Mellifluous Solutions to the 2014-2016 Ebola Epidemic
Danielle Abdennour
Introduction
Understanding the biology of the Ebola virus and the human body in conjunction with West Africa’s historical, political, and social contexts have all been necessary factors in determining how to combat such a fatal and infectious disease and end an epidemic. Science has shown that one of the most useful yet simple solutions for fighting Ebola in the early stages of infection is just that—solutions. In other words, providing intravenous fluids or simply rehydrating Ebola-infected patients can counter the effects of the hemorrhagic fever. Another simple solution to avoiding illness or ensuring quick recoveries is more mellifluous than technical. Music has provided a way for local musicians to spread vital information about the epidemic, not the infection. Local musicians have been crucial in calming counterproductive fear of the disease and addressing distrust of authorities and biomedical aid amidst political turmoil and a history of colonial abuse. Overall, examining various interdisciplinary approaches to the 2014-2016 Ebola epidemic in West Africa makes this infectious disease more understandable and less terrifying. Taking the right approaches, some of them being relatively simple, helps us remember that the Ebola virus is not the most contagious in the world, and shows us that it does not have to be as lethal as seen during the 2014-2016 Ebola epidemic. Ebola is treatable, and it is manageable.
However, there have been some obstacles in the fight against the disease. It is for this reason that analyzing the lessons learned from this epidemic can provide a resource for not making the same mistakes again in the event of other, future epidemics and pandemics. This thesis will include the following sections to discuss these mellifluous solutions and lessons learned. The first section will discuss the origins of Ebola, immediate national and international responses, and associated problems with those responses. Next, there will be an explanation of the biomedical and biochemical aspects of Ebola, treatments, and prophylactics. The third section will discuss the problems that were unrelated to scientific knowledge surrounding the virus, which includes how mistrust of foreigners, lack of infrastructure, and the historical relationship between West Africa and France played a role in the epidemic. Next, section four will introduce western versus African bioethics and the importance of community engagement in spreading the word about Ebola. Finally, section five will elaborate on the lessons learned from the epidemic and what worked effectively, followed by a short conclusion.
Section 1: Origins, immediate responses, and associated problems
The Ebola Virus Disease, also known as EVD, has existed for much longer than the duration of the Ebola epidemic which began in 2014 in francophone West Africa. According to Gregory Pence, the very first contraction of the Zaire ebolavirus strain by a human from guano bat excrements was in a bat cave in Uganda in eastern Africa in the 1980s. However, “in 2014, bats infected an 18-year-old man in Guinea, where poverty and bad health systems spread quickly to neighboring Sierra Leone and Liberia. Soon it became epidemic, killing 60-70 percent of those infected” (2021, p. 26). After the first contraction of the disease in the 1980s, more outbreaks continued. Outbreaks would later develop into an epidemic by the emergence of the Zaire ebolavirus in West Africa in 2014. With the first ever Ebola epidemic came the race to understand EVD and learn how to treat the individuals infected with the virus.
Meanwhile, the emergence of the Ebola virus also led to a frightening portrayal of the disease in news media and in popular shows and films, contributing to the fear that individuals across the globe have felt towards Ebola. According to Halsey, who discussed several examples, “In early Autumn 2014, the word ‘Fearbola’ was popularized as a description of the public's reaction to the intensity and nature of the initial press coverage of a handful of EVD cases in the United States. Airline flights were canceled, students were denied admission to school, and many with negligible risk were quarantined” (2016, p. 988). Of course, much of this can be attributed to the newness of the virus. Such fear was present in West Africa as well, with gruesome yet fabricated images of virus-afflicted civilians covered in blood on the front pages of newspapers. “One image—likely from a horror movie—displayed a man clad in a bow tie, clutching his face as bloody eyeballs bulge from his sockets with the headline, ‘Ebola Claims Ten Lives.’Another newspaper showed blood trickling down a heavily pock-marked face of what appears to be a mannequin” (Halsey, 2016, p. 998). The fear suddenly became almost as contagious as EVD itself, thus distorting the truth and preventing everyday citizens from knowing how to best protect themselves from the disease. There were even spikes in certain epidemic-related video games during the Ebola epidemic. According to an Esquire report, there was a large spike in the sale of a video game called Plague Inc during the Ebola outbreak (Ovendun, Clark, et. al, 2020). Essentially, this game puts the player in the role of a virus with the goal of infecting as many people in the world as possible. Other cases exaggerating Ebola have also become prevalent in Hollywood productions. One particular example of a film or television show is the 2019 National Geographic television drama called The Hot Zone. In a scene in this show, an African man who becomes infected with EVD is depicted breaking out in bloody blisters across his face, which doesn’t actually occur as a result of contracting the Ebola virus (Peterson, Soudars, et. al, 2019). These images parallel those in West African newspaper articles that made headline news at the initiation of the epidemic, thus reflecting global perceptions held surrounding EVD despite more realistic scientific data.
