Globalization and Public Health Management of Ebola

The assessment reflects on the implications of globalization for public health management and prevention of Ebola. It identifies the significance of globalization in terms of public health and the subsequent impact on public health management of Ebola and measures taken to address the condition. The assessment also compares Ebola to other conditions such as Polio, chicken pox and the H1N1 avian flu virus which have vaccines from a socio-political perspective. It evaluates public health management and prevention strategies for Ebola with respect to the differences among wealthy and poor nations.

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Master of Public health
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Introduction:
The human civilization has been prone to many maladies over the course of time
which have shaped the doctrines and frameworks of healthcare systems all over the world.
Public health systems are primarily required to address contextual environments while
dealing with outbreaks of communicable diseases. One of the prominent examples of such
outbreak could be identified in the Ebola outbreak of West Africa. The following assessment
is intended to identify the significance of globalization in terms of public health and the
subsequent impact on public health management of Ebola and measures taken to address the
condition. The particular highlights of the assessment would include a brief illustration of
source of Ebola, its background and routes of transmission followed by its impact on humans.
Another specific aspect of the assessment could be identified in the comparison of Ebola to
other conditions such as Polio, chicken pox and the H1N1 avian flu virus which have
vaccines from a socio-political perspective. This would be characterized by reflecting
profoundly on the reasons for which Ebola does not have a vaccine. The final section of the
assessment would be dedicated to evaluation of public health management and prevention
strategies for Ebola with respect to the differences among wealthy and poor nations
(Cushman et al., 2015). The discussion in the assessment could be used for deriving
appropriate response to the question, ‘How has globalization influenced the public health
management and prevention of Ebola?’
Ebola background:
The first known outbreaks of Ebola Virus Disease (EVD) can be traced back to 1976
in two different locations, Nzara in South Sudan and Yambuku in the Democratic Republic of
Congo. The disease obtains its signature name from the Ebola River since the second
outbreak was in a village in Yambuku which was near the river. However, the most
prominent Ebola outbreak was in 2014-2016 in West Africa since the discovery of the virus.
The severity of the outbreak was noticed in the considerably identified in the magnitude of
cases and deaths alongside its transmission across borders. The outbreak spread to Liberia
and Sierra Leone after originating in Guinea (Gemmell & Harrison, 2017). The concerns of
EVD are identified in the resultant fatal hemorrhagic fever which could be induced through
infection by any Ebola virus strains. The commonly identified Ebola virus species amount to
five among which one is responsible for causing the disease in non-human primates. The five
species of Ebola virus are Zaire ebolavirus, Sudan ebolavirus, Bundibugyo ebolavirus, Tai

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Forest ebolavirus and the Reston ebolavirus that does not cause Ebola in humans. In order to
ascertain the symptoms of EVD it is essential to identify the incubation period for the virus
that can be defined as the period between infection and the first sighting of symptoms. In the
case of Ebola virus, the incubation period ranges from 2 to 21 days. The first symptoms noted
at the onset of the disease include fever, muscle pain, sore throat, fatigue and headache. The
following conditions become complex with rashes, diarrhoea and symptoms of kidney and
liver impairment as well as possibilities of internal and external bleeding in certain cases.
These factors are clearly indicative of the impact of EVD on humans (Hobson, 2017).
The transmission of the disease is also considered as an ambiguous aspect since there
is no clear estimation of the source of the disease. However, the common assumption
pertaining to its transmission is generally identified as a spill-over event when a human
comes in contact with an infected animal followed by person to person transmission. The
commonly identified sources of infection are fruit bats, porcupines, forest antelope and
primates such as gorillas and chimpanzees (Rosen, 2015). The route of spill-over event is
identified in contact with bodily fluids of infected animals while person to person
transmission occurs through contact with bodily fluids of patients that have deceased or are
sympathetic with respect to EVD. Person to person transmission of Ebola is facilitated
through direct contact of mucous membranes or broken skin with infected body fluids, blood,
infected animals and objects as well as sexual transmission. It is also imperative to note that
Ebola is not transmitted through air or water and insects such as mosquitoes. The only
animals that have been found to be vectors of EVD are few mammalian species largely
referring to primates. After transmission between hosts, the virus enters the mucosal surface
and inhibits the host immune response that provides the opportunity for viral replication in
dendritic cells, monocytes and macrophages. In the following stages, the virus is transmitted
to the spleen and liver through the bloodstream that lead to reduction in levels of Protein C,
deregulation of the coagulation cascade, severe chemokine and cytokine responses and
release of tissue factor from macrophages and monocytes (Macintyre et al., 2015).
Ebola vaccine:
The detrimental consequences of the Ebola outbreak can be compared to a
catastrophic event that led to loss of over 11000 lives and infecting around 28000 people.
Therefore, it is imperative to consider the implications of a lack of vaccine for Ebola in this
scenario which could have otherwise prevented the numerous losses of lives. Hence it is

