not everyone can or is willing to make this effort .. which is why politicians and advertising succeeds.
1
The journal publishers make no contribution whatsoever to the costs of research. Not a penny of the $45 you would have to spend to download the article in question would go to the researchers who wrote it.
4
If I understood this op ed correctly, Colonialism and Western academic medical research practices were responsible for the scale of the recent Ebola outbreak. Just as rubber is extracted from Liberia and serves the West, the writers told us, Western scientists had extracted knowledge, and published it in international journals that were, even decades later, too expensive for Liberians to download. The writers blamed the Western researchers for not including Liberians as co-investigators. They pointed to a failure of the West to train Liberian health workers and clinics. They said that no one in West Africa knew that Ebola might be endemic, or latent, in certain sanctuary sites that Western researchers had posited because West Africans were not told. They claimed that Western scientists knew that health care workers and clinics in Liberia and other West African countries could become epicenters of Ebola epidemics but, again, didn't tell Africa.
The op ed piece was correct in many ways. The West's response should have been and should be better, stronger, more coordinated with West Africa. Information should flow more freely. But nowhere in the article is there an admission that scientists or public health officials or governments or educational institutions in Liberia or other West African countries must take any responsibility whatsoever for public health or economic or infrastructure failures in their own nations that contributed to the spread of this awful disease.
The op ed piece was correct in many ways. The West's response should have been and should be better, stronger, more coordinated with West Africa. Information should flow more freely. But nowhere in the article is there an admission that scientists or public health officials or governments or educational institutions in Liberia or other West African countries must take any responsibility whatsoever for public health or economic or infrastructure failures in their own nations that contributed to the spread of this awful disease.
If I understood this op ed correctly, Colonialism and Western academic medical research practices were responsible for the scale of the recent Ebola outbreak. Just as rubber is extracted from Liberia and serves the West, the writers told us, Western scientists had extracted knowledge, and published it in international journals that were, even decades later, too expensive for Liberians to download. The writers blamed the Western researchers for not including Liberians as co-investigators. They pointed to a failure of the West to train Liberian health workers and clinics. They said that no one in West Africa knew that Ebola might be endemic, or latent, in certain sanctuary sites that Western researchers had posited because West Africans were not told. They claimed that Western scientists knew that health care workers and clinics in Liberia and other West African countries could become epicenters of Ebola epidemics but, again, didn't tell Africa.
The op ed piece was correct in many ways. The West's response should have been and should be better, stronger, more coordinated with West Africa. Information should flow more freely. But nowhere in the article is there an admission that scientists or public health officials or governments or educational institutions in Liberia or other West African countries must take any responsibility whatsoever for public health or economic or infrastructure failures in their own nations that contributed to the spread of this awful disease.
The op ed piece was correct in many ways. The West's response should have been and should be better, stronger, more coordinated with West Africa. Information should flow more freely. But nowhere in the article is there an admission that scientists or public health officials or governments or educational institutions in Liberia or other West African countries must take any responsibility whatsoever for public health or economic or infrastructure failures in their own nations that contributed to the spread of this awful disease.
19
I would imagine most college students could access these research articles for free in their library. I am not sure of the specific arrangements universities make with particular journals, but I am sure it has something to do with the public good of education.
If ever the was a clear public good justification, it would be in these areas ravaged by the disease. It's probably about time to start sending some free account codes to the researchers in these areas.
If ever the was a clear public good justification, it would be in these areas ravaged by the disease. It's probably about time to start sending some free account codes to the researchers in these areas.
6
The arrangement between university libraries and the journal publishers is this: the libraries pay what the publishers demand or they don't get access to the journal. Acquisition budgets for books have been decimated by the need for journal subscriptions that cost thousands of dollars per year. It is an absolute racket.
1
Of course the Liberian health ministry is going to deflect any responsibility for knowledge about Ebola and dealing with the outbreak to someone else. It was somehow related to rubber plantations and German medical researchers not allowing Liberian's to co-author research articles.
