TIME Infectious Disease

Ebola Vaccines Are Being Expedited

Professor Adrian Hill, Director of the Jenner Institute, and Chief Investigator of the trials, holds a phial containing the Ebola vaccine at the Oxford Vaccine Group Centre for Clinical Vaccinology and Tropical Medicine (CCVTM) in Oxford, southern England on Sept. 17, 2014.
Professor Adrian Hill, director of the Jenner Institute and chief investigator of the trials, holds a vial containing the Ebola vaccine at the Oxford Vaccine Group Centre for Clinical Vaccinology and Tropical Medicine in Oxford, southern England, on Sept. 17, 2014 Steve Parsons—Reuters

"Nothing can be allowed to delay this work"

International experts want a fully tested and licensed Ebola vaccine scaled up for mass use in the near future, according to a recent World Health Organization (WHO) meeting.

WHO organized a panel of more than 70 experts, from scientists to medical ethicists, to reach consensus over the status of Ebola vaccines currently being tested. WHO released news from the meeting on Wednesday, the day after the U.S. confirmed its first patient with Ebola. According to the WHO statement, the mission is to “accomplish, within a matter of months, work that normally takes from two to four years, without compromising international standards for safety and efficacy.”

Two vaccines have great potential and are ready for safety testing. The first vaccine is developed by the U.S. National Institute of Allergy and Infectious Diseases (NIAID) and GlaxoSmithKline. That vaccine is currently undergoing a human-safety trial at the National Institutes of Health (NIH) campus in Bethesda, Md., as well as at the University of Oxford. The second vaccine is under development by the Public Health Agency of Canada in Winnepeg. That vaccine will start a human-safety trial in early October. Canada has already donated 800 vials of their vaccine to WHO, the organization says. Once more data is available on what dosing should be used, WHO says these vials could translate to around 1,500 to 2,000 doses of the vaccine.

The goal of the safety trials is to confirm that the vaccines are safe enough to move on to a larger human trial. Dr. Anthony Fauci, director of NIAID and the lead on the NIH vaccine, tells TIME the safety trial is so far “uneventful,” which is a good thing. “There really [are] no red flags so it seems to be going along quite well,” he says. The vaccine had already been tested in monkeys and showed very promising results.

WHO and other organizations have been expediting the testing and approval processes for these drugs since early summer, but the NIH’s vaccine has been under development since 2003. At the time, it did not have the pharmaceutical funding to move forward. “[In 2003] there was very little interest for the obvious reasons that there was no disease around,” says Fauci. “Recently, we now have a much more vigorous interest from pharmaceutical companies.”

WHO hopes that in October and November, the vaccines will make it through their safety trials and into next-stage human testing. Between January and February 2015, the goal is to have next-phase human trials approved and initiated in countries affected with Ebola. People at a higher risk for the disease, like health care workers, are a priority.

The meeting did not highlight ZMapp, the drug given to two American patients who were evacuated from Liberia to Emory University in Atlanta. Mapp Biopharmaceutical, the company that produces ZMapp, is a small team that says its resources are now exhausted. Their drug is grown in tobacco plants and requires waiting for a crop in order to produce more of it.

One of the ways trials could be quickened is if the researchers take a “wedge” approach, which means that a wedge or slice of the study population is selected for a first step in the trial, and what is learned in that step is then used on the next slice of the participants. While trials are ongoing, there are still significant technical obstacles that need to be addressed once a vaccine is ready for mass use: how vaccines will be distributed, for instance, and how low-resource health systems can ensure that vaccines are stored below –100 degrees.

In the WHO meeting, the phrase “Nothing can be allowed to delay this work” was repeated multiple times, and since Ebola has now infected more than 7,000 people and even made it to the U.S., the race to develop an effective vaccine is becoming all the more frantic.

