Recently I had an interesting discussion with one of my colleagues: Who are the beneficiaries of our intervention? Of course youre first thinking of the sick. People who contracted Ebola have to be treated and if possible cured. You think of the families in quarantine that anxiously expect the end of their incubation period, hoping not to show symptoms themselves. This way of thinking is expressed as well by the Time Magazine, announcing Ebola fighters as the TIME person of the year 2014, emphasizing the achievements of the medical personnel. They are the ones with a real an eminent danger of contracting Ebola themselves.
On the other hand contracted less than 7,000 Sierra Leoneans EVD so far. With a total population of approximately 5 million. A target group of 7,000 people can be called manageable. But unfortunately, the opposite is the case: The 4,993,000 Sierra Leoneans that stayed uninfected until now are our target group. To protect the healthy from infection is the main objective. And that is not the task of doctors or nurses. Other things are needed here:
- Creating awareness
- Changing behavioural habits
- Coordination and logistics
Prevention is the key. That is a message being distributed by the government as well:
But of course it is less attractive to walk from house to house distributing leaflets than caring for the sick and the needy, dressed up like an astronaut. The same concept was found valid in the fight against HIV: Donor prefer investment in HIV drugs over simply distributing condoms. The Gates Foundation makes the following statement:
Our largest investment is in efforts to discover and develop an HIV vaccine.
Without knowledge of the figures, my impression is the following: The majority of donors, UN bodies and NGOs focussed on the medical sector in the Ebola Response. Treatment centre are being built almost overnight, there is heavy investment in vaccines and treatment research, physicians from all over the world are being recruited. That fits to the UN Mission for Ebola Emergency Response (UNMEER) (UN Resolution 2177 of the UN Security Council).
Their main task is the logistical distribution of treatment centres, vehicles and telecommunication equipment in the countries affected the hardest by Ebola.
Those activities involve high costs. But they will not change the fact that the probability of survival of the 7,000 infected are highly dependent on chance and on their general health condition. On top of that, most activities are implemented extremely slowly and their results will not impact the current crisis, it is rather a provision for future ones.
What is needed on a much bigger scale is social mobilization, well planned and organised. The people have to wake up. Social control is needed. Certain behaviours have to stop. Each and every Sierra Leonean, who refuses an invitation to a burial, is a hero. Each and every one who keeps her door shot to visitors, is a hero. Everybody avoiding body contact even to close friends, is a hero.
I see many parallels to the HIV epidemic for example in South Africa. There I heard people saying: Our traditions are older than HIV. We will not change our behaviour. But new infectious diseases can kill the holder of the tradition. The other way around is certainly less common.
This article is a translation from the original German version.