Western medical knowledge should be shared when it will help with a crisis like this, no doubt. We all need to support a process of treating those infected and trying to the degree possible to prevent future outbreaks. But Liberia and other African nations are also responsible for the condition they find themselves in and implying the west is largely to blame will perpetuate some of the self created problems, not fix them.
Western medical knowledge should be shared when it will help with a crisis like this, no doubt. We all need to support a process of treating those infected and trying to the degree possible to prevent future outbreaks. But Liberia and other African nations are also responsible for the condition they find themselves in and implying the west is largely to blame will perpetuate some of the self created problems, not fix them.
5
There are indeed financial roadblocks to the dissemination of scientific papers and journal articles in the form of those subscription services that are gathering these materials and charging high fees to access them. An analogy to this can be found in the GIS data gathered by cities. In Portland, there is a free website (portlandmaps.com) where you can look at a property and garner all sorts of useful information on utility hookups, construction permits, and the like. Certain cities in California demand that you pay for this information, which was, after all, gathered at taxpayer expense.
1
One need not look any further than the educational system in Liberia to understand the issue here. There is not one significant bit of research going on in any of Liberia's universities, not even the medical school at the University of Liberia. They have no librarires, no internet, no trained research staff. Liberia is flying blind towards every calamity that might befall them and as interesting as this article is, it is Monday morning quarterbacking. Until government leaders and their donors wake up to the fact that they need to radically reform tertiary education throughout the developing world this will not be news...it will be the day-to-day reality of people suffering from the short-sightedness and wilfull neglect of their leadership.
15
Dr. Dahn rightly points out that we missed a key fact about Ebola in
Africa. And kudos to the NYT for highlighting it now. Unfortunately, the NYT's reporting on Ebola in the U.S. was inadequate to counter the hysteria of residents and the partisanship of politicians from
Texas, NJ and NY when a case arrived on our shores and since then. In the field of public health, no cases is news. But apparently not so to the NYT.
Africa. And kudos to the NYT for highlighting it now. Unfortunately, the NYT's reporting on Ebola in the U.S. was inadequate to counter the hysteria of residents and the partisanship of politicians from
Texas, NJ and NY when a case arrived on our shores and since then. In the field of public health, no cases is news. But apparently not so to the NYT.
2
How exactly was the Times supposed defeat the massive and deliberate generation of hysterical fear by political operatives with their own media outlets?
At bottom, this is a moral and political, not scientific, challenge; are global elites prepared to renew and fortify commitments of substantial resources to address the obscene disparity in worldwide wealth distribution? Or is substandard healthcare and attendant morbidity and mortality simply collateral damage?
3
We have glaring health disparities at home. Just saying.
3
"Yes, We Were Warned About Ebola." In the not too distant future:
"Yes, We Were Warned About Global Warming"
"Yes, We Were Warned About Mass Extinction"
"Yes, We Were Warned about GMOs"
"Yes We Were Warned About Nuclear Proliferation"
and yes were were warned about politically made decisions and studied ignorance.
"Yes, We Were Warned About Global Warming"
"Yes, We Were Warned About Mass Extinction"
"Yes, We Were Warned about GMOs"
"Yes We Were Warned About Nuclear Proliferation"
and yes were were warned about politically made decisions and studied ignorance.
35
Don't forget water shortage and the housing bubble.
2
True, but the essay glosses over, mentioning only in passing, the role of traditional practices in handling the dead. This is especially touchy because any attempt to change or even criticise such practices will be denounced as imperialism, colonialism, etc etc, often by Western 'liberals' as well as by the Third World populations you're trying to help.
13
What I find most distressing is the attitudes of the elites and the elitist nations that think that they can avoid becoming a country that is host to this murderous disease.
It is far cheaper to spend the medical research and epidemic containment dollars on preventing the disease's expansion and finding viable cures than it is to pay for the consequences of ignoring it until it threatens the very fabric of the nation.
But, sadly, such is the approach of the politicians of the world who are more interested in what they get out of their efforts than they are about the interests of The People over whom they rule.
It is far cheaper to spend the medical research and epidemic containment dollars on preventing the disease's expansion and finding viable cures than it is to pay for the consequences of ignoring it until it threatens the very fabric of the nation.
