Reflections on ethical challenges associated with the Ebola epidemic.

The recent tragic, horrifying and extensively reported Ebola epidemic [1] must surely lead us to question why, despite major medical progress, such epidemics continue to emerge. We should also consider their implications for our global collective future. Seeking to understand the Ebola epidemic requires viewing it in the broadest historical and sociopolitical contexts that have shaped health globally, [2] and specifically in West Africa. The West African context includes the 300-year slave trade from the 1500s to the 1800s, the scramble for Africa in the late 1880s, the legacy of colonialism, and its more recent post-independence history characterised by weak governance, corrupt dictatorships, exploitative competition for its natural resources, conflict, serial wars and migration. As a result of these complex interacting forces and the region's vulnerability within the global political economy, West Africa is one of the world's poorest regions, with Liberia, Guinea and Sierra Leone being three of the world's poorest countries. In his controversial 1994 article 'The coming anarchy' , Robert Kaplan [4] wrote that 'West Africa is becoming a symbol of worldwide demographic, environmental and societal stress … [its] conditions will soon confront our civilization … West Africa's future, even tually will also be that of most of the rest of the world. ' In the light of many recent world events, his predictions are evidently partly valid. The first, most impressive and most sustained response to the recent Ebola epidemic predictably came from Médecins Sans Frontières (MSF), whose members yet again showed remarkable valour in taking on this major challenge [5] (several South Africans volunteered to assist MSF in Sierra Leone [6,7]). The World Health Organization also made some contributions, but its response, like those of many others, was too little too late. President Obama's pledge to provide support at the end of October 2014 came just before the epidemic peaked. Eleven treatment centres were built by the USA when the epidemic was waning, so very few patients benefited. Critics have viewed responses from those beyond Africa as being determined more by concerns for donor country security and fear of spread to their shores than concern for people whose lives had been blighted for many decades by, inter alia, global economic policies driven by neoliberal ideology. However, the more than USD4 billion contributed by many donors, combined with the dedicated efforts of local personnel, MSF and others, made it possible to control the epidemic. The big …