Via Vox.com, a good article by Julia Belluz: Seven reasons why this Ebola epidemic spun out of control. Excerpt:
How did Ebola spiral so badly out of control?
There are a few obvious features that have made this outbreak different and more violent: the virus hit unprepared countries in West Africa that had no previous experience with Ebola, and it quickly moved to densely populated urban hot spots (as opposed to isolated, rural areas where the virus typically popped up in Central and East Africa).
But there are other more subtle factors that are helping Ebola survive today for the first ever Ebola epidemic. They hold lessons for public health responses of the future on how to better contain such a deadly disease.
1) Public-health campaigns started too late and didn't reach enough people
In Uganda, as soon as an Ebola case is identified, public health officials overwhelm all streams of media with messages about how to stay safe. People won't leave their houses out of fear of infection, and they immediately report suspected cases to surveillance officials. It's one of the reasons Uganda has successfully stamped out four Ebola outbreaks, even ones that have turned up in urban areas.
Dr. Anthony Mbonye, Uganda's director of health services, said this aggressive public-health awareness campaigning didn't start soon enough in the current West African outbreak. "They responded too slowly to make the community aware of the disease," he told Vox.
Ishmeal Alfred Charles, who has been working on the Ebola front-line in Freetown, Sierra Leone, said there was little awareness about Ebola until late July, about four months after the first suspected cases emerged in the country.
"It only got serious when we lost Dr. Sheik Umar Khan," he said of the prominent local Ebola physician whose July 29 death made international headlines. "That's when the political wheels (started turning) and the government started putting resources together to help."
Charles also noticed that, in the initial periods of the outbreak, most of the public-health messaging about Ebola was concentrated on mainstream media, including TV and radio, so it was mainly reaching the middle- and upper-classes of the country.
"Not a lot of people have access. We're talking about people who are living in very poor communities so they basically have little or no Internet or TV or radio."
For this reason, by the summer, Charles — who works as a program manager with the Catholic aid agency Caritas — took to the streets to spread the word. "We get people out into small communities to talk to people (about Ebola)," he said. "We gave megaphones to our community volunteers and told them to go public places, to markets, to houses." Of course, the message came too late and Ebola has now reached almost every district in Sierra Leone.
2) The countries affected by Ebola have some of the world's lowest literacy rates
Health campaigning and raising health literacy is not easy in places where people can't read. As you can see in the map below, the countries that are now most affected by Ebola — Guinea, Liberia, and Sierra Leone, circled in green — are also the ones with the lowest literacy rates in the world.