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Ebola epidemic is a ‘Black Swan’ event, say U of M infectious disease experts

The commentary argues that more so than any other infectious disease, Ebola is threatening regional and country stability in West Africa.

A health worker checks the temperature of a woman entering Mali from Guinea at the border in Kouremale.
REUTERS/Joe Penney

West Africa’s Ebola epidemic is a “Black Swan” event that is likely to severely alter how the world approaches future global public health crises — even more so than the AIDS epidemic has done — according to a commentary published Friday in JAMA Internal Medicine by Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP).

The commentary argues that more so than any other infectious disease, Ebola is threatening regional and country stability in West Africa, as well as exposing serious flaws  — driven in large part by budget cuts — in the ability of the World Health Organization (WHO) to lead a coordinated and effective response.

The commentary is co-authored by Dr. Kristine Moore, CIDRAP’s medical director, and Lawrence Gostin of the O’Neill Institute for National and Global Health Law in Washington, D.C.

Sudden and extreme

The term “Black Swan” was coined in 2007 by risk analyst and scholar Nassim Nicholas Taleb to describe an event that occurs unexpectedly (“because nothing in the past can convincingly point to its possibility”), that has a major — indeed, extreme — impact, and that becomes explained after the fact with “concocted” rationalizations.

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Osterholm and his commentary co-authors propose that the unfolding Ebola epidemic has all the makings of such an event, although with one exception  — “the global public health community will be working to contain it for months, or years, to come.”

Michael Osterholm
Michael Osterholm

They also say that because of its “Black Swan” characteristics, the Ebola epidemic offers two major lessons that should change the way all of us think about the global threats and potential effects of infectious diseases.

Lesson No. 1: “There is now clear evidence that an infectious disease such as Ebola virus disease can threaten the stability of a country’s or region’s government, economy, and social fabric,” Osterholm and his colleagues write. “Although other infectious diseases, including AIDS, malaria, tuberculosis, childhood diseases that are preventable by vaccine, and diarrheal illness, have killed more people in Liberia, Sierra Leone, and Guinea during the past year than Ebola virus disease has killed to date, those diseases have not destabilized the region. This is another painful lesson that what kills us may be very different from what frighten us or substantially affects our social system.”

The Ebola epidemic thus suggests that the urgency with which we develop vaccines for an infectious disease should not necessarily be driven by past experiences with the disease.

“An essential characteristic of a Black Swan event is the inappropriate rationalization after the fact with the benefit of hindsight,” the commentary’s authors explain. “Researchers and public health officials should have and could have imagined what a virus such as Ebola that is transmitted through direct contact could do once it infected people outside of sparsely populated rural Africa and found its way into the crowded and impoverished neighborhoods of large African cities. The lesson to be learned is that more creative imagination is needed in considering future infectious disease scenarios and in planning accordingly.”

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Lesson No. 2: The world has relied on WHO “to lead and coordinate the international response to infectious disease outbreaks of global importance,” but so far, due primarily to budget and staff cuts, the organization “has not been able to mobilize sufficient funding to implement the response plan” that its own “Ebola Response Roadmap” has called for, write Osterholm and his commentary co-authors.

“We are concerned, that, without fundamental reform, the WHO will no longer [be] able to fulfill the mandate in its constitution to be the leading, coordinating agency for global health, even though the organization may have a strong desire to do so,” they add. “If its member states were to ensure adequate funding and authority, it could become, once again, the leading global health agency — and it should.”

‘Microbes can humble us’

“Before the West Africa Ebola epidemic,” Osterholm and his co-authors conclude, “most people in the United States had never heard of the virus, and if they had, considered it to be the cause of an obscure disease that lurked in the remote forests of a faraway continent. Almost no one would have predicted that physicians in the United States would be caring for patients with Ebola virus disease, that college campuses would be wrestling with matriculation policies for international students because of concerns about importing the virus, or that US troops would be sent to West Africa.”

“Once again,” they add, “we are reminded that microbes can humble us and that we should constantly work to improve out ability to detect, predict, and response to the Black Swan events that they may cause.”

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You can read the commentary in full on the JAMA Internal Medicine website.