Thanks to Greg Folkers for sending the link to this critically important article in PLOS Neglected Tropical Diseases: Outbreak of Ebola Virus Disease in Guinea: Where Ecology Meets Economy.
Guinea, Liberia, and Sierra Leone, sadly, fit the bill for susceptibility to more severe outbreaks. While the devastating effects of the civil wars in Liberia and Sierra Leone are evident and well documented, readers may be less familiar with the history of Guinea, where decades of inefficient and corrupt government have left the country in a state of stalled or even retrograde development.
Guinea is one of the poorest countries in the world, ranking 178 out of 187 countries on the United Nations Development Programme Human Development Index (just behind Liberia  and Sierra Leone ). More than half of Guineans live below the national poverty line and about 20% live in extreme poverty.
The Guinea forest region, traditionally comprised of small and isolated populations of diverse ethnic groups who hold little power and pose little threat to the larger groups closer to the capital, has been habitually neglected, receiving little attention or capital investment.
Rather, the region was systematically plundered and the forest decimated by clear-cut logging, leaving the “Guinea Forest Region” largely deforested.
The forest region also shares borders with Sierra Leone, Liberia, and Cote d'Ivoire, three countries suffering civil war in recent decades. Consequently, the region has found itself home to tens of thousands of refugees fleeing these conflicts, adding to both the ecologic and economic burden.
A United Nations High Commission for Refugees census of camps in the forest region in 2004 registered 59,000 refugees. Although the formal refugee camps have now been dismantled with improved political stability in the surrounding countries, the impact on the region is long lasting.
Having worked in Guinea for a decade (1998–2008) on research projects based very close to the epicenter of the current Ebola virus outbreak, one of the authors (DGB) witnessed this “de-development” first-hand; on every trip back to Guinea, on every long drive from Conakry to the forest region, the infrastructure seemed to be further deteriorated—the once-paved road was worse, the public services less, the prices higher, the forest thinner.
Guinea fell further into governmental and civil disarray after former president Lansana Conté's death in 2008 left a power vacuum, with a series of coup d'états and periods of violence. Although the political situation has now somewhat stabilized, the country struggles to progress; socioeconomic indicators such as life expectancy (56 years) and growth national income (GNI) per capita ($440) have crept up in the past few years, but still remain low.
Despite a wealth of mineral and other natural resources, Guinea still possesses the eighth lowest GNI per capita in the world, and the incidence of poverty has been steadily increasing since 2003.
Lastly, why is this outbreak of Ebola virus happening now? As best as can be determined, the first case of Ebola virus disease in Guinea occurred in December 2013, at the beginning of the dry season, a finding consistent with observations from other countries that outbreaks often begin during the transition from the rainy to dry seasons –. Sharply drier conditions at the end of the rainy seasons have been cited as one triggering event .
Although more in-depth analysis of the environmental conditions in Guinea over the period in question remain to be conducted, inhabitants in the region do indeed anecdotally report an exceptionally arid and prolonged dry season, perhaps linked to the extreme deforestation of the area over recent decades. At present, we can only speculate that these drier ecologic conditions somehow influence the number or proportion of Ebola virus–infected bats and/or the frequency of human contact with them.
The precise factors that result in an Ebola virus outbreak remain unknown, but a broad examination of the complex and interwoven ecology and socioeconomics may hep us better understand what has already happened and be on the lookout for what might happen next, including determining regions and populations at risk. Although the focus is often on the rapidity and efficacy of the short-term international response, attention to these admittedly challenging underlying factors will be required for long-term prevention and control.