But, sadly, such is the approach of the politicians of the world who are more interested in what they get out of their efforts than they are about the interests of The People over whom they rule.
2
The article says the paper was behind a subscription pay wall with a high cost to download. The high cost of reading it reduced access so it was less read. If it had been free access maybe this important information would have been remembered and known in time to make a difference. Much scientific research is still effectively locked away from public access. More should be done to ensure that all scientific research is public.
34
You assume (wrongly) there was an infrastructure in place that would have ensured this information was seen and acted on.
3
Mr. and Ms. Gates, Pres. and Ms. Carter, Mr. Bloomberg, Mr. Buffet,
I'm a socialist democrat so my inclination is that these sorts of issues are ideally addressed through government interventions, not NGOs (aka charity). But I also like to think I'm a pragmatist.
It won't solve all the problems cited here, but how about organizing a program to establish and maintain full-scope medical literature libraries in or near the most prominent medical facility in the capital city of each UN member nation with a per capita income below xxxx (or some other criteria). I imagine that most of the contents would be digital and ideally remotely accessible. Of course the tricky bit would be fully integrating the project into the local medical/public health infrastructure of each country.
You - and specifically your staff resources especially those that are in-country - are far more experienced than I am at devising and implementing this kind of project. But please don't let's wait wait for the WHO to sort themselves out and fund it. (I'm thinking that you might ask the Norwegians if they would like to work with you.)
I'm a socialist democrat so my inclination is that these sorts of issues are ideally addressed through government interventions, not NGOs (aka charity). But I also like to think I'm a pragmatist.
It won't solve all the problems cited here, but how about organizing a program to establish and maintain full-scope medical literature libraries in or near the most prominent medical facility in the capital city of each UN member nation with a per capita income below xxxx (or some other criteria). I imagine that most of the contents would be digital and ideally remotely accessible. Of course the tricky bit would be fully integrating the project into the local medical/public health infrastructure of each country.
You - and specifically your staff resources especially those that are in-country - are far more experienced than I am at devising and implementing this kind of project. But please don't let's wait wait for the WHO to sort themselves out and fund it. (I'm thinking that you might ask the Norwegians if they would like to work with you.)
19
"how about organizing a program to establish and maintain full-scope medical literature libraries in or near the most prominent medical facility in the capital city of each UN member nation with a per capita income below xxxx... Of course the tricky bit would be fully integrating the project into the local medical/public health infrastructure of each country."
It would be AMAZING to have that available in the US, let alone in Liberia or wherever else. There are very few medical libraries in the US that could claim to be truly full scope, mostly because of lack of funding and/or infrastructure.
You might be shocked at how few resources are available to the average US physician, even if s/he is affiliated with a major medical center or hospital.
It would be AMAZING to have that available in the US, let alone in Liberia or wherever else. There are very few medical libraries in the US that could claim to be truly full scope, mostly because of lack of funding and/or infrastructure.
You might be shocked at how few resources are available to the average US physician, even if s/he is affiliated with a major medical center or hospital.
Hear, hear! No one in 2015 should have to go to a hospital with no running water or medical supplies, and every country should have the capability of processing blood from survivors of diseases such as Ebola so that it can be safely transfused to those still suffering.
State of the art medical aid is not enough, however. Better educating people throughout the world, including here in the U.S., as to what any of us can do to limit the spread of contagious diseases is imperative. Knowing how to apply a tourniquet and other first aid measures commonly taught in health classes are important, but learning how to protect oneself and others from increasingly dangerous antibiotic-resistant bugs addresses a problem that most of us are much more likely to face.
State of the art medical aid is not enough, however. Better educating people throughout the world, including here in the U.S., as to what any of us can do to limit the spread of contagious diseases is imperative. Knowing how to apply a tourniquet and other first aid measures commonly taught in health classes are important, but learning how to protect oneself and others from increasingly dangerous antibiotic-resistant bugs addresses a problem that most of us are much more likely to face.
5
So where will the money come from to ensure poor countries have awesome medical facilities to fight a future plague? Medical science is critical but the harder and real truth is that there will be another plague in a poor country and there will be a lot of hand-wringing afterwards for all the obvious reasons.