TIME Infectious Disease

The 5 Biggest Mistakes in the Ebola Outbreak

Members of a burial team wearing protective suits bury an Ebola victim in Freetown, Sierra Leone.
Members of a burial team wearing protective suits bury an Ebola victim at King Tom Cemetery, which is bitterly resented by residents of the adjoining slum, called Kolleh Town, in Freetown, Sierra Leone, Sept. 21, 2014. Samuel Aranda—The New York Times/Redux

Experts weigh in on how the outbreak got this out of control

The U.S. Centers for Disease Control and Prevention (CDC) recently projected that if trends continue unimpeded, cases of Ebola could pass the million mark by January. While that’s an unlikely scenario, many are still wondering: How on earth did it get this bad? We canvassed experts for some clues.

1. The response was far too slow
There was a period in April when it appeared that the Ebola outbreak had subsided, prompting a collective sigh of relief. Guinea’s Ministry of Health even said that country’s caseload appeared to be under control. But the outbreak didn’t subside. Instead, it barreled through interconnected towns and villages in more-populated areas of Guinea, Liberia and Sierra Leone. And after the outbreak’s perceived lull, however, came one of the largest flare-ups. Some scientists say that during that time, their warnings were ignored.

One such scientist is Robert Garry, a Tulane University virologist who had visited a hospital in Sierra Leone caring for some of his colleagues, including Dr. Sheik Humarr Khan — one of the first doctors to die of the disease in Sierra Leone. Garry then warned various groups, including the State Department, that the outbreak was highly concerning. No one, he says, really listened to him. “Their response was cordial, but nothing really happened,” says Garry. “I was really concerned about the lack of attention. I caught a lot of flack for saying I didn’t think the numbers [of reported cases and deaths caused by Ebola] were accurate. Some of us realized this was not going to be controlled.”

In a recent paper published in the New England Journal of Medicine, Peter Piot, director of the London School of Hygiene and Tropical Medicine and one of the original researchers to discover Ebola in 1976, writes: “Ebola has reached the point where it could establish itself as an endemic infection because of a highly inadequate and late global response … It was not until five months and 1,000 deaths later that a public health emergency was declared, and it was nearly another two months before a humanitarian response began to be put in place.”

2. A lack of cultural sensitivity
Patricia Omidian, a medical anthropologist, was sought by the World Health Organization (WHO) to spend time in Liberia to help Ebola response workers better understand the communities they were serving. “I think the biggest mistake that occurred very early was that primary health care was ignored and communities were not included in their own health issues,” she says. “Programs were rolled out and people were told what not to do. No effort was made to ensure engagement and increase trust.”

Omidian’s work included explaining some of the cultural practices among Liberians, including burial rituals that involve a lot of physical contact, putting mourners at risk of contracting the virus. “This disease attacks the best of [Liberians'] culture — that of touching and caring and kindness,” says Omidian.

3. We don’t have deployable medical teams
The CDC, WHO and U.N. have important jobs when it comes to containment practices like tracking down people who may have come in contact with infected patients, and using technology to predict disease spread. However, none of those groups actually treat patients, or have doctors and nurses they can deploy. This is something that Dr. Jack Chow, professor of global health at Carnegie Mellon University and a former WHO assistant director general, says needs to change.

“The Obama mission to Liberia, which is relying on the military at the last minute, shows that the U.S. and other industrial countries haven’t built up comparable deployable medical units on the civilian side, and need to do so to prepare against future ‘flashdemics’ — high-velocity, high-lethality outbreaks,” says Chow. “In addition to building an international epidemic response force, we need to conceptualize ‘global health defense’ to include bolstering the health systems of the poorest countries.”

4. A lack of approved drugs and cures
The scarcity of drugs and vaccines is not due to a lack of innovation. Drugs have been in development for years, but since pharmaceutical companies have had no financial incentive to fund them, researchers have hit walls. “People like me and others who have worked for years in vaccines and countermeasures are frustrated,” Thomas Geisbert, a professor of microbiology and immunology at the University of Texas Medical Branch in Galveston, said in an earlier TIME article. The supply of ZMapp, the drug that was given to a few health care workers, is exhausted. It comes from a small pharmaceutical company with nine employees, and the drug grows in a tobacco plant — requiring scientists to wait for a new crop to grow just for a new batch. Thankfully, clinical trials for other drugs have kicked off.

