The worst is yet to come, especially when we take into account the social and economic impact of the epidemic, which has so far hit only a small number of patients (by contrast, the combined death toll of Aids, tuberculosis and malaria, the ‘big three’ infectious pathogens, was six million a year as recently as 2000). Trade and commerce in West Africa have already been gravely affected. And Ebola has reached the heart of the Liberian government, which is led by the first woman to win a presidential election in an African democracy. There were rumours that President Ellen Johnson Sirleaf was not attending the UN meeting because she was busy dealing with the crisis, or because she faced political instability at home. But we knew that one of her staff had fallen ill with Ebola. A few days ago, we heard that another of our Liberian hosts, a senior health official, had placed herself in 21-day quarantine. Although she is without symptoms, her chief aide died of Ebola on 25 September. Such developments, along with the rapid pace and often spectacular features of the illness, have led to a level of fear and stigma which seems even greater than that normally caused by pandemic disease.
But the fact is that weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola’s rapid spread. Weak health systems are also to blame for the high case-fatality rates in the current pandemic, which is caused by the Zaire strain of the virus.
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