16
You sound like you believe it couldn't happen in the US, but if health care becomes more disparate I can see no reason to believe that. While access is a huge issue, identification is also paramount - and when a significant proportion of the population does not have the mindset or economic means to have a health event such as that can get deadly so quickly checked out, then you are vulnerable.
I think the question isn't where will the money come from, but how can we not afford to ensure medical support and health care knowledge.
"Penny wise and pound foolish".....
I think the question isn't where will the money come from, but how can we not afford to ensure medical support and health care knowledge.
"Penny wise and pound foolish".....
4
But some of these "poor" countries are actually rich in resources. It's just that the people do not benefit.
7
Sorry if i wasnt more clear. Yes a plague can happen anywhere on the planet but the issue I raise is that the money for medical facilities has to come from somewhere. Poor countries will continue to be lesser served regardless of what this essay "wants to happen." Where will the money come from? No answer to that one. Wishful thinking.
My father worked for the World Health Organization (in the Pan American Health Organization), and here was a role that WHO should have filled: providing resources to the local health care communities in Africa, such as medical libraries, and specialists to advise the community for a rapid response to an epidemic. No such infrastructure or specialists were made available in Africa, at least for the countries mentioned in this article. Part of the problem was reduced funding for the UN and WHO. But it seems to me that the leadership of WHO was also remiss. As the size and excellence of WHO has waned in the late 20th century, the importance of NGO's (like MSF and Partners in Health) has increased. But these NGO's can only do so much, and in the case of the Ebola crisis they only stepped in in a major way once the epidemic was massive. We should all realize that the world is going to pay a price for allowing WHO to atrophy. And it is not just third world nations that are going to pay that price.
49
If there was an end to violence in Africa, I think there would be lots of investment and assistance from other countries in African infrastructure.
13
I appreciate the author's knowledge and the historical context of the piece, but it is a bit of a disservice to Liberia to not mention the 10 year civil war that went on there during the late 90's and 00's. Even with commitments to long term training, it is hard to keep staff around in an active war zone. If that hadn't devastated the infrastructure of the country, this outbreak (or, at least the huge reach of the outbreak) probably would have been avoided. I agree that the system that responds to these things needs to be improved, but I think it would also be helpful to take note of the ultimate cause of this - war - before we go and spend billions jumping through other hoops that may or may not help next time.
4
We forget one immutable truth at our own peril: white, black or brown--we are all human beings capable of catching and spreading Ebola. When we ignore epidemics which appear to ignore "our" people, we increase the chance all people will be infected, even ourselves. Furthermore, it's the underfunded and unsexy field of public health which will most help to protect us.
The final irony of Ebola is the way health care providers can unknowingly be among the first victims of the virus, further amplifying its spread and further degrading the available medical response.
If we continue to forget these lessons, we should prepare for Ebola anywhere and everywhere.
Doug M, MD
The final irony of Ebola is the way health care providers can unknowingly be among the first victims of the virus, further amplifying its spread and further degrading the available medical response.
If we continue to forget these lessons, we should prepare for Ebola anywhere and everywhere.
Doug M, MD
30
The late Tom Clancy, master of the techno-thriller, based a book, "Executive Action" on the premise that Ebola could be weaponized and used to attack civilians. This was the follow-on to "Debt of Honor" at the end of which a jet airliner was deliberately crashed into the Capitol during a ceremony that resulted in the effective decapitation of the U.S. government. Clancy later wrote about an aggressive leader who meddles in the Ukraine to expand the influence of Russia. Sound familiar?
No surprises here. If no Liberian public health official even heard about those Ebola research papers published in Europe, let alone read any, it's because it lacks a national government as we've come to expect and understand it; like most of Africa.
My enduring impression of Liberia -- indeed, of most West Africa -- comes from a grim black-&-white photograph that I think appeared in Newsweek Magazine at least a quarter-century ago. Taken during a coup, it showed some politicians tied to log poles slowly being shot to pieces, one-by-one, by a ragged squad of laughing, jeering mutinous soldiers. A form of torture. They riddled one body with scores of bullets until it was all but unrecognizable while the others grimly awaited their turn. Even so, those poor devils fared better than they would have in neighboring Sierra Leone. There, they would have been slowly hacked to pieces with axes and machetes or burned alive.