Many countries and organizations were willing to help West Africa, but others feared the effects of the virus. A more specific example of a lack of medical personnel being deployed to West Africa is the Peace Corps pulling volunteers from West Africa at the start of the Ebola epidemic. According to a report from the Health Times, after two workers had been possibly exposed to the virus without exhibiting symptoms, the organization decided to remove all other volunteers from Guinea, Liberia, and Sierra Leone; this also mirrored a Nigerian hospital shutting down after a man with Ebola had been admitted there (Rhodan, 2014). Without completely understanding how transmissible or even how treatable EVD was with the proper resources, it seems that many groups were either hesitant or unwilling to be put in such a dangerous position at that time.
Also important to note is that amidst all of the international aid and response methods, it still took significant time for individuals living in West Africa and directly experiencing Ebola to understand the virus. An outpouring of support from foreigners may have contributed to distrust already present in the region, making West Africans more resistant to aid. Essentially who the message comes from plays a major role in how individuals will react. Based on a report from NPR surrounding a young missionary working in Guinea, “The Baptists began educating villagers about how to protect themselves against Ebola. Those messages don't always get a warm welcome because of suspicion toward strangers” (2015). Such examples of mistrust as a result of the above international responses will also be analyzed in greater detail later in this thesis.
Section 2: The biomedical and biochemical aspects of EVD, treatments, and Prophylactics
As previously discussed, popular perceptions of Ebola in films and other media are often terrifying, filled with individuals eating exotic wild game, facing hopelessness, and experiencing bloody and gruesome deaths. On the other hand, while scientific research has proven how contagious Ebola is compared to other infectious diseases such as Typhoid Fever and Meningitis (McCandless, Kashan, et. al, 2018) as the epidemic progressed, researchers have also come to understand how the virus attacks the body and how it can be effectively treated. Transmission of EVD can occur between a variety of animals such as chimpanzees, gorillas, antelopes, and humans. However, coming into contact with blood or body fluids such as guano from fruit bats in the Pteropodidae family is how the very first case of Zaire ebola was introduced into the human population in the 1980s, as discussed previously (WHO, 2021). This is where human to human transmission begins, especially without awareness of the disease, proper sanitation practices, or infrastructure that are necessary to more feasibly combat a new disease. Similar to transmission among animals and humans, human to human
contact among bodily fluids, blood, or contaminated bodies and objects can lead to the spread of this disease. Simply burying the body of a dead family member who was infected could continue to spread EVD to those still living via contact with the body during culturally appropriate mourning rituals.
The structure of the Ebola virus also allows scientists to examine how contagious EVD is, how it infects human cells, and ultimately how to treat and prevent it. Similar to some other viruses, EVD possesses glycoprotein spikes that line its outer envelope. These glycoprotein spikes allow the virus to identify the specific cell type to which it needs to adhere. Since viruses are not living and require a host cell in order to replicate their genetic material and to further propagate, these spike glycoproteins also facilitate the injection of the virus’ genetic material into host cells. From there, viral particles which have invaded the host cell can, in a sense, “hijack” that cell’s machinery to replicate and produce viral proteins that will, eventually, lead to the death of the human host cell.
Replenishing fluids as compensation has been a prevalent topic of conversation for the scientific community surrounding treatments for EVD for a couple of reasons. First of all, not only is this method practical, but it is also one of the most simple ways to increase the survival of an Ebola-infected patient.
