Ebola continues to spread in Liberia, Guinea, Sierra Leone and Nigeria, where 932 of the 1,711 infected with the viral hemorrhagic fever have died. This is the worst Ebola pandemic since the disease was discovered in 1976.
Although the outbreak is limited to West Africa, Dr. Kent Brantly and nurse Nancy Writebol, two U.S. missionaries who contracted the disease in Liberia, were transported recently to a hospital in Atlanta, Georgia, under quarantine. This development has triggered significant alarm among many Canadians who, like many Americans, believe that bringing the two Ebola patients to this continent was a serious mistake.
Much of this concern stems from the fact that Ebola has no known cure, and that the Zaire strain of the virus — the one responsible for the current outbreak — is the most lethal form of the disease. However, if the virus somehow escapes quarantine in Atlanta, or if infected passengers from Africa land directly at North American airports, Canada’s public-health infrastructure would almost certainly prevent an Ebola epidemic here.
Despite its death rate of almost 60 per cent, the virus spreads only through direct contact with the body fluids of an infected person or animal; unlike other infectious diseases such as H1N1, SARS and tuberculosis, Ebola is not airborne (i.e., spread through respiratory droplets).
More important, the Public Health Agency of Canada, along with its provincial partners in health management, addresses public-health threats with various disease-specific protocols that are the legacy of more than a century of reforms precipitated by disease outbreaks in Canada.
Cholera epidemics in the 1830s, and widespread concern in the 1860s over the health dangers associated with European immigration, prompted the proclamation of British North America’s first Public Health Act in 1866, and the creation of a Central Board of Health to manage threats to population health. This era also saw the introduction of provincial controls to stop cholera’s spread, including compulsory notification of infection and immigrant detention and fumigation at quarantine stations.
After 6,000 Montreal residents died of smallpox in 1885-86, Ontario passed its first Vaccination Act in 1887, which introduced compulsory vaccination for infants and allowed civic officials to order vaccinations for adults in the event of an outbreak.
A spike in Canadian deaths from tuberculosis brought about the 1906 revisions to the federal Immigration Act, which, for the first time, barred tubercular immigrants and standardized new health-screening requirements at Canadian ports. After the widespread adoption of medical theory by the early 20th century, civic authorities launched anti-tuberculosis campaigns against public spitting and conducted laboratory testing of disease victims and/or carriers.
After almost 50,000 Canadians died of Spanish influenza immediately after the First World War, the Federal Board of Health — the precursor to today’s Health Canada and Public Health Agency — was created to manage domestic health crises and monitor population health.
Waves of polio infection in the 1930s, ’40s and ’50s led to widespread vaccination and mandatory swimming-pool chlorination throughout Canada by 1960; recurring measles epidemics in the 1960s impelled most Canadian school boards to require measles inoculation about 1970, and later the measles-mumps-rubella vaccine when it became available in 1983.
Perhaps most significantly, the arrival of severe acute respiratory syndrome in Toronto in 2003 precipitated the introduction of unprecedented infection-control protocols to stop the epidemic, and the formation of a rudimentary, SARS-specific disease-surveillance system.
Although these developments did not bring about a permanent mechanism for federal-provincial data-sharing during epidemics, the lessons learned during the SARS outbreak would offer a key starting point for containing the Ebola virus, which has a much lower risk of transmission.
Collectively, the policies and programs created over the past 150 years in response to epidemic crises have produced an effective Canadian public health apparatus that, should Ebola arrive here in the future, will almost certainly prevent a viral pandemic in Canada.
Isabel Wallace is a sessional lecturer in history at Trent University in Peterborough, Ont.