Of course Liberia bungled Ebola's quiet emergence. Before too long I expect its impoverished, semi-literate population to be somewhat diminished, if not largely annihilated, by a host of new diseases brought to its cities by migrants from the rural countryside.
My enduring impression of Liberia -- indeed, of most West Africa -- comes from a grim black-&-white photograph that I think appeared in Newsweek Magazine at least a quarter-century ago. Taken during a coup, it showed some politicians tied to log poles slowly being shot to pieces, one-by-one, by a ragged squad of laughing, jeering mutinous soldiers. A form of torture. They riddled one body with scores of bullets until it was all but unrecognizable while the others grimly awaited their turn. Even so, those poor devils fared better than they would have in neighboring Sierra Leone. There, they would have been slowly hacked to pieces with axes and machetes or burned alive.
Of course Liberia bungled Ebola's quiet emergence. Before too long I expect its impoverished, semi-literate population to be somewhat diminished, if not largely annihilated, by a host of new diseases brought to its cities by migrants from the rural countryside.
14
Perhaps it's time to update your impression of West Africa.
1
Excellent article... Wouldn't it be great if there were some sort of global agreement that research like this be made available for free to medical professionals in the relevant regions? A small thing, but it could make a difference.
39
Susan, fortunately there is a WHO HINARI agreement with major health publishers to allow free access to full text journal articles BUT unfortunately, not too many medical professionals know about this health internetwork journals and manuals and ebooks database nor how to use it well. International NGOs such as MSF & Farmer's Partners cannot register for HINARI which is ONLY for lesser developed countries.
2
Research that US citizens pay for through NIH grants... is also not available to read without paying $45 an article. Shouldn't there be a rule about that?
1
Susan, you and the authors of the original op-ed piece will be pleased to know that there is an agreement of the kind you envision. For the last 14 years, Research4Life, a public-private partnership of UN entities, scientific publishers, university libraries, and technical partners, has been working to reduce the knowledge gap between researchers in developed and less developed countries by providing free and low cost online access to critical scientific research from 15,000 peer-reviewed journals and 30,000 books.
In Liberia researchers and physicians in eligible institutions (including not for profit universities, hospitals, research institutes, and government libraries) can access the content of these journals and books at no charge.
I can confirm that Liberia’s Ministry of Health is registered for access to Research4Life’s HINARI program and as such will have free access to a vast storehouse of peer-reviewed medical research from key medical journals and books, including some 2700 articles on Ebola, of which over 400 have been published since the beginning of this year. As Chair of Research4Life's Executive Council, I will be happy to put Dr Dahn, Dr Mussa and their colleagues in Liberia in touch with the HINARI help desk at WHO in Geneva if they would like assistance in ensuring that their ministry has all the information necessary to derive maximum benefit from this free resource.
In Liberia researchers and physicians in eligible institutions (including not for profit universities, hospitals, research institutes, and government libraries) can access the content of these journals and books at no charge.
I can confirm that Liberia’s Ministry of Health is registered for access to Research4Life’s HINARI program and as such will have free access to a vast storehouse of peer-reviewed medical research from key medical journals and books, including some 2700 articles on Ebola, of which over 400 have been published since the beginning of this year. As Chair of Research4Life's Executive Council, I will be happy to put Dr Dahn, Dr Mussa and their colleagues in Liberia in touch with the HINARI help desk at WHO in Geneva if they would like assistance in ensuring that their ministry has all the information necessary to derive maximum benefit from this free resource.
Many good practical points are made by others here, but as long as we embrace narrow knowledge and think we can preserve ourselves at each others' expense, we are vulnerable to ignorance and deceit.
I do wish we had better world news and geographical, not to mention geopolitical knowledge. Blame is not knowledge. Compassion arises out of awareness as enshrined in our Constitution: "life, liberty, and the pursuit of happiness" is not a gated community.