Bringing Systems-Thinking to #Ebola2014

How #Ebola2014 Got to Guinea – A Follow-Up Piece

Historically, the vast majority of documented Ebola outbreaks have been confined to communities in Central Africa [1]. However, a 2004 report by the CDC predicted that Ebola would eventually emerge in tropical West Africa – and now, as we watch the disease wreak havoc on Guinea and its neighboring countries, it’s clear that they were right [2]. This said, there are still a few questions that deserve our attention.

What we know is this: what we’re seeing today is the first Ebola outbreak in Guinea ever recorded [1].

Now, is it possible that Guinea has experienced outbreaks in the past – prior to 1976 when the disease was first “identified” by modern medicine in South Sudan and the DRC [1]? Absolutely. And given that most scientists agree that Ebola is a zoonotic disease [3], could it be that Ebolavirus has been circulating – harmlessly and indefinitely – among reservoir species in Guinea [4]? Sure thing.

…But these aren’t questions that I’m interested in addressing at the moment.

Right now, we’re bearing witness to an outbreak in Guinea that has allegedly infected more than 100 people, killing the majority of those who cross its path – for the first time in at least forty years, if not more than that [5].

So, how did this happen?

…Something must have changed, making the Guinean population more vulnerable to Ebola than it’s ever been in the (documented) past.

I’m not a virologist – and I don’t claim to be the world’s leading expert on filoviruses. At best, I’m a systems engineer who sometimes moonlights as an epidemiologist. But to my untrained eye, all signs point to some sort of ecosystem disruption.

In my last article, I explored this angle further and proposed that industrial logging and deforestation in Central Africa may have acted as an enabling condition for the (re-)emergence of Ebola in West Africa. My objective was not to give a definitive answer to the question asked in the headline. Instead, it was to provide a systems-thinking perspective to a space largely inhabited by health professionals and microbiologists.

Ebolavirus range predicted by the CDC [2].

I’ve received a few comments regarding my theory – suggesting that Ebola was bound to make an appearance in West Africa someday, that the question was never “if” but rather, “when”. I don’t disagree with this; I simply believe that the “how” question is still valid – even when it comes to seemingly inevitable events. Understanding how Ebola (re-)emerged in Guinea might help us prevent similar zoonotic disease outbreaks in other vulnerable regions. Expertise in the virus and the people it affects is essential to answering this question but can’t be considered in isolation. The animals that carry the disease and the ecosystem in which they live are equally important. We must also be willing to take a step back and look at the larger, cross-disciplinary system that connects them.

—Maia Majumder, MPH