5. Treating Ebola as a “West Africa” problem
“It’s crucial countries not be lumped together,” says Nigerian Minister of Economy and Minister of Finance Ngozi Okonjo-Iweala. “The media writes about Africa and West Africa, but there needs to be differentiation. This will end up hurting the economies of countries that have no problems. Ghana never had any cases, Burkina Faso never had any cases.” Okonjo-Iweala was also the former managing director of the World Bank, and has seen how stigma damages economies.

“We should stick to the specific countries so as not to cause massive economic damage,” says Okonjo-Iweala. “We have worked very hard to get the private sector to invest in Africa for the continent to grow based on the fact that we are a continent with a lot of vigor and good rates of return on investment. If you scare away investors by lumping the continent into one big mass, what good does it do? It will take another decade to recover.”

Nigeria has had 19 cases, seven deaths and everyone else survived. As of Tuesday, the 21 days of incubation expired for people who treated the infected, so currently no one is being monitored. “We’ve worked hard as a continent to overcome this kind of stigma of disease,” says Okonjo-Iweala.

TIME Infectious Disease

CDC: Cases of Ebola Could Double Every 20 Days

Members of a burial team wearing protective suits bury an Ebola victim in Freetown, Sierra Leone.
Members of a burial team wearing protective suits bury an Ebola victim at King Tom Cemetery, which is bitterly resented by residents of the adjoining slum, called Kolleh Town, in Freetown, Sierra Leone, Sept. 21, 2014. Samuel Aranda—The New York Times/Redux

A new CDC report predicts the enormous cost of delayed response to Ebola

If Ebola conditions continue without a scaled-up effort, the CDC estimates that cases of Ebola in West Africa will double every 20 days — and in an absolute worst-case scenario without any intervention, numbers could reach 1.4 million by Jan. 20.

Using a new Ebola Response prediction tool, the CDC has published results that show that if current trends continue unimpeded, Liberia and Sierra Leone will have approximately 8,000 total Ebola cases, or 21,000 if the tool accounts for underreporting, by Sept. 20. Liberia will account for about 6,000 of those cases.

The numbers are frighteningly high, but it should be noted that it’s a prediction of a hypothetical situation in which absolutely no intervention were to happen. That won’t be the case if many countries and the UN keep their promises. The model also shows that a big response could turn the outbreak around. In another hypothetical situation, the outbreak could ease up and eventually end if 70% of people with Ebola are placed in medical care facilities, Ebola treatment units, or somewhere where transmission could be contained.

“The model shows that a surge now can break the back of the epidemic,” said Dr. Tom Frieden, director of the CDC, in a press conference. “The importance of implementing effective programs rapidly cant be over-emphasized. The cautionary finding of the modeling is the enormous cost of delay.”

During the press conference, Dr. Frieden said the outbreak is very fluid and changing, but that he does not think West Africa will meet their worst case scenario predictions. “If you get enough people effectively isolated, the epidemic can be stopped…Even in dire scenarios, if we move fast enough we can turn it around. I do not think the most dire circumstances will come to pass,” he said.

The CDC report comes out on the same day the World Health Organization released their reports on the outbreaks at six months in all affected countries, and it appears that cases in Nigeria and Senegal have stabilized “for the moment.” Last week, President Obama announced a deployment of 3,000 U.S. military personnel and over $500 million in defense spending to go to West Africa, and the UN announced a new task force called the U.N. Mission for Ebola Emergency Response. The hope is that an exponentially increased response will prevent these possible scenarios.

TIME Infectious Disease

There Could Be 20,000 Ebola Cases by November if More Isn’t Done Now

Ebola Lessons
Nurses train to use Ebola protective gear with World Health Organization, WHO, workers, in Freetown, Sierra Leone on Sept. 18, 2014. Michael Duff—AP

Public-health experts warn that the epidemic could turn from “a disaster into a catastrophe”

A new study by the World Health Organization released on Tuesday warned of 20,000 Ebola cases worldwide in just over a month’s time if authorities failed to ramp up efforts to combat the growing epidemic.

“We estimate that, at the current rate of increase, assuming no changes in control efforts, the cumulative number of confirmed and probable cases by November 2 will be 5,740 in Guinea, 9,890 in Liberia, and 5,000 in Sierra Leone, exceeding 20,000 cases in total,” read the report published in the New England Journal of Medicine this week.

