The Critical Question We're Not Asking About The Ebola Outbreak

Benedict Smarts stands next to tombs of his ancestors, on December 12, 2012, on the conce
TO GO WITH AFP STORY BY ANNE CHAON Benedict Smarts stands next to tombs of his ancestors, on December 12, 2012, on the concession of Indonesian Golden Veroleum Liberia, southern Liberia, where, since the end of 2010, large parts of the last great primary forest of Liberia disappear to make way for palm oil in defiance of traditions and local customs closely linked to forest. Previously hidden deep in the forest, tombs are now surrounded by palms trees for oil palm exploitation. AFP PHOTO / ANNE CHAON (Photo credit should read ANNE CHAON/AFP/Getty Images)

The ebola outbreak in West Africa has the world on edge: Will the virus spill into new communities? Will it cross more borders? Even oceans? How can caregivers raise the victims' chances of survival, as well as reduce their own chances of getting sick?

Some experts emphasize the importance of another, generally overlooked question: How can we thwart such deadly outbreaks in the first place?

"For very good reason, the news coverage and activities are subsumed with containing this outbreak and limiting human infections," said Jonathan Epstein, a wildlife veterinarian with EcoHealth Alliance, a New York-based organization of scientists focused on the dual goals of conservation and public health. "That aside, at some point, hopefully sooner, we need to understand how the outbreak occurred, understand what the risks were and make sure it doesn't happen again."

At the very end of "Contagion," a short sequence of clips provides a prequel to the global pandemic that plays out in the film: A bulldozer clears a patch of trees for a new piggery, into which a displaced and diseased bat drops a chunk of banana, which is gobbled by a pig that later lands in the hands of a chef. The chef, who doesn't wash his hands, infects Gwyneth Paltrow's character, and a nightmare scenario ensues.

The ebola strain that has so far killed at least 729 people across West Africa does not spread through the air and therefore isn't as contagious as the fictitious MEV-1 virus in the movie. Still, Hollywood's story isn't a stretch, experts say. A similar pandemic is quite possible. Even in the current outbreak, there is no treatment, and transmission is relatively easy through direct contact with bodily fluids, such as blood, saliva and diarrhea. More than half of those infected with the hemorrhagic fever die. And this virus, too, is likely zoonotic -- meaning it jumped from animal to human.

In fact, the leading suspect in what is now believed to be the worst ebola outbreak in history is the bat.

Overall, more than 60 percent of emerging infectious diseases over the last six decades -- from HIV/AIDS to severe acute respiratory syndrome (SARS) to chikungunya -- have originated in bats, primates and other animals. Of an estimated 1 million animal viruses out there, only about 2,000 have so far been identified.

The connection is sometimes mentioned by public health officials. Stephan Monroe, deputy director of the National Center for Emerging and Zoonotic Infectious Diseases at the Centers for Disease Control and Prevention, closed an ebola-related press conference on Monday with a reference to the need for a "better understanding of how this dreadful disease first crosses over from animals to humans so we can prevent this from happening." But it was the only mention of animals during the press conference.

Making the shift from a reactionary to a proactive, precautionary approach, Epstein and other experts say, goes beyond the purview of public health officials and medical doctors. It requires the work of veterinarians, ecologists, economists, sociologists and politicians, among others. And such holistic efforts don't happen naturally. Health care, at least in the U.S., is focused primarily on treatment, with pharmaceutical money behind much of the research. Meanwhile, doctors, veterinarians and other professionals have grown increasingly specialized -- which is to say they've grown apart. So communication across disciplines is rare, making it easy to overlook useful links.

A multidisciplinary approach, so-called one health, seeks to remedy this situation. At its core, the one-health movement aims to raise awareness of the connections between the health of the environment, animals and human beings, and the importance of collaboration across both disciplinary and political borders.

Scientists may work together to study an animal virus and how it spills over into humans. But that is just the first step, according to Epstein. Experts are then needed to figure out why humans are coming into contact with infected wildlife.

Hunger is one obvious factor. In most parts of West Africa, sources of protein aren't simply purchased at the corner bodega or strip mall supermarket. Desperation, as well as tradition, sends people into the forests to hunt wildlife, including bats. Lack of food for a growing population of people is also among the key drivers of deforestation in the region, as nations make room for more agricultural development.

Whether it begins with people venturing into wildlife habitats for food or development destroying wildlife habitats, the result is animals and humans sharing closer quarters.

"There's solid scientific evidence pointing to the fact that human activities like agricultural expansion and hunting and deforestation do facilitate spillover and outbreak events and do pose some risks," said Epstein.

Experts suggest that nearly half of the world's emerging zoonotic infectious diseases are linked to changes in land use.

Laura Kahn, a research scholar at the Woodrow Wilson School of Public and International Affairs at Princeton University, pointed to a Catch-22 situation. "On the one hand, you want livestock to provide meat," she said. "But how can you do it sustainably without destroying the forest? That leads you to large-scale farming -- factory farming -- and that has all of its problems."

"Here in affluent Western countries, it's easy for us to sit back here and speculate and tell them what they should and shouldn't do. But we're not in their situation," added Kahn, a leader in the one-health movement. "We're not starving."

Epstein agreed. Still, he suggested, more can be done to at least educate local people about the health risks involved in how they hunt and butcher wild animals. "There are simple steps, such as hand-washing, that could really reduce the risk of spillover of viruses and prevent infection," he said.

Of course, not everyone in Guinea, Liberia or Sierra Leone -- the centers of the ebola outbreak -- is impoverished and undernourished. Corrupt government leaders, and the funds they strip from health services, environmental protection and public education, could be contributing to the outbreak, some say.

"The faction or fraction that has control of the government at a particular historical juncture uses political power to reap personal economic benefits through the processes of plundering and pillaging the public coffers," George Klay Kieh Jr. said in Atlanta on Saturday, during a speech honoring Liberia's Independence Day. Kieh is the dean of the College of Arts and Sciences at the University of West Georgia, a political scientist, and the son of a Liberian politician.

"In short, the Liberian government became and is still like a buffet service, in which those who control the government and their relations 'eat all they can eat for free,'" he added, "while the majority of Liberians look through the windows with empty stomachs."

Kieh Jr. pointed to the heavy investments that Liberian leaders have made in the palm oil industry, with the public reaping none of the financial benefits. Deforestation for palm oil production, meanwhile, raises the risk of another disease outbreak. And outbreaks, as Epstein and his colleagues suggest, can be extremely damaging to the bottom line of a company or a country. The SARS outbreak in 2003 was estimated to have cost anywhere from $15 billion to more than $50 billion globally.

Even well-meaning governments may be missing the mark. In most countries, the department of health has minimal interaction with the department of agriculture, Kahn said. Neither may be looking for sick wildlife or livestock as a warning sign of a coming outbreak in humans. Likewise, doctors may not be looking for an animal-borne disease in a sick person, slowing down diagnosis and potentially spurring greater spread of disease.

"This isn't just in Africa. It happens in the U.S., too," said Kahn, who recalled multiple examples of sick families in which a doctor couldn't make a diagnosis, but a veterinarian friend of the ill was able to immediately identify the zoonotic pathogen.

Tayo Babalobi, a Nigerian veterinary epidemiologist, is helping to lead the one-health charge in his country, where officials fear the ebola outbreak may spread. Nigeria is home to some 170 million people.

"The most important contributory factors [in the spread of disease]," Babalobi said, "are ignorance at high and low levels."