Even with this possible solution of utilizing statins and ARBs, the scientific community has engaged in research to seek out other solutions as well. One of these proposed drugs is called Zmapp, a monoclonal antibody cocktail used to induce a prompt immune response. Utilizing a process called “pharming,” genes that code for antibody proteins against EVD can be delivered, via viral vehicles, to the tobacco plant Nicotiana benthamiana, where the plant will in turn produce its own antibodies towards EVD which can later be extracted and purified (Quereshi, 2016).
Another example of a possible treatment against the virus that scientists have been investigating in the face of the Ebola epidemic includes the use of small interfering RNAs, or siRNA. In a 2014 study, siRNA was modified to target VP35 and utilized a modified lipid nanoparticle, or LNP, to deliver the siRNA to host cells; after animals were infected with Ebola and then treated with the siRNA technology, all subjects survived, while all untreated controls died (Cross, Mire, et. al., 2018, p. 422).
All of the above treatments are examples of methods that scientists and physicians have researched in order to aid those who have already been exposed and infected with EVD. However, as seen with many other viruses and epidemics, prophylactic methods such as vaccination against Ebola could be crucial to preventing infection in the first place and limiting the spread of this disease.
Section 3: Problems that were unrelated to scientific knowledge surrounding EVD
While there has been immense scientific research and discovery surrounding how to treat Ebola, there have been some obstacles to actually providing such treatments to West African individuals. Paul Farmer explains, “Improving care means introducing capacity to monitor electrolytes, which we've recently done in rural Sierra Leone, instead of doing a single lab test for Ebola. It means cooler units -- even fans would help -- and personal protective gear made for tropical conditions. It means improved nutrition and a lot more support for the public health delivery system” (2015, p. 2). Resources as simple as air conditioning, electricity, proper PPE, and overall improved facilities have allowed Americans and Europeans infected with EVD to recover and survive, despite the high mortality rates in West Africa. Without providing these simple resources that are so widely available in the western world, it does not matter how many high-tech drugs are available to combat Ebola. In addition, Farmer questions if there is a relationship between the reluctance of West Africans to seek care due to “hot and raggedy Ebola units” (2015, p. 2). If better underlying conditions that we take for granted in the western world become more accessible in West Africa, more people might in turn seek medical care. This could even show that some of the advanced drugs and technology might not even be necessary.
In addition, the lack of infrastructure in Guinea, Sierra Leone, and Liberia has contributed to poor resource distribution and inadequately combatting EVD. Similar to the importance of providing simple resources to West Africans nations, it is also crucial to possess the means to communicate and transport such resources. Essentially, the two go hand in hand. Some examples of a lack of infrastructure include low health care worker capacity, inability for good contact tracing, poor road systems and transportation, and weak telecommunications. Guinea, Sierra Leone, and Liberia are some of the poorest nations in the world experiencing weak infrastructure, with health care worker capacity being at one or two per population of 100,000; at the same time, poor transportation and roads have led to delayed diagnostic confirmation in those regions (Coltart, Lindsey, et. al, 2017, p. 14). It is not only the diagnostic samples that require swift transportation and decent roads. Transporting simple resources such as air conditioning and electricity units, as well as drugs and vaccines that may need appropriate refrigeration, are all dependent upon good infrastructure systems that are not prevalent in much of rural West Africa. At the same time, having few well-equipped health care workers will also do more to harm than to improve the situation. Strong contact tracing, another aspect of a strong infrastructure, is crucial for controlling the spread and mitigating isolation among those who have been infected or exposed. The lack of infrastructure and contact tracing corroborates the high numbers of infection mortality rates seen across the borders of West Africa.