The Ebola virus is spread primarily through exposure to body fluids of symptomatic patients. Transmission of the virus is prevented through early diagnosis, contact tracing, patient isolation and infection control along with the safe burial of those killed by Ebola.

However, the virus has primarily hit impoverished West African communities, where many of these protocols are difficult or impossible to enforce.

“If we don’t stop the epidemic very soon, this is going to turn from a disaster into a catastrophe,” Christopher Dye, a co-author of the study and director of strategy at the WHO, told reporters in Geneva. “The fear is that Ebola will become more or less a permanent feature of the human population.”

The publication of the new report comes as Sierra Leone concluded an ambitious lockdown of the country for three days by effectively asking its 6 million residents to stay at home while approximately 30,000 volunteers and health officials canvassed the country to distribute soap and instructions on how to prevent contraction of the virus.

There are currently 5,833 recorded cases of Ebola across six African nations. The disease has killed at least 2,833 people.

TIME Infectious Disease

Ebola ‘Pretty Much Contained’ in Senegal and Nigeria

Christopher Dye, Director of Strategy of the World Health Organization speaks to the media about Ebola Virus Disease in West Africa, during a press conference, at the European headquarters of the United Nations in Geneva on Sept. 22, 2-14.
Christopher Dye, Director of Strategy of the World Health Organization speaks to the media about Ebola Virus Disease in West Africa, during a press conference, at the European headquarters of the United Nations in Geneva on Sept. 22, 2-14. Salvatore Di Nolfi—EPA

Good news for containment of an outbreak that has killed more than 2,800 people

The outbreaks of Ebola in Senegal and Nigeria have been “pretty much contained,” the World Health Organization said Monday.

There have been no new confirmed cases of Ebola in Senegal since the first case was reported Aug. 29, and the last case of Ebola reported in Nigeria was Sept. 8, the WHO’s regional office for Africa said in a statement. The news comes on the same day the WHO released details from the second meeting of the International Health Regulations Emergency Committee on Ebola. One of the top conclusions from the group was that travel and trade should continue in West Africa:

“Flight cancellations and other travel restrictions continue to isolate affected countries resulting in detrimental economic consequences, and hinder relief and response efforts risking further international spread,” the committee said.

The Committee reiterated WHO stances on making sure health care workers are protected from possible infections and ensuring people who are quarantined still have access to food and water.

There are currently 5,833 cases of Ebola in Sierra Leone, Liberia, Guinea, Senegal, Nigeria and the Democratic Republic of the Congo (though the DRC outbreak is thought to be unrelated to the others). Among those cases, 2,833 people have died.

 

TIME Infectious Disease

Ebola Lockdown in Sierra Leone Finds 150 New Cases

Ebola Sierra Leone Lock Down
A volunteer health worker talks with a resident on how to prevent and identify the Ebola virus in others, and distributes bars of soap in Freetown, Sierra Leone, Sept. 20, 2014. Michael Duff—AP

The lockdown was one of the most aggressive containment strategies employed so far in the outbreak

A three-day lockdown meant to contain the Ebola virus in Sierra Leone ended late Sunday night with officials hailing it as a “huge success” after health workers found almost 100 victims who perished from the disease and another 56 who have been infected.

The head of the Emergency Operations Center leading Sierra Leone’s Ebola response, Stephen Gaojia, called the lockdown “a huge success,” Reuters reports. About 123 people had contacted authorities by Sunday morning thinking they might be infected; 56 tested positive for the virus, 31 negative and 36 were still awaiting results.Final numbers will only be released once information is compiled from around the country.

The lockdown was one of the most aggressive containment strategies to be employed so far in the growing effort to contain the worst Ebola outbreak in history, which has killed more than 2,600 people across West Africa. Sierra Leone ordered its six million residents to stay indoors for three days, while 30,000 health workers, volunteers and teachers circulated, educating households on how to prevent the spread of the disease.

Health Minister Abubakkarr Fofanah told AFP that volunteers had managed to reach about 80% of homes and said: “Although this campaign has ended, there is a possibility we would have a similar one some other time.”

