Before the death toll from the current Ebola outbreak reached 1000 earlier this week, VICE News spoke with American virologist Dr. Joseph Fair, who has been working in Sierra Leone for a good part of the past decade. We spoke with Fair about how humans contact Ebola, how bushmeat has influenced the spread of the disease, and the role of the international community in this crisis.
VICE News: Dr. Fair, we first spoke with you in Liberia several months ago, then both you and our team returned to the United States. Why did you go back to aid in the crisis?
Dr. Fair: I have a long history and connection with Sierra Leone, having worked here since 2004. Dr. Khan [the country's top Ebola doctor who contracted and died from the disease in July] and his staff were some of the first people that I ever met in Sierra Leone, and I have worked with them since then in several capacities. They were like my family, as they were to everyone who had the privilege of working with them.
I have worked in several countries in Africa and I truly love the people of Sierra Leone, despite it being largely the most difficult country where I've worked. They have an infectious happiness despite all they've endured, and an almost inhuman ability to forgive. As a personal anecdote, I just recently traced my DNA and found that my genome is comprised of approximately 3 percent Mende origin [one of the two largest ethnic groups in Sierra Leone]. Being from the southern US, that is not a complete surprise or even particularly unexpected, but the connection is deeper than work. I can't help but believe that I have always been called home here to Sierra Leone.
We understand that a number of health workers, including your close friend Dr. Khan, have contracted and died from the disease. Can you explain how both health workers and average citizens in West Africa contract Ebola?
Healthcare workers are at a significantly higher risk of contracting the disease because of their direct contact with infected individuals and the "uncontrolled" environments where they work — with patients who are acutely ill and suffering from vomit and diarrhea, thus exposing the workers to high levels of risk. For the public, transmission most often occurs through close contact with ill individuals. Culturally, it is common for women and traditional healers to care for the sick, where they come into close contact with the blood and body fluids of the infected.
An earlier major route of transmission was the local preparation of bodies for burial, which usually involves intense displays of grief that include hugging and kissing the bodies of the deceased. Now that much more of the population is convinced that the disease exists, however, we have the opposite issue, as we do not have enough teams to bury the bodies.
Does Ebola affect a certain demographic or part of the population more than others?
Ebola transmission most often occurs in women, as they are typically the caregivers.
When we were last in Liberia, you spoke with us about the socio-economic factors affecting pandemics. What are the socio-economic factors at play in this Ebola crisis?
This disease, like many infectious diseases, is highly correlated with socio-economic status. The poor are the most affected due to the sanitary conditions where they live, as well as the level of education in understanding what the disease is and how it is transmitted.
A number of news reports have pointed to a serum called ZMapp, which has been experimentally given to two infected Americas and has had some success. How does ZMapp work and what are the potential positive outcomes and/or challenges that the use of this medical treatment presents?
ZMapp is antibody-based therapy that was recently developed by a public-private partnership with the Canadian government and others. The difficulty with ZMapp, as well as other candidate therapies and vaccines, is that it has never undergone human clinical trials, so we don't know the long-term effects of the drug. Given the choice of drug or no-drug, however, I personally would prefer to have the drug option, despite the risks. This outbreak has sparked an ethical debate in the scientific and medical communities, forcing us to weigh up the benefits and the risks of administering a drug that has never undergone a clinical trial.
While the public seems to strongly feel that this drug should be made available for Ebola, in every other circumstance, this would likely be considered criminal. Thus, the World Health Organization (WHO) and the medical community have some tough choices to make and the decisions that result from that will likely result in setting a benchmark.
Mapp Biopharmaceutical has announced that its supply of ZMapp has been exhausted. The company said the last of the medication was sent to Liberia to treat two doctors with Ebola.
When we spoke during the filming of "Bushmeat in the Time of Ebola," we focused on cultural practices, such as the consumption of bushmeat, that have influenced the spread of this disease. At the time, many of the Liberians we spoke to continued to eat the meat, despite a ban, and claimed Ebola was a government hoax. Have attitudes changed as the disease has spread, and are there other cultural factors that may have influenced the outbreak?
Bushmeat consumption has generally decreased as awareness of the disease has spread. Generally, bushmeat is linked to only the index [or first] case, yet any decrease in its consumption, especially with regards to endangered or "dangerous" animals — those known to carry diseases transmittable to humans — is positive.
Last week, the WHO declared the Ebola outbreak an international public health emergency. With that in mind, what does the future hold and what role does the international community have to play?
The global alert is meant to mobilize an international effort to stop this disease. It calls on all possible resources around the world to mobilize and respond to the epidemic, and aims to stop Ebola spreading to other parts of Africa and the globe.
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