Dying a Natural Death: Ethics and Political Activism for Endemic Infectious Disease

In late 2014, the outbreak of Ebola virus disease (EVD) in West Africa

was at its peak. Th ose infected numbered in the tens of thousands.

“Hotspots” with multiple cases appeared across four nations, both in

overcrowded major cities and in isolated rural villages. Hospitals were

overfl owing. Th ere were insuffi cient laboratory facilities and trained

health care workers to diagnose cases swiftly; and disintegrated or absent

public infrastructure in all domains, from roads and sewers to epidemiologists

and health promoters, hampered international responders. Nurses

and doctors—already far overstretched, and servicing absurd populations

at a ratio of 1:1000 even before the outbreak—were often among the fi rst

infected and dead.