[Reuters]

TIME Infectious Disease

Sierra Leone Staggers in Ebola Isolation Effort

Sierra Leone Ebola
A health worker volunteer talks with a resident on how to prevent and identify the Ebola virus in others, and distributes bars of soap in Freetown, Sierra Leone, Saturday, Sept. 20, 2014. Michael Duff—AP

FREETOWN, Sierra Leone (AP) — Some in Sierra Leone ran away from their homes Saturday and others clashed with health workers trying to bury dead Ebola victims as the country struggled through the second day of an unprecedented lockdown to combat the deadly disease.

Despite these setbacks, officials said most of Sierra Leone’s 6 million people were complying with orders to stay at home as nearly 30,000 volunteers and health care workers fanned out across the country to distribute soap and information on how to prevent Ebola.

The virus, spread by contact with bodily fluids, has killed than 560 people in Sierra Leone and more than 2,600 in West Africa since the outbreak began last December, according to the World Health Organization. It is killing about half of the people it infects.

The streets of the capital, Freetown, were empty Saturday except for the four-person teams going door to door with kits bearing soap, cards listing Ebola symptoms, stickers to mark houses visited and a tally to record suspected cases.

Among the volunteers was Idrissa Kargbo, a well-known marathoner who has qualified for races on three continents but whose training and career have been stymied by the outbreak.

Although early responses to the disease have been marred by suspicion of health workers, Freetown residents on Saturday seemed grateful for any information they could get, Kargbo told The Associated Press.

“Some people are still denying, but now when you go to almost any house they say, ‘Come inside, come and teach us what we need to do to prevent,'” Kargbo said. “Nobody is annoyed by us.”

Sierra Leone’s government is clearly hoping the lockdown will help turn the tide against the disease which the U.N. health agency estimates will take many months to eradicate in the country. In a speech before the lockdown, President Ernest Bai Koroma said “the survival and dignity of each and every Sierra Leonean” was at stake.

The strategy has drawn criticism, however. The charity group Doctors Without Borders warned it would be “extremely difficult for health workers to accurately identify cases through door-to-door screening.”

Even if suspected cases are identified during the lockdown, the group said Sierra Leone doesn’t have enough beds to treat them.

In a district 20 kilometers (12 miles) east of Freetown, police were called in Saturday to help a burial team that came under attack by residents as they were trying to bury the bodies of five Ebola victims, Sgt. Edward Momoh Brima Lahai said.

A witness told state television the burial team initially had to abandon the five bodies in the street and flee. Lahai said later the burials were successfully completed after police reinforcements arrived. The bodies of Ebola victims are very contagious and must be buried by special teams.

In northern Sierra Leone, health worker Lamin Unisa Camara said Saturday he had received reports that some residents had run away from their homes to avoid being trapped inside during the lockdown.

“People were running from their houses to the bush. Without wasting time, I informed the chief in charge of the area,” said Camara, who was working in the town of Kambia.

Several health care workers and volunteers complained that supply kits were delivered late, preventing their teams from starting on time.

But Kargbo, the marathoner, said his team was on track to meet its goal of visiting 60 households by the end of the lockdown Sunday. He said the effort would be worth it if the outbreak is shortened even a little.

Other Freetown residents, however, were having trouble making it through the three days.

“The fact is that we were not happy with the three days, but the president declared that we must sit home,” said Abdul Koroma, the father of nine children in Freetown.

“I want to go and find (something) for my children eat, but I do not have the chance,” he said.

TIME Infectious Disease

U.N. Launches ‘Unprecedented’ Mission to Combat Ebola

"We need a 20-fold increase in assistance," says U.N. Security-General

The U.N. announced a new mission to combat Ebola in West Africa on Thursday, promising greater resources on the ground as cases of Ebola hit 5,335.

“The gravity and scale of the situation now requires a level of international action unprecedented for a health emergency,” said U.N. Secretary-General Ban Ki-moon at a U.N. Security Council emergency meeting on Thursday.

