Chris Blattman

“Ebola is the Kardashian of diseases”

I tweeted that statement earlier this week, followed by “Do not get distracted. Malaria, TB, HIV is what matters.”

First, credit goes to @gbloembergen who comes up with much cleverer statements while holding alcoholic beverages than I do.

Second, why I agree with him:

  • Ebola is deadly serious but it seems to me the scaremongering is getting out of hand. Countries with even basic state capacity, such as Uganda, tend to be able to get outbreaks under control. A Western country could contain an outbreak, as could many (but not all) of Liberia or Sierra Leone’s neighbors. The reason we are seeing this explode is because, inevitably, Ebola is appearing in some of the weakest states in the world.
  • Thus the problem is not Ebola. Ebola outbreaks are the symptom of very weak states. The world can and should help to contain the outbreak there, but not forget what the cause is.
  • Meanwhile, malaria, TB and HIV/AIDS are already at pandemic proportions and I venture destroy more lives, more economies, and perhaps even more politics than Ebola.
  • Something like a third of Botswana have HIV or AIDS. 25 millions Africans have it, and more than a million die a year from it. A million. This is hugely economically and politically disruptive in some of the most advanced and politically important states in Africa, especially southern Africa.

I am not a public health expert so I’d love to be corrected. The right person to talk about this is probably Evan Lieberman at MIT, and in my ignorance I welcome summaries or insights from readers.

One response I received on Twitter that is important: the reaction to Ebola is what is abruptly destroying the economies of Liberia and Sierra Leone. Some of this is sensible, and maybe that economic and political disruption will make Ebola a greater curse than HIV or TB or malaria. But I can’t escape the idea that the reaction is an overreaction, and that the economic and political destruction is partly due to Western hype. That’s a tragedy indeed.

77 Responses

  1. @cblatts I will have to agree that Ebola has been elevated to scaremongering proportions. However, if such a Kardashian disease results in reinvigorated efforts to improve public health systems, one might argue that the scaremongering might be worth it; might even have spillover effects for your listed top killers. fyi I am not a public health expert either.

  2. I understand where Dr. Blattman is coming from, and I would have agreed with him a year ago, when we were dealing only with small, sporadic outbreaks. But this Ebola outbreak in west Africa is something different. It is wiping out entire families, ripping giant holes in the social fabric of communities that were already on the edge. Malaria kills kids, and it is horrible, and we should work harder to eradicate it, but it doesn’t kill the mom, the dad, and the grandparents, and leave a bunch of orphans, like Ebola is doing now in Liberia and Sierra Leone. This outbreak is not a ‘distraction’ from anything. The suffocating fear that has resulted from it has led to the collapse of the health systems in these countries, which will ultimately will cause many many preventable deaths from non-Ebola causes. The outbreak has to be stopped so we can go back to caring (or not caring, as the case may be) about malaria and HIV. The fear psychosis that comes with Ebola is part and parcel of an infectious disease that kills over half of the people it infects, and until we come up with a cure, the fear will remain. Now more than ever.

    The idiots who are flooding the twitter-sphere with their irrational fears about Ebola coming to the US never cared about malaria or HIV in the developing world in the first place, and it’s a good bet they won’t once the outbreak is over.

    We need to develop the capacity to deal with not only established endemic infectious diseases like malaria, HIV, and diarrheal diseases, but also viruses like Ebola that emerge guerilla-like from the bush and then vanish. We need to be able to walk and chew gum at the same time. It’s not an either-or proposition.

  3. Nice point. Another appropriate tag might be “Ebola is the Ice Bucket Challenge of Diseases.”

    Felix Salmon wrote a piece about how the crazy attention around the Ice Bucket Challenge have led to a windfall in donations to the ALS Foundation. But some of that money is coming at the expense of charitable gifts to other organizations that likely can have more meaningful impacts on more people. This is not to say that finding an ALS cure is not important (as you are not saying containing ebola is not important), but charitable giving (and resources spent on diseases) should be allocated based on criteria other than viral videos and TV coverage.

  4. It’s not only the reaction to Ebola, it’s the ensuing humanitarian crisis that is so damaging. For example, because of the risk of infection, many health facilities have shut down, so there’s nowhere to have a baby or to go for other health issues – people are dying because of this. Because of the quarantine which was done to “protect” people, there are people that now don’t have sustainable access to food and water – people are getting sick and dying from this. NGOs that don’t work in health have pulled out because of fear – all the jobs they created are slowly leaving as no one knows when they will come back. Business people are leaving, and the economy is struggling. So yes, the reaction is exaggerated and causing problems (from a Western point of view), but from the frontlines here in Liberia, this country (and SL and Guinea), are suffering from broader consequences of what can no longer just be characterized as a public health concern or an Ebola outbreak, because the repercussions are felt across sectors.

  5. Yes, HIV/TB/Malaria/Respiratory are the big killers. However, to take a dynamic point of view: #Ebola is rising rapidly, while other health probs are more of a known quantity. As you say, more seasoned/stronger healthcare systems can snuff out Ebola as it arises, but if it explodes now in SL/Liberia, it may be unmanageable even elsewhere. E.g. contact tracing when >95% of an area has an exposed family member is not something we’re ready for (I hear this is the reality in some parts of SL/Lib). Thus action now – even if it distracts us from overall larger issues for a while – may have disproportionate benefit.

    On a side note, is it not generally true that rapidly emerging diseases tends to be more destabilizing than slow-moving but larger ones?

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