Early Ebola Intervention

As I’ve alluded to in previous posts, I’m a big believer in being rational about charity. Ideally, one has several independent randomized controlled trials on which to decide how cost-effective an intervention. But sometimes that just isn’t possible. Disease outbreaks are a perfect example. Each one is different, and by the time one is able to study the situation, so much damage has been done.

It’s now believed that the current Ebola outbreak in West Africa started in Dec. 2013. Ebola had never been seen in this part of Africa before, so there was no reason to expect it.  The only way this could’ve been stopped at that point is if the entire continent of Africa were educated on recognizing Ebola, and had stockpiles of testing supplies. To say that’s unrealistic is a dramatic understatement.

In March 2014 was when the first cases were confirmed, and when MSF declared an outbreak [1]. This is the point where a massive intervention would be most efficacious. The number of cases was <100. Say each of those cases, and 10 of their closest friends were tested, so maybe 1,000 tests. At $100/test[2] that’s $100,000, which would’ve ended up saving at least 5,000 lives (and counting!). Even if each of those individuals needed to spend a night in quarantine, that’s likely another $100, so we’re up to $200,000 for 5,000 lives, or $40/life.

This assumes that the quarantine capacity already exists, and that rapid testing facilities are available. One could imagine the cost increasing 10-100x (up to $20 million).  Still $4,000/life saved seems pretty attractive. The reason it’s so cost-effective is that the intervention needed to happen early, before it could possibly be justified. If CDC had gotten involved with the required material and personnel, and some rather harsh mandatory testing and quarantine procedures were used, many lives could have been saved. And then people would be questioning why so much money was spend (and civil liberties violated) over something which turned out to be a non-issue. Was it worth it to buy that expensive umbrella when you didn’t end up getting wet?

Granted, I have the benefit of hindsight in the other direction. After seeing that this outbreak was so terrible, it’s easy to say that somebody should’ve done something earlier. All previous Ebola virus outbreaks died out after a few hundred fatalities; so throwing lots of money at it early on could’ve seemed premature. Especially when you consider that even now, deaths caused by HIV/AIDS and Malaria are on par with those caused by Ebola this year [3]. It’s difficult to prepare for some unknown, low-likelihood emergency when the day-to-day problems are so large.

Which is why the CDC, WHO, and international community should’ve gotten involved much earlier. For a long time only Doctors Without Borders was doing anything substantial[4], and they just didn’t have the resources needed. The US recently committed 3,000 troops, and up to $500 million[5]. Pay a little now or pay a lot later.

-Jacob

 

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  1. [1]http://www.msf.org.uk/article/guinea-ebola-epidemic-declared
  2. [2]http://www.bostonglobe.com/opinion/2014/10/11/stop-ebola-epidemic-must-able-diagnose-quickly/LFWpKNwHTGPqfcWRyKOKqK/story.html
  3. [3]https://i.imgur.com/At2nqgB.png
  4. [4]http://newsinfo.inquirer.net/613145/doctors-without-borders-ebola-out-of-control#ixzz3IAPjJjiL
  5. [5]http://time.com/3380545/u-s-to-commit-500-million-deploy-3000-troops-in-ebola-fight/
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