The goal of the mission, called U.N. Mission for Ebola Emergency Response, is to stop the outbreak, treat the infected, ensure essential services are available, preserve stability and prevent further outbreaks. Ban said he plans to have a team on the ground by the end of the month.

The U.N. had previously estimated that they would need an additional $1 billion to keep the number of Ebola cases in West Africa within the tens of thousands. So far 2,622 people have died from Ebola in Sierra Leone, Liberia and Guinea alone.

“Ebola matters to us all. The outbreak is the largest the world has ever seen,” Ban said, calling for a 20-fold increase in assistance. “The number of cases are doubling every three weeks. There will soon be more cases in Liberia alone than the four-decade history of the disease.”

The Security Council also unanimously passed a resolution calling countries to provide health personnel and supplies, and declared that the outbreak was a threat to international peace and security. The resolution was co-sponsored by 131 countries, which is the greatest number in the council’s history, according to Samantha Power, the U.S. ambassador to the U.N.

The meeting comes after President Obama committed a deployment of 3,000 U.S. military personnel and over $500 million in defense spending to West Africa earlier this week. Reuters reports that French President François Hollande announced the deployment of a military hospital to a remote part of Guinea.

Other countries that Ban thanked for offering support so far include: Canada, China, Cuba, the Democratic Republic of Congo, Ethiopia, France, Germany, Ghana, Ireland, Italy, Japan, Kenya, Norway, Qatar, Russia, Rwanda, South Africa, Switzerland, Uganda and the U.K. There will likely be more stepping up in the future.

TIME Sierra Leone

Ebola Crisis Puts Sierra Leone on Three-Day National Lockdown

Ebola Timeline Of A Crisis
Medical personnel inside a clinic take care of Ebola patients in the outskirts of Kenema, Sierra Leone, on July 27, 2014 Youssouf Bah—AP

But some experts fear such measures actually do more harm than good

Sierra Leone has begun a three-day nationwide lockdown as it struggles to contend with the Ebola virus’s unprecedented, lethal thrust across West Africa.

Citizens of Sierra Leone, among the nations worst hit by the epidemic, will be banned from leaving their homes from Thursday to Sunday, the Guardian reports. During that time, health workers will travel from house to house, identifying cases, and about 21,000 police and soldiers will be deployed to keep people off the streets.

Officials in Sierra Leone have said that the lockdown would help contain the aggressive Ebola virus, which is spread through contact with bodily fluids. The disease has so far killed 2,453 people across Sierra Leone, Liberia and Guinea, and the World Health Organization (WHO) on Tuesday projected the outbreak’s toll could reach 20,000.

However, some medical officials have drawn parallels between the lockdown and the quarantines imposed elsewhere in West Africa, including in a Liberian slum where similar restrictions fueled riots and have since been lifted. Food shortages and the abandonment of sick neighbors are other possible consequences, they fear.

“It has been our experience that lockdowns and quarantines do not help control Ebola as they end up driving people underground and jeopardising the trust between people and health providers,” Doctors Without Borders said in a statement. “This leads to the concealment of potential cases and ends up spreading the disease further.”

The group also expressed concern that the roving health workers would not be equipped to accurately diagnose Ebola during the home checks and that, even when cases are identified, Sierra Leone still lacks the resources to care for more sick people.

The WHO says that about $1 billion is needed to tackle Ebola — but nations, organizations and donors have in total pledged just $838 million to fighting the crisis, and just $155 million of that sum has in fact been delivered, TIME reported on Wednesday.

The U.S government, which has pledged $500 million of that total sum, said on Tuesday that it would also set up a command center in the Liberian capital of Monrovia, sending in about 5,000 members of the armed forces.

In a speech at the Centers for Disease Control and Prevention’s headquarters in Atlanta, U.S. President Barack Obama said the Ebola epidemic had “profound security implications,” calling it “a potential threat to global security if these countries break down, if their economies break down, if people panic.”

On Wednesday, U.N. Secretary-General Ban Ki-moon said his organization was preparing to launch a ground mission in the affected countries. The U.S. has also circulated a Security Council draft resolution that instructs member states to send support, including medical personnel, to West Africa, the New York Times says.