West Africans do not just express this mistrust towards their own governments, but towards foreigners and strangers as well. Much of this can be attributed to past experiences that Africans have had with Europeans, especially during the colonial period. This description applies to the French colonial responders who responded to the Bubonic Plague crisis in Senegal between 1914 and 1945. “Yet at the same time, both civil and medical officers were determined to use medical knowledge to justify their continuing rule over Africans, whose forms of knowledge were either irrelevant, or worse, distorted and harmful to the public good. Both groups of French decision makers brought with them cultural baggage which denigrated Africans, while at the same time permitting facile generalizations about a complex continent” (Echenberg, 2001, p. 90). In the mid-1900s, injections of pentamidine became compulsory for Africans to prevent sleeping sickness; those who protested such injections were criminalized as being individualistic and undisciplined, despite the significant side effects and failure of the drug to adequately prevent the disease (Giles-Vernick and Webb, Jr, 2013, p. 81-83). Lack of knowledge of African culture, as well as forcefully injecting West and Central Africans with pentamidine, was another instance of how colonial medicine has led the African population to widely distrust foreigners preaching that they know what’s best for their population.
Section 4: Western versus African bioethics and the importance of community Engagement
Few sources have been found regarding specifically West African bioethical principles that medical workers are supposed to follow surrounding the EVD epidemic. In fact, most bioethical principles are largely influenced by the western world, such as Europe and the United States. African biomedical authorities are currently undergoing an analysis of their own values, trying to create a unique set of African bioethical principles that remain distinct from those of the western hemisphere. This can be exemplified by the role of PABIN in Africa, or the Pan-African Bioethics Initiative, which Barugahare introduces in his article on African bioethics. PABIN itself lists one of its strategic plan action items as “contributing a concerted African voice to the international discussions on ethics and science in health research” (Ouagadougou, 2007). Therefore, the role of organizations and initiatives such as PABIN may be able to counter the popular opinion that “current bioethics is foreign to Africa and, therefore, lacks ‘Africanity’/‘Africanness’ or ‘authenticity’ in Africa” ( Barugahare, 2018). However, this idea of developing common pan-African ideologies is not new. In fact, the first president of Guinea in 1958, Ahmed Sékou Touré, was a Pan-Africanist. According to Maelenn-Kegni Toure, President Touré helped found the Pan-African Democratic African Rally, led protests against French western colonization and ideology, and attempted to establish a union of African states, later resulting in the 1963 Organization of African Unity (2009). It is necessary to point out that while there currently is not enough information on specifically West African bioethics, African groups and individuals have been trying to establish collective ethical views and ideologies for years. Just as “western” ethics and values do not encapsulate just one nation or religion, the same could be true for a set of united and established African ethical standards.
Overall, it is important that African institutions continue to develop their own bioethical standards, especially after delayed response to EVD from foreign countries and organizations. For example, some African ethical principles include ubuntu and human life invaluableness. While concepts of ubuntu and human life invaluableness are identified as southern African, the previously discussed Pan-Africanism has acted as a political movement to unite Western, Eastern, Central, and Southern Africa. Considering Guinea’s history of Pan-Africanism and a Pan-African president, adherents of this concerted ideology might welcome such disparate ethical principles. Therefore, ubuntu and human life invaluableness may be able to offer insight on the ethicality of some of the actions taken by foreign and African organizations during the 2014-2016 EVD epidemic. In this section, ubuntu and human life invaluableness will be contrasted with bioethical principles from both western ideology and Catholic Social Teaching, then be applied to the ethicality of the prophylactic vaccine response taken to the EVD epidemic. Though Catholic adherents are a minority in West Africa, Catholic Social Teaching will be contrasted to African ethical principles in the coming section because of the influence of French Catholic missionaries in West Africa. There are also Catholic medical NGOs operating in Guinea neighboring West African countries. For example, Catholic Relief Services (CRS) has played a role in Guinea since 2000 and in the more recent Ebola epidemic by training local healthcare workers and providing routine care (Stulman, 2015). In addition, Catholic Social Teaching is grounded in natural law, which is presumably intrinsic to humanity. According to Jean Porter, Catholic Social Teaching “suggests a way of thinking about the natural law that is distinctively theological, while at the same time remaining open to other intellectual perspectives, including those in the natural sciences” (2005, p. 5). Catholics therefore “insist on the possibilities for some kind of universal ethic, grounded in reason rather than in prerational nature” (Porter, 2005, p. 41), thus providing for the possibility of comparison between Catholic and African ethical viewpoints. In sum, southern African ethical standards have been applied to the situation in West Africa, predominantly due to a lack of indigenous language and open access scientific research in this region. Therefore, further research into and official development of West African ethics, or des éthiques ouest-africaine, is crucial.
