Via Risk = Hazard + Outrage, Dr. Jody Lanard and Dr. Peter M. Sandman write: Ebola-- Failures of Imagination. Excerpt from a long and important post:
The alleged U.S. over-reaction to the first three domestic Ebola cases in the United States – what Maryn McKenna calls Ebolanoia – is matched only by the world’s true under-reaction to the risks posed by Ebola in Liberia, Sierra Leone, and Guinea. We are not referring to the current humanitarian catastrophe there, although the world has long been under-reacting to that.
We will speculate about reasons for this under-reaction in a minute. At first we thought it was mostly a risk communication problem we call “fear of fear,” but now we think it is much more complicated.
Some of the world’s top Ebola experts say they are worrying night and day about the possibility of endemic Ebola, a situation in which Ebola will continue to spread, and then presumably wax and wane repeatedly, in West Africa.
They – and we – find it difficult to understand why Ebola has not yet extended into Cote d’Ivoire, Mali, and Guinea-Bissau. (After we drafted this on October 23, a case was confirmed in Mali.)
Fewer experts refer publicly to what we think must frighten them even more (and certainly frightens us even more): the prospect of Ebola sparks landing and catching unnoticed in slums like Dharavi in Mumbai or Orangi Town in Karachi – or perhaps Makoko in Lagos. (Imagine how different recent history might have been if the late Ebola-infected Minnesota resident Patrick Sawyer had started vomiting in Makoko instead of at Lagos International Airport on July 20.)
The Pandemic Scenario
The possibility of an Ebola pandemic throughout the developing world is the scenario that keeps us up nights. We think it must keep many infectious disease experts up as well. But few are sounding the alarm.
The two of us are far less worried about sparks landing in Chicago or London than in Mumbai or Karachi. We wish Dallas had served as a teachable moment for what may be looming elsewhere in the world, instead of inspiring knee-jerk over-reassurance theater about our domestic ability to extinguish whatever Ebola sparks come our way.
We are glad that Dallas at least led to improvements in CDC guidelines for personal protective equipment and contact tracing, and belatedly jump-started front-line medical and community planning and training. But it doesn’t seem to have sparked the broader concern that is so vitally needed.
Americans are having a failure of imagination – failing to imagine that the most serious Ebola threat to our country is not in Dallas, not in our country, not even on our borders. It is on the borders of other countries that lack our ability to extinguish sparks.