TIME ebola

Why the U.S. Has a Special Responsibility to Help Liberia with Ebola

Residents look on as the body of a man suspected of dying from Ebola lies in a busy street, after it was reportedly dragged there to draw attention of burial teams following days of failed attempts by his family to have his body picked up, in Monrovia, Liberia, Sept. 15, 2014.
Residents look on as the body of a man suspected of dying from Ebola lies in a busy street, after it was reportedly dragged there to draw attention of burial teams following days of failed attempts by his family to have his body picked up, in Monrovia, Liberia, Sept. 15, 2014. Daniel Berehulak—The New York Times/Redux

In committing troops and cash to fighting Ebola in Liberia first, the U.S. is drawing on old historical ties

When U.S. President Barack Obama announced a dramatic expansion of American aid and military personnel to help combat Ebola in Liberia on Sept. 16, it wasn’t just because the country was suffering the worst of a devastating outbreak that has claimed nearly 2,500 lives and sickened at least twice as many more in West Africa. Though the rapidly rising death toll—the number of cases in Liberia nearly doubled over the past three weeks—is enough to more than enough to merit international concern, there are also deep historical links between Liberia and the U.S. Liberia is the closest thing America ever had as a colony in Africa, and the two countries share a unique history, strong ties—and a certain responsibility to each other.

Dubbed “Another America” by American historian James Ciment in his recent book on the country, Liberia was founded by American statesmen in 1820 and populated, forcibly by some accounts, with former slaves. According to Ciment’s account, it was an attempt to rid the United States of its burgeoning population of freed blacks, which Kentucky Senator Henry Clay, then speaker of the House, called in 1816 “useless and pernicious, if not dangerous.” It was a kind of “ethnic cleansing” for a country uncomfortable with the idea of slavery yet not prepared to accept blacks as full members of society, Ciment said in a recent interview.

By the the time of the Civil War, Clay’s American Colonization Society, founded with fellow Congressmen John Randolph and Daniel Webster to purchase land in West Africa, had sent more than 10,000 American blacks to the new country, which they called Liberia. They named the capital Monrovia, after James Monroe, who was the U.S. President when the capital was established.

The new immigrants, who came to be known as “Americoes,” set up a society largely modeled on that of the antebellum South, taking local natives as servants, and, eventually, as slaves who could be ‘leased’ out to work on the country’s lucrative rubber plantations. That early legacy of inequality laid the foundations for the revolutionary foment that eventually led to a sequence of brutal civil wars beginning in 1989 that ended only in 2003.

Liberia has only just emerged from the ravages of those conflicts, and its economy, infrastructure and leadership are not yet prepared to take on a crisis as big as the current Ebola outbreak. Sierra Leone, of course, suffers a similar post-conflict situation due to its own recent civil war, but there Ebola is not as widespread.

Still, there has been some grumbling from residents of both Sierra Leone and Guinea, the two other countries most affected by the outbreak, that they are not getting as much American largesse. American officials say that the assitance at the epicenter of the outbreak will help all afflicted countries. But each of those countries is getting additional assistance from former colonial masters as well: France is sending 20 health and medical disaster specialists to Guinea and has donated $200,000 to the French Red Cross’s operations there, in addition to a $1 million grant to the European Union’s humanitarian agency’s work on Ebola in the region. And Britain has announced that it will be sending troops to its former colony, Sierra Leone, to set up a 62-bed facility there. It has also committed $40 million to battle the outbreak region wide.

But even nations with no historical connection to the region are pitching in, not least would-be soft power China, which pledged to dispatch 174 epidemiologists, nurses and doctors to Sierra Leone. Considering China’s huge investments in the region, however, it has been criticized for its paltry economic assistance in the crisis.

The driving issue with all this assistance, is not how much is being offered, but how quickly it can get there. Even America’s proposed treatment wards, about ten of which will be built across the country, only offer enough places for 1,700 Ebola patients. The best solution for stopping Ebola in its tracks is quickly identifying and isolating victims. But 1,700 places for Ebola patients is barely adequate for the number of suspected cases in Liberia at the moment. With numbers doubling every three weeks, the longer it takes to get the treatment wards in place, the more beds—and graves—there will need to be.

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