According to Doctors Without Borders, there have been over 1,500 deaths from measles in the Democratic Republic of Congo (DRC) in the first five months of 2019. This is more than the official death toll from Ebola in DRC during the current epidemic, an epidemic that is now the second-worst in history. For Ebola, a vaccine has been used in field trials in DRC and other regions in Africa at risk for Ebola outbreaks. The results of those trials are very encouraging, so much so that the strategy has been adjusted in order to immunize even more people.
This brings up an interesting public health question: Which disease is most important in combating? The easy answer is that both are important and that both should be combated, but it’s not that easy, especially when resources are limited. Deaths are not the only indicator of the burden of a disease, either. A government might want to attack a disease that has more public attention or fear. Popular culture has painted Ebola as a disease that liquefies its victims, making them die a terrible death. Measles, on the other hand, is often described as “benign,” and those who survive it are said to be immune for life.
Survival is another big factor. The case fatality rate (proportion of deaths among the infected) is about 50%, according to the World Health Organization. Though it could be higher if proper treatment is not available. On the other hand, the case fatality rate of measles is about 1 in 1,000 (0.1%), about 500 times lower than Ebola. Measles virus is much, much more infectious, however. A person with measles can infect up to 18 other people, while someone with Ebola infects about two people on average.
In a country like the United States, measles is not considered as big a public health threat because the country can deliver supportive therapies to those who contract the disease fairly quickly. We can also move vaccine out to populations. The rule of law allows for court-mandated interventions such as mandated social distancing (i.e. quarantine) or compulsory immunization. This may not be the case in developing nations. On the other hand, there are few Ebola units in the United States, and not many healthcare providers would know how to deliver care in a safe way that prevents infection, even if there would be a few cases. It would certainly lead to some sort of panic at some level because US residents are not familiar with Ebola like they are with measles or any other vaccine-preventable disease.
Things get a little more complicated when we start weighing a disease that primarily attacks and kills children versus one that attacks and kills older adults. If a disease harms children, then the disease is causing decades of productivity by those children to be affected, and that may not be sustainable for a society. However, when a disease affects older adults, it is not affecting years of productivity but it is likely to be deadlier, and there is a value to the loss of a person, even if it is difficult to quantify.
In most governments, these kinds of decisions on which public health issue to attack more vigorously or where to devote resources are not decisions made by a single entity. It is usually done in committee, be it a presidential cabinet or department, a legislature, or a health board. It falls upon members of those bodies to make the tough decisions and allocate resources in a way that achieves their goals. For measles versus Ebola in DRC, authorities there are going to have to decide on what they can do to address one disease or the other, or both diseases simultaneously. Unfortunately for them, DRC doesn’t have many public health resources to begin with.