This is the first of a two-part series.
NOTHING creates public panic or sells pulp fiction quite like a horror disease, and the haemorrhagic fever Ebola is a peerless example. Before 1995, Ebola was a rare occurrence but epidemics now occur with increasing regularity thanks to a global network of disease surveillance laboratories established since the start of this century which provide diagnoses using antigen or PCR testing.
Any illness with high fever is no longer a sign that an individual’s immune system is doing its job: it’s to be treated as a siren signalling a potential catastrophic pathogenic outbreak that must be stopped in its tracks before it spreads around the world. Over the last decade Ebola has prompted the World Health Organization (WHO) to declare two Public Health Emergencies of International Concern (PHEIC) to facilitate the testing of vaccines and therapeutics under emergency use authorisations.
Ebola is the infectious disease which sits at the intersection between the public health and climate change agendas. In a 2008 paper, Emerging Infectious Diseases (EID) written by Dr Peter Daszak, who is now the chief executive of EcoHealth Alliance (the cut-out that funded the Wuhan Institute of Virology to search for bat coronaviruses in the name of protecting human health and preventing pandemics), posited that two-thirds of EIDs are of zoonotic origin, meaning that they crossed from animals to humans and were caused by human population growth and encroachment into wildlife habitat. He claimed: ‘This encroachment may have been a key factor in Africa for the global emergence of Marburg and Ebola viruses and human immunodeficiency virus (HIV).’
Daszak’s assertion is ahistorical propaganda. It entirely ignores an important aspect of the story of these haemorrhagic diseases – the role that syringes and vaccines played in their emergence.
Marburg haemorrhagic fever virus was ‘discovered’ in 1967 after staff at Behringwerke AG, a vaccine factory in Marburg, Germany, became sick. They were all working with African green monkeys imported from Uganda. The animals’ kidneys were used to culture polio virus in order to manufacture vaccines. Staff at the Paul Ehrlich Institute in Frankfurt and a vet working at the Institute of Virology, Vaccines and Sera (Torlak) in Belgrade, Serbia, also became ill after working with tissue from the same batch of Ugandan monkeys supplied by Litton Bionetics, a US military contractor. Seven of the 31 infected people died of haemorrhagic shock. Four of six people in the second and third outbreaks were infected by laboratory needle-stick accidents. A new infectious disease was soon declared by the US Centers for Disease Control (CDC) and it was named after the town where it first appeared. No electron microscope image of this virus was ever taken at the time but the scientific process builds on accepted facts, and the existence of Marburg virus became accepted fact after further experiments made lab animals sick.
Nearly a decade later, in 1976, people in and around the small rural town of Yambuku, Zaire (now Democratic Republic of Congo (DRC)) where there was a mission with a hospital and a school run by Belgian nuns, became sick and died of organ failure. In all 318 people, including 11 of the staff at the hospital, fell ill with flu-like symptoms which progressed to abdominal pain, gastrointestinal bleeding, severe liver disease and blood clotting throughout the body. Mosquito-borne yellow fever, which is also a haemorrhagic fever, was suspected. Historically yellow fever was reported to be of little risk to Africans as it was generally mild, transient and indistinguishable from other fevers, but Europeans had higher mortality rates and more severe disease. Over a three-month period, 280 died in Yambuku including several of the nuns. As the nuns had been vaccinated for yellow fever, dogma prevailed. Rather than contemplate the possibility of vaccine failure, the hunt began for an alternative explanation and an international commission was dispatched to investigate.
The first Ebola fatality was a teacher at the Yambuku mission school who had been given an injection of chloroquine to treat malaria from which he recovered before succumbing days later to haemorrhagic fever. Prior to his illness he went on mission business to outlying villages and bought smoked and fresh antelope and monkey meat on his way home. He and his family ate antelope stew but not the monkey meat. The oft-repeated claim that Ebola virus is transmitted from animals to humans via the consumption of ‘bushmeat’ appears to rest on this anecdote although no other members of his family are reported to have succumbed. The quest for a bushmeat link is now routine during epidemics and the tenuous claim that bats are the ‘animal reservoir’ is used to explain the current wider geographic dispersal.
Today the WHO and the CDC acknowledge that Marburg and Ebola viruses are difficult to transmit unless someone comes in direct contact with bodily fluids. They are less forthcoming about the main historical route of transmission. The 1977 Zaire commission identified it as the injections which were the primary means by which Yambuku mission staff administered medications. The mission hospital kept no records of outpatients or diagnoses and was minimally equipped: ‘Five syringes and needles were issued to the nursing staff each morning for use at the outpatient department, the prenatal clinic and the inpatient wards. These syringes and needles were sometimes rinsed between patients in a pan of warm water. At the end of the day they were sometimes boiled.’
Most of the victims were women aged 18 to 30 who attended the Mission’s antenatal clinic where they were given a vitamin injection. The commission’s report says no one who was infected by injection survived and that it ‘had the strong impression that Ebola haemorrhagic fever acquired by injection differed from that due to contact with another case.’ Sick people were treated with chloroquine, tetracycline and aspirin. The epidemic ended after the Yambuku Mission hospital closed.
Next: Paula investigates how Ebola was diagnosed and what evidence there is for the existence of it as an identifiable disease.