It is important for anyone intervening in the epidemic to take part in community engagement and solidarity. Essentially, it is crucial that foreigners responding to the crisis in West Africa adapt to the culture there. According to McConnell and Darboe, “Preventing Ebola transmission requires adaptation of valued social practices that involve touch, such as handshaking, sharing food, caring for the sick, and touching the bodies of the dead. Presenting these practices as wrong and bad can provoke conflict and misunderstanding where they are seen as a social good” (2017, p. 33). It might seem contradictory to engage in a handshake or share food, as well as undertake proper cultural burial practices. However, as long as these are done in a safe manner, they can be crucial in improving trust and showing compassion to individuals who are already faced with enough stress regarding falling ill or losing loved ones. In one case, a West African woman named Fifi who suspected she had Ebola went to her traditional healer looking for gloves to aid her Ebola-infected relative, but the healer warned her that gloves are disrespectful; later, after the death of Fifi’s relative, she cleaned the body without gloves to avoid disrespect, became infected herself, and eventually died of Ebola (Marindo, 2017, p. 210). Objects as simple and common in western medicine as gloves may be seen as offensive in African culture. Simple differences in meaning can lead to more infection and more death, reasserting the necessity of working with the community to improve understanding.
Section 5: Lessons learned/what worked and why?
Some lessons learned from the 2014-2016 Ebola epidemic include swift international response, utilizing cheaper and more accessible drugs, the importance of proper infrastructure, understanding cultural practices and beliefs, and proper foreign and national collaboration in order to effectively treat and prevent the disease. Guinea, Sierra Leone, and Liberia are some of the poorest countries in the world and have recently dealt with civil conflict, contributing to deficient infrastructure, including lack of health facilities, weak roads, and fragile telecommunication systems (Coltalt et. al, 2017). This is why, in the face of a new epidemic, international intervention should first respond by supplying poor countries with proper PPE and building health and laboratory facilities with air conditioning and ventilation. However, international and foreign workers must communicate with national leaders and then community members and civilians. In order to do so effectively, it is important to understand both cultural beliefs and practices to improve trust in countries facing political turmoil. According to Sankoh, “Responders initially told Liberians not to eat bushmeat until they realized that bushmeat was a source of both protein and income for citizens. The revised message was that bushmeat could be eaten if cooked properly, and this message was effective.” If foreigners come in and start telling the public to stop certain cultural practices, it is understandable that the local population will be resistant to the message if they do not understand the basis of such orders, only worsening the transmission of a disease. This underlines the importance of foreign intervention in understanding basic local practices. Another instance of foreign workers effectively spreading the word among local community leaders can be exemplified by an approach taken by Dr. Mbaye, a Senagalese doctor who worked to combat the virus in the Democratic Republic of Congo in 2019. He explains, “We decided to have what we call ‘community expression’ meetings, or tribunes, where we sit and listen to what people have to say, give them the chance to ask questions, then answer them as best we can. People began to understand that we were there to help them solve their problems, not tell them how to solve them. For example, we say: ‘Ebola isn’t our problem, it’s your problem. It’s your family, your child, your community. And it’s for you to help them accept the response teams. You need to be engaged for your community. This is very important’” (WHO, 2019). It seems like directly allowing people to ask questions and feel heard via community engagement allowed them to start to realize the type of threat they faced regarding Ebola. Dr. Mbaye goes on to explain that he and his colleagues attempted to spread the word among a dangerous militia group, successfully gaining trust of the militia after meeting with the leader and explaining the facts of Ebola.
