New England Journal of Medicine
September 27, 2018 Vol. 379 No. 13
Outbreaks in a Rapidly Changing Central Africa — Lessons from Ebola
Vincent J. Munster, Ph.D., Daniel G. Bausch, M.D., Emmie de Wit, Ph.D., Robert Fischer, Ph.D.,
Gary Kobinger, Ph.D., César Muñoz-Fontela, Ph.D., Sarah H. Olson, Ph.D., Stephanie N. Seifert, Ph.D., Armand Sprecher, M.D., Francine Ntoumi, Ph.D., Moses Massaquoi, M.D., and Jean-Vivien Mombouli, Ph.D.
West and Central Africa are experiencing explosive growth in urban populations, economic activities, and connectivity. The recent Ebola virus epidemic in West Africa demonstrated the vulnerability of the local health care infrastructure to newly emerging infectious diseases. Two key factors contributing to the epidemic’s unprecedented size were growth-related: large urban populations that overwhelmed the public health infrastructure of these resource-poor countries and the extensive spatial and technological connectivity of the population.1 These factors portend an increased risk in Central Africa of emerging infectious diseases caused by both known and unknown pathogens. Such unwelcome side effects of rapid growth can be mitigated only by strengthening the health care infrastructure, including diagnostic and clinical capacity, to meet the health care needs of the population; investment in the training of health care workers and African scientists; expansion of research capacity; development of disease-surveillance programs focused on humans, livestock, and wildlife; and rapid deployment of control measures when outbreaks occur…