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imperative to consider the reasons for which Ebola does not have a vaccine while other
diseases such as polio, H1N1 and small pox do have vaccines. The comparative review would
suggest inferences from a socio political perspective reflecting primarily on the interests of
globalization in the development of a vaccine. Globalization has been assumed as a profound
instrument in changing social, economic, cultural and political frameworks all over the world.
However, the primary objective of globalization is leveraged by multinational corporations
and wealthy nations to realize their economic interests. It is imperative to consider that the
vaccines for diseases such as polio, small pox and H1N1 were developed on the urgency of
these diseases being commonly observed in all countries.
On the contrary, Ebola is specifically restricted to the developing countries in Africa
with mortality rates in developed countries such as the US and Spain could be considered
minimal. Therefore, the limited prospects of economic returns in the development of Ebola
vaccine could be assumed as a prominent reason for the delay in creation of a vaccine for
Ebola. The threats of Ebola virus have been profoundly observed since 1976 with over 26
outbreaks since that resulted in 1500 infections. However, there had been no steadfast
progress in the research and development for an Ebola vaccine as a response to the severity of
the condition.
The understanding of the factors leading to the lack of a registered vaccine for Ebola
as compared to other conditions which have a vaccine can be illustrated with references to
practical examples for rejection of candidate vaccines. First of all, researchers who have
developed functional vaccines for Ebola could not present it as a feasible business
opportunity in order to obtain funding and license for the vaccine. The humongous cost
associated with development and licensing of the Ebola vaccine is estimated in hundreds of
millions of dollars (Panczyk et al., 2017). Furthermore, it is imperative to observe that socio-
political perspectives had a major role in the promotion of initial efforts in the development
of a vaccine.
The research for developing an Ebola vaccine was initiated ten years before the West
Africa outbreak which rendered promising results albeit at a slow pace. The most noticeable
cause for the slow progress could be identified in the examples of development of proven
vaccines which prevented Ebola infection in primates that were not permitted for human
tests. While the primary rationale for development of a vaccine for Ebola would have to be
aligned with the welfare of the people in Africa and prevent further outbreaks, it was

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observed that research was primarily guided on the basis of preventing bioterrorism attacks
with Ebola virus. Since the initiation of research into development of an Ebola vaccine, many
candidate vaccines have been subjected to clinical trials on primates. However, the social
imperatives of testing unknown vaccines on humans led to the stalemate responsible for the
lack of a registered vaccine for EVD.
The complete dependence of the research and development activities in context of the
vaccine on the pharmaceutical industry draws insights into the limitations over considering
social interests at a specific period of time. Hence political precedents have to be considered
in this case as wealthy countries should exercise their financial strength by investing in the
research projects for development of Ebola vaccine. Since the primary interest for
pharmaceutical companies is vested in financial returns, they would be less likely interested
in production of a drug that could not facilitate productive economic dividends. Hence the
commitment of wealthy countries to the cause would be a prolific measure for improving the
prospects of a functional Ebola vaccine. The example of WHO’s R&D agreement that is
intended to ensure collaboration of wealthy and poor countries for development of new,
innovative and cost effective vaccines (Panczyk et al., 2017).
Public health management and prevention:
The Ebola outbreak in 2014-2016 was noted as a global phenomenon with prominent
impacts noted in all corners of the world. However, the effectiveness of public health
management and prevention strategies for the disease could be reviewed from the context of
wealthy and poor nations. The origin of EVD was in West Africa that is primarily
characterized by lower economic and educational status as compared to other countries such
as the US which are comparatively higher in terms of education and economic status.
Therefore, the public health management and prevention strategies would be characterized by
drastic differences in the two different contexts (Gemmell & Harrison, 2017).
The public health management and prevention measures in areas such as Guinea,
Liberia and Sierra Leone were primarily subject to mistrust from communities, social stigma
for health workers and community resistance to medical intervention. The reason for these
outcomes related to public health management of Ebola in poor countries could be identified
in the lack of economic stability and a profound history of structural violence. The case of
Sierra Leone could be considered as an example for illustrating the context of a poor country.
The primary purpose of outsider visits to Sierra Leone was characterized by its reputation as

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a central port for the Atlantic slave trade followed by British colonialism for its mines. In the
period of post colonialism the country was subjected to oppressive rule that led to limitations
over the access of the population to basic healthcare services, employment and education.
Furthermore, the ten year civil war from 1991-2002 was also responsible for inducing
economic instability as well as disruption of a social structure. Therefore, the context of poor
countries such as Sierra Leone characterized by distrust in government officials and agencies
alongside the perception of inequalities experienced by citizens could be considered as major
setbacks for effective public health management and prevention of Ebola.
The public health management and prevention for Ebola was initiated by national
government as well as national and international NGOs supported by the WHO (Macintyre et
al., 2015). The primary emphasis of the measures was aligned with aspects of community
sensitization i.e. the make indigenous communities conform to the fact that native practices
promote the spread of Ebola. This factor suggests the implications of the context of wealthy
nations in which the cause of a disease is ascertained in the habits and practices of society
and individuals. Despite the conflict in contexts, it can be observed that measures for
addressing socio-cultural dimensions through consideration of community needs and
limitations can provide feasible results in public health management and prevention of Ebola.
The example of introducing safe burials which experienced resistance from native
communities were associated with collaboration with local leaders and explaining the
necessity of the intervention to the community thereby leading to adaptation of the measures
for public health management and prevention of EVD.
Conclusion:
The assessment reflected clearly on the implications of globalization for public health
management and prevention of Ebola. It can be clearly inferred from the review that social
determinants of economic status and political interests are notably identified as influences on
the framework for dealing with Ebola. The development of vaccines for Ebola is primarily
inhibited due to the lack of commitment of wealthy nations and dependence of research and
development on funding from pharmaceutical companies. With response to globalization, the
public health management and prevention of Ebola can be addressed in varying contexts
through tailoring the initiatives to suit community needs and practices.
References

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