Section 6: Conclusions
Based on these lessons learned, it is beneficial to look at the 2014-2016 Ebola epidemic and analyze what worked and why. Despite immense hysteria surrounding “fearbola” in media across West Africa and around the world, it is important to consider the response taken by different countries and organizations such as the WHO, Médecins Sans Frontières, the International Medical Corps, and the Bill and Melinda Gates Foundation. The WHO lacked trained and experienced healthcare workers to deploy to West Africa, but still many organizations worked together to identify and understand what was behind the outbreak that began in late 2013. Médecins Sans Frontières was the first organization on the ground to notify both the Institut Pasteur and the WHO about developing cases in West Africa. France became readily involved, despite prior historical ties, colonial abuse, and the West African nations declaring independence from France in the mid 1900s. Laboratories in both Lyon and Paris readily undertook the task of identifying the specific hemorrhagic disease and classifying the strain of Ebola due to the lack of any compatible laboratories in West Africa. France also donated millions of euros to the outbreak, followed by the expansion of the work of Institut Pasteur de Dakar in Senegal to start a lab in Guinea as well. It is thanks to the arrival of the IPD lab in Guinea as well that developed rapid PCR testing to quickly identify those infected.
In addition, research helped physicians and scientists to quickly understand the mechanism of how Ebola acts on the human system and endothelial barriers, leading to further research into effective treatments and vaccines which are now currently being used to combat the epidemic. For instance, replenishing fluids and utilizing siRNAs, angiotensin receptor blockers and statins, and Zmapp antibody cocktails are all possible treatments for EVD. While there has been some hesitancy to receive the available ERVEBO vaccine in West Africa, this may have to do with communication or affordability. However, in Guinea, there has been immense vaccination success since its more recent introduction to the region in 2021. Improved communication among international responders, community leaders, and thus everyday citizens has resulted in the vaccination of more than 1,600 Guineans and Guinea’s need for additional doses of vaccines. Regardless, vaccination can be a costly option. Research has also shown that cheaper drugs including statins and ARBs were already fairly accessible to the West African population and have been fairly effective at counteracting Ebola in most available studies. This was a crucial finding that may have helped the population in the region while scientists looked into other solutions such as monoclonal antibodies and vaccines.
Community engagement, not just simple communication, also proved to be a crucial part of controlling the spread of disease once it was effectively implemented. The failure to engage with local communities early on had detrimental effects, especially considering that multiple West African individuals place more trust in community leaders than in government officials; however, once responders acknowledged social structures and cultural values, this resulted in a more effective outbreak response (Coltart, Lindsey, et. al, 2017, p. 15). Bioethics also played an important role in understanding community engagement. There is little research on specific West African bioethical standards pertaining to the Ebola epidemic, but Pan-Africanism allows southern African ethical principles such as ubuntu and human life invaluableness to be applied to the situation. Ubuntu emphasizes interdependence on and solidarity with one’s community, and human life invaluableness refers to the sacredness of each human life. These values contrast with western Principlism yet find some common ground with Catholic Social Teaching, all while proving the importance of engaging with communities from the grassroots. Some examples of effective community engagement were encouraging fellow Africans to engage in cultural practices that would help inform the public about the disease, such as through artistic expression. Using song and music from the very start in The Gambia, West Africa, was living proof of the usefulness of community engagement. In The Gambia, infrastructure using a type of prophylactic musical approach helped prepare the population for Ebola, and not one case of Ebola emerged there (Stone, 2017, p. vii) despite frequent traffic between The Gambia and Guinea via Senegal. This shows that it is sometimes the most unexpected that can also be the most effective solutions to scientific problems. If such community engagement and adaptation to cultural values took place earlier in other West African nations, as seen in The Gambia, the outbreak could have potentially been stopped earlier.
Finally, the lessons learned and conclusions formed surrounding the Ebola epidemic in West Africa can thus be applied to other epidemics and pandemics, such as the COVID-19 pandemic. For instance, common drugs such as ARBs were found to be a possible treatment for Ebola. Throughout the COVID-19 pandemic, it has proved crucial to perform research trials on common drugs that might prove effective to determine what in fact works while developing new treatments and vaccines. In addition, during the Ebola epidemic, hysteria was propagated via the media, and West African communities lacked trust in their own governments and foreign aid. A similar problem has existed throughout the COVID-19 pandemic, with people distrusting their health officials and governments on the proper course of action for staying healthy or for receiving vaccines. This once again emphasizes the importance of community engagement and proper messaging anywhere in the world. Providing information about social distancing and hygiene to disadvantaged communities who lack resources for receiving reliable news is crucial to slowing the spread of the virus, for example. This is especially true in a pandemic, when an even larger variety of cultures and nations are affected, often with very diverse ethical beliefs. In sum, it is important for countries, NGOs, and scientists to work together during epidemics or pandemics while engaging with the public and taking into account all cultural, social, and ethical beliefs.
