Cross Post – Most powerful lesson from Ebola: We do not learn our lessons

BY MAXWELL J. SMITH & ROSS E.G. UPSHUR

This article is cross posted from the OUPblog.  To see the original article please follow this link: http://bit.ly/1mjAg0Z

‘Ebola is a wake-up call.’

This is a common sentiment expressed by those who have reflected on the ongoing Ebola outbreak in West Africa. It is a reaction to the nearly 30,000 cases and over 11,000 deaths that have occurred since the first cases of the outbreak were reported in March 2014. Though, it is not simply a reaction to the sheer number of cases and deaths; it is an acknowledgement that an outbreak of this magnitude should have never occurred and that we as a global community remain ill-prepared to prevent and respond to deadly global infectious disease outbreaks.

The idea that this outbreak serves as a wake-up call is intended to provoke governments, global health leaders, researchers, and health care providers to identify the deficits in how the outbreak was managed. (Was the response too slow? Did governments or global health authorities fail to meet their obligations?) Ultimately, it is an acknowledgement, if not a pledge, that we must learn from this outbreak before we are faced with another. Yet, should we be persuaded that the Ebola outbreak will catalyze meaningful change?

‘It’s like déjà vu all over again.’ – Yogi Berra (attributed)

Unfortunately, this may be a more fitting sentiment. In the past 15 years alone, numerous infectious diseases have prompted similar ‘wake-up calls’ to improve global outbreak preparedness and response. These include outbreaks of severe acute respiratory syndrome coronavirus (SARS), H5N1, H7N9, and H1N1 influenza viruses, Middle East respiratory syndrome coronavirus (MERS-coV), and the emergence of pathogens with antimicrobial resistance, including multi-drug-resistant/extensively-drug-resistant tuberculosis. Perhaps even more to the point is that knowledge and isolated outbreaks of the Ebola virus since 1976 were not sufficient to ‘wake us’ in time to adequately prepare for the current outbreak.

The most important lesson we must learn from this Ebola outbreak regards our inability to learn lessons from past outbreaks. We have hit the snooze button repeatedly and ‘learn’ the lessons all over again when the next outbreak emerges. We either have collective amnesia or collective narcolepsy.

Perhaps, in our view, this is a moral lesson of a moral failing. Our failure to learn affirms a defect in our collective moral attitude toward remediating the conditions that precipitate the emergence of global outbreak threats. These conditions include profoundly inadequate public health and primary health care infrastructures in many countries and, more fundamentally, an inability to recognize and accept the responsibilities we share as a global community to address shared vulnerabilities. In practice, this translates into not only investing in global outbreak surveillance infrastructure, but also strengthening health systems in the worst-off countries. This latter crucial point has been acknowledged, but unfortunately has largely received only lip service.

Ultimately, learning this lesson necessitates engagement with the ethics of global outbreak preparedness and response. We must ask why there are repeated failures to implement the ethics guidance developed over the past few decades following outbreaks like SARS and H1N1 influenza. By failing to adequately engage communities in outbreak response, instituting travel bans and restrictions, and declining to share valuable data and tissue, this outbreak saw the adoption of policies and practices that fostered distrust and ran antithetical to the ethics lessons we have purportedly ‘learned’ from past outbreaks. It is as if past lessons have been wiped from our collective memory. Where these ethics learnings were implemented there was substantial progress; for example, burial practices that initially contributed to the spread of Ebola were successfully modified once communities were engaged, which helped to curb the spread of disease.

The fundamental manner in which we approach global outbreak preparedness and response must be seen not as merely technically deficient, but also morally deficient. Commitments to improving global outbreak surveillance and early outbreak warning systems (i.e., technical improvements) must be matched with commitments to cultivating the ethics lessons that emerge following outbreaks. If future actions are guided by the same values that have led to these repeated moral failures, we should doubt whether any meaningful change to global outbreak preparedness and response will occur. Substantial progress is therefore contingent on a reorientation of our moral attitude.

Without acknowledging the moral character of our failures and reorienting the paradigm of global outbreak preparedness and response to one that values global solidarity and justice, it is doubtful whether our repeated shortcomings will be corrected. We cannot entirely prevent infectious disease outbreaks from occurring; however, we can strive to ensure our moral failures are not repeated.

Image credit: United Nations Mission for Ebola Emergency Response (UNMEER)/Martine Perret. CC BY-ND 2.0 via Flickr.

Maxwell J. Smith is a PhD Candidate at the University of Toronto in the Dalla Lana School of Public Health and Joint Centre for Bioethics. He is also an Ethicist at Sunnybrook Health Sciences Centre and North York General Hospital. Dr. Ross E.G. Upshur is the head of the Division of Clinical Public Health at the University of Toronto Dalla Lana School of Public Health, Assistant Director of the Sinai Health Systems’ Lunenfeld Tanenbaum Research Institute, and a Professor in the Department of Family and Community Medicine and Dalla Lana School of Public Health at the University of Toronto. Together they are the authors of a recently published paper, “Ebola and Learning Lessons from Moral Failures: Who Cares about Ethics?” published in Public Health Ethics. Follow Maxwell’s research and follow Dr. Upshur @upshur_ross.