Two Years On, Paul Farmer Reflects on the Ebola Outbreak in West Africa

Posted 15 November 2016

Paul Farmer looked across the expanse of the cavernous hotel ballroom where he was chairing a symposium on Ebola and remarked on the wide variety of experts present. He noted that people attending the session at the 2016 ASTMH Annual Meeting included experts trying to understand the epidemiology of the outbreak that swept through Liberia, Guinea and Sierra Leone in 2014, along with scientists probing the clinical course of Ebola infections, and researchers looking at the genomics of disease.
 
“I also see friends who worked in the public health response and people who survived Ebola, so the reasons today for engagement vary,” said Farmer, a professor of global health at Harvard Medical School and a physician and anthropologist who is a co-founder of the NGO Partners in Health.
 
Farmer said that now, two years removed from the outbreak, he is especially concerned with what he called the “political economy of Ebola.” That’s a reference, he said, to the “large scale social forces underpinning this epidemic” that help to explain why it exploded almost exclusively in Liberia, Guinea, and Sierra Leone.
 
“Understanding the political economy of these three countries is important because they were the only ones that were heavily affected,” he said. “The epidemic threw out tendrils to other countries, but in no other places in the world did Ebola spread in the same manner.”
 
Farmer said the reason Ebola was so deadly in these places was not simply due to the terrible biology of the virus. Rather, he said it was because the three countries “are what some people call clinical deserts.” In particular, he said their lack of health professionals and facilities equipped to deal with the massive loss of fluids caused by Ebola is a key reason “ so many people died” from the disease who might otherwise have lived.
 
Farmer lamented that these same countries also are “public health deserts” and thus were not able to stop the disease from spreading rapidly. And he noted this lack of capacity is now hampering efforts to follow Ebola survivors and learn more about the long-term consequences of an infection.
 
Farmer also said it was critical to constantly keep in mind the incredible sacrifice of physicians, nurses, ambulance drivers, and other health care professionals who died during the outbreak. He remarked that Liberia was left with only about 50 physicians serving the general public, the equivalent, he said, of the entire population of Boston being served by only a dozen physicians.
 
“We really owe them a great debt of gratitude,” Farmer said. “These are people who did their best to stop the epidemic and take are of the people who were infected. “
 
Farmer then asked for minute of silence to reflect on the courage of frontline health workers who gave their lives fighting the epidemic.