References
Clark, M., & Ovenden, O. (2021, February 20). The 20 best pandemic movies, books, docs and games to satisfy (or soothe) your coronavirus anxiety. Esquire. Retrieved April 13, 2022, from https://www.esquire.com/uk/culture/books/a31330699/pandemic-movies-streaming-n etflix-books-tv-games/
Coltart, C. E., Lindsey, B., Ghinai, I., Johnson, A. M., & Heymann, D. L. (2017). The ebola outbreak, 2013–2016: Old lessons for new epidemics. Philosophical Transactions of the Royal Society B: Biological Sciences, 372(1721), 1–24. https://doi.org/10.1098/rstb.2016.0297
Cross, R. W., Mire, C. E., Feldmann, H., & Geisbert, T. W. (2018). Erratum: Post-exposure treatments for ebola and Marburg virus infections. Nature Reviews Drug Discovery, 17, 413–434. https://doi.org/10.1038/nrd.2018.73
Echenberg, M. J. (2002). Black Death, White Medicine: Bubonic Plague and the politics of public health in colonial Senegal, 1914-1945. James Currey.
Farmer, P. (2015, January 16). The secret to curing West Africa from ebola is no secret at all. The Washington Post. Retrieved April 14, 2022, from https://www.washingtonpost.com/opinions/paul-farmer-the-secret-to-curing-west-afri ca-from-ebola-is-no-secret-at-all/2015/01/16/658a6686-9cb9-11e4-bcfb-059ec7a93dd c_story.html
Giles-Vernick, T., & A., W. J. L. (2013). Global Health in Africa: Historical perspectives on disease control. Ohio University Press.
Halsey, E. S. (2016). An Outbreak of Fearsome Photos and Headlines: Ebola and Local Newspapers in West Africa. The American Journal of Tropical Medicine and Hygiene, 95(5), 988–992. https://doi.org/doi:10.4269/ajtmh.16-0245
Leahy, K. (2015, January 23). American Millennial Missionary in Guinea isn’t scared off by ebola. NPR. Retrieved April 13, 2022, from https://www.npr.org/sections/goatsandsoda/2015/01/23/379282713/american-millenni al-missionary-in-guinea-isnt-scared-off-by-ebola
Marindo, R. (2017). Gendered Epidemics and Systems of Power in Africa: A Feminist Perspective on Public Health Governance. Africa Development , 42(1), 199–219. https://doi.org/https://www.jstor.org/stable/90013906
McCandless, D., Kashan, O., Quick, M., Webster, K., & Starling, S. (2021, November 23). The microbescope – infectious diseases in context. Information is Beautiful. Retrieved April 13, 2022, from https://www.informationisbeautiful.net/visualizations/the-microbescope-infectious-dis eases-in-context/
Pence, G. E. (2021). Pandemic bioethics. Broadview Press.
Peterson, B., Souders, K., & Vintar, J. (2019). The Hot Zone. Netflix.
Porter, J. (2013). Nature as reason: A Thomistic theory of the Natural Law. William B. Eerdmans Pub.
Rhodan, M. (2014, July 30). Ebola outbreak: Peace Corps pulls volunteers from West Africa. Time. Retrieved April 13, 2022, from https://time.com/3060483/ebola-peace-corps/
Stone, R. M. (2017). Mobilizing musical performance and expressive culture in the ebola 2014 epidemic: Introduction. Africa Today, 63(3), vii-ix. https://doi.org/10.2979/africatoday.63.3.01
Qureshi, A. I. (2016). Treatment of ebola virus disease. Ebola Virus Disease, 159–166. https://doi.org/10.1016/b978-0-12-804230-4.00011-x
World Health Organization. (2021). Ebola virus disease. World Health Organization. Retrieved April 13, 2022, from https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease