[ChuckMcM]

Going 'meta' for a moment, this is a tragedy of huge proportions, the question I have been considering is whether or not it is even possible to avoid?

Updates from MSF which highlight the level of mistrust and superstition amongst the infected population, where people hide their sick relatives from isolation wards and take them back to their village. We cannot exactly put a giant fence around the place (and not that this would be a reasonable goal anyway).

Do we invade these countries and force our will on them in order to prevent a humanitarian tragedy? What gives us that right? What gives anyone that right? To someone who is not sick, forcing them from their village, for forcing them to stay in their village violates their basic human rights, and yet it is for their own good, but if they don't believe that, what moral authority allows us to overrule that belief?

As you can see I struggle with the challenge of imposing a solution on these people, knowing that without aggressive actions tens of thousands, perhaps hundreds of thousands of them will die. While explaining to someone who doesn't understand the virus, or the danger, who undergoes forced relocation to a quarantine camp and is never sick during the outbreak, that they were in very real danger from this thing they do not believe in.

[narrator]

The American perspective is to solve every problem with the military or money. We believe that violence and more money are the only effective solutions to every single problem the world faces. Original thinking just doesn't happen.

A creative solution would be to temporarily halt all regulations on anti-ebola drug development and let them experiment on any willing person in Liberia who wishes to receive treatment. The example of Banting and Best in the 20s is a great example of the enormous progress that can be accomplished if there is no regulation on medicine. These guys came up with the idea for extracting insulin from animals and injecting it into humans. They tested it out on willing patients, the first being a 14 year old, released the invention for use by the public and won the Nobel prize in the span of 3 years (1921-1923). That speed of drug development and testing is impossible today.

A good analogy of the present situation would be this. Someone is drowning in the river. You can use the military to prevent him from knocking any nearby bathers into the river as he floats down stream but don't you dare throw him something handy like a branch or a quickly improvised flotation device because that might help him float and it may not work and there would be lawsuits or regulatory violations! You can pay someone to swim after him and try and save him, but the stream is really rushing fast and they might drown too, but that's seemingly a-ok.

[DennisP]

I'm a libertarian too, and agree that the FDA is overly cautious, but I don't think drug research is an effective response to an acute epidemic. When something's growing exponentially you have to stop it quickly.

[jfoutz]

I'm from the american southwest, there's a kind of snake here who's effects of venom are remarkably similar to the effects of ebola. All the crazy regulation has been holding up any US research, but in northern mexico, a Doctor Stanley has been doing monkey trials. His unique combination of mineral oil seems to boost immune response, while the venom inures the cells to ebola's most harmful attack vectors.

I realize the people of Africa are very poor and can't really afford the scale of production necessary. Perhaps your country would be willing to help out with a few million dollars, I'm sure this snake oil would do some good.

[lotsofmangos]

Don't listen to that charlatan, you would be much better investing the money in my range of anti-viral mist diffusers. I've had one running for a year now and nobody on my street has Ebola. It also seems to work against tigers.

[bewo001]

You mean, a kind of oil made with snakes? A snake-oil?

[krschultz]

So far it seems like quality of medical facilities & care is far more important than the availability of drugs. I think even without the drugs, if all of the original patients had access to great hospitals, this wouldn't have spread the way it has. Unfortunately those resources simply do not exist in the affected countries.

I'm all for effectively unlimited money from the first world to help pay for a response to this outbreak, but even if there was unlimited resources you can't just build up a whole medical infrastructure with the snap of your fingers.

[waps]

And who pays for the, potentially unbounded fallout from that decision ?

Let's say this happens : http://en.wikipedia.org/wiki/Thalidomide

(First read about the advantages of the drug, then move to the crises. in particular the birth defects crisis)

And please don't just say that people knowingly took the risk, read the article first to see how that played out.

People won't accept the consequences of decisions made under duress (and this decision would be "death or we experiment on you". Decision to be made in an isolation camp, guarded by soldiers with guns), for obvious reasons, and this has been an accepted legal principle since a millenium before Jesus was born. You're suggesting just canceling it ? Really ?

What you're suggesting is a really, really, really, really bad idea.

[ekianjo]

Why? When you are going to die you should have the choice to go on a treatment which is untested. That's what people with AlS have been asking for YEARS and still cannot get because they have to follow the usual regulatory process.Cancer patients can get drugs as soon as Phase I, I don't see why we don't allow other patients who are in critical condition to try whatever is new out there. What do you have to lose?

[x0x0]

The death rate from the current ebola is approximately 50%. While that sucks, what patients have to lose is both a 50% chance of living and their right not to be a playground for medical experimentation.

edit: and just who vets the people/companies who get to offer drugs to desperately ill people? Does anybody with $1k to buy needles get to make a sign and advertise curative injections? I'm sure glibertarian idiots will say it was a freely made choice, but choices made while infected with ebola (or even scared of being so infected) aren't freely taken, not to mention the asymmetric information.

[crusso]

glibertarian idiots

Please avoid making personal attacks like this on HN.

As a mostly libertarian-minded person myself, the height of compassion is to allow dying people to reach out for any hope out there.

Cruelty would be to prevent people from attempting to save their own lives "for their own good"; especially when no alternative cure is being offered by the politicians and bureaucrats making such life-impinging decisions.

Yes, the quacks and charlatans will try to take advantage and they should specifically be combatted. That doesn't mean that people should not be able to make decisions about their own lives.

[ekianjo]

> edit: and just who vets the people/companies who get to offer drugs to desperately ill people?

Look at the scientists who were helping fight Ebola in Africa. When they discovered they were infected as well they had the chance to take a new treatment and they took it. And they recovered.

The question of who decides is important, I'm not saying it should be overlooked but the possibility is not even there for those who actually want to take it desperately. And no need to throw the "libertarian" word for everything you disagree with, we are talking about having choice here.

[krschultz]

And some of the people that were given the experimental drug in Africa died as well. Correlation does not equal causation.

We all love silver bullets and magic serums, but the real answer here is to get the basics right. There are major improvements that can happen in sanitation, medical care, keeping quarantines effective, proper handling of the dead, etc. A lot of major epidemics were stopped in the 1800s and early 1900s with these kind of things, Ebola can be fought in many ways without inventing a drug.

Solving the crisis on a large scale isn't really a "medical" challenge in the normal sense, it is about logistics and resources and public trust in government & doctors.

[ng12]

I would argue there are at least a few orders of magnitude between someone with morning sickness and someone who will almost definitely die of Ebola or T1 Diabetes.

It's a calculated risk, sure, but I don't think the Thalidomide example is particularly relevant.

[hueving]

>It's a calculated risk, sure, but I don't think the Thalidomide example is particularly relevant.

It's very relevant. It shows that people are too willing to take risks with major unknowns. Where do you make the cutoff with your drug experiments? Only people that are certain to die? People with high exposure risk? People that are having difficulties recovering? Any selection you pick there is completely arbitrary because you don't know the potential downsides to the experimental stuff you want to try.

[ghshephard]

"Where do you make the cutoff with your drug experiments? "

I don't know where you make the cutoff, but I'm comfortable saying that its somewhere below having a disease with a 50% mortality rate in under 14 days. I'm pretty much okay taking any risk at that point.

[DanBC]

What if the risk was survival but with locked-in syndrome and constant very high pain? Or survival but severely brain damaged - no ability to feed yourself; or talk; or understand the conversations of other people.

[andygates]

What about preventative treatment? Say we have a prototype vaccine. Now you have to find the cutoff between a chance of getting a fairly deadly disease, and the chance of a vaccine not working or having nasty side effects. That's a much greyer area.

[Padding]

You didn't get the point of the argument.

What do you do when something with 51% mortality in 15 days comes up? And then something with 49% in 13 days .. where do you draw the line? And what do you do when people continue to cry out?

[narrator]

So you're suggesting that we let potentially hundreds of thousands of people die to prevent a potential tort lawsuit? Would you be ok if we shoot them if they try and leave the quarantine though to get an unapproved treatment? Do you see how crazy your logic is? The benefit of Thalidomide was that it prevented morning sickness and you're comparing that to treatment of a disease with a fatality rate of greater than 50%! You have no sense of proportion at all!

[lotsofmangos]

It seems reasonably proportionate not to suspend all regulations on drug testing. If you did that then the vitamin peddlers out to make a fast buck would swamp anything that might actually help. The amount of con artists massively outnumbers the amount of people with a cure for Ebola.

I agree that it may be an idea to look at trying some of the experimental treatments, however given there is a 50% chance of surviving with palliative care and that we know how to stop it spreading given the resources, I am not sure that turning the situation into an unregulated free-for-all for every quack looking to make their name will really help matters.

[cstross]

There are pros and cons for both sides of this argument.

The question is whether to suspend normal precautionary procedures during an extraordinary situation, not whether to ditch normal precautionary procedures which exist for very good reasons (see the Elixir Sulfanilamide disaster for why):

http://www.fda.gov/aboutfda/whatwedo/history/productregulati...

You're rightly concerned for the possible side-effects of using untested treatments on people during an emergency. But flip the question around: who's liable for not deploying an available experimental treatment that is later determined to work, but only after tens of thousands have died while it sits, unused, on the shelf due to lack of test data?

[ObviousScience]

> who's liable for not deploying an available experimental treatment that is later determined to work, but only after tens of thousands have died while it sits, unused, on the shelf due to lack of test data?

No one, that's exactly the point.

There's no way to sort out misdeeds, eg, fake cures from real attempts if we lift the normal trial and liability procedures. No one would use untrialed drugs if they had to take the full liability.

So the reality is that there is no good way to send only useful drugs there while skipping the filtering process.

If you're okay with some people being poisoned or lied to for money in the hope that some people will get a real drug, then we could make that work, but I'm not sure we want to go down that path.

[cstross]

There's no way to sort out misdeeds, eg, fake cures from real attempts if we lift the normal trial and liability procedures. No one would use untrialed drugs if they had to take the full liability.

I'm ready to assume that medics treating an emergency epidemic are unlikely to knowingly turn to quack remedies -- homeopathic or bogus ones -- as opposed to items like ZMapp, a monoclonal antibody treatment by a well-regulated pharmaceutical company that just happens not to have been approved for human clinical trials yet.

http://www.cdc.gov/vhf/ebola/outbreaks/guinea/qa-experimenta...

Furthermore, let me add that conducting a randomized controlled clinical trial (for effectiveness and safety) when dealing with a pathogenic infection with a > 50% fatality rate is arguably unethical: you can collect data on clinical applications and apply a retrospective control sample of patients to determine whether it improved the outcome where it was used, but withholding a potentially effective treatment becomes extremely problematic under some circumstances -- the historic classic example was zidovudine for HIV, which was rushed through human trials into use in just 27 months because it was the first effective treatment for a then-100% fatal disease (HIV). (Some of the double-blind trials were short-circuited when it became apparent that continuing to alternate patients with placebo controls was likely to be injurious.)

http://en.wikipedia.org/wiki/Zidovudine

[Padding]

I fully agree with you. This is the rational decision to make, and the best one, considering the fallibility of humans.

At the same time though, we need to realize that this is primarily about protecting the health professionals and care givers, and only indirectly the sick. (The sick will of course indirectly profit from professionals being just that - professional, but only in the "long term".)

We should have no delusions about willingly letting people die, in the name of professionalism, just to have a clean concience and the ability to claim to have done nothing wrong.

[jcromartie]

This is not a proposal for developing general-purpose drugs. This is for developing emergency treatment for an acute viral outbreak emergency. If an anti-Ebola drug works, then it saves lives. If it doesn't work (or is dangerous) then it's still less dangerous than Ebola itself.

[kijin]

> forcing them to stay in their village violates their basic human rights

Better-informed villages, towns, and cities have every right to refuse to admit, or interact with, individuals from superstitious villages. Self-defense is a powerful right, and I'd say it easily trumps a potentially infected person's right to visit a cousin.

People are free to die for their beliefs, whether such beliefs are true or not. But they have no right to make other people die with them. If push comes to shove, better-informed villages will expel all infected persons (preferably into quarantine centers, not into the jungle), post armed guards at every entrance, and either isolate themselves or only admit visitors from villages that have enacted a similar policy.

[swombat]

That sounds reminiscent to what happened during the Black Death.

Unfortunately, it doesn't sound like it worked particularly well, considering the Plague still took a sizeable percentage of the human population at the time.

[kijin]

Villages that quarantined themselves during the Plague were left completely to their own devices. Back then, you couldn't even try to communicate with other villages without risking the messenger's life.

Today, outsiders can airlift food, clean water, and medical supplies to any isolated village that asks for help. So let's stop wasting resources on people who don't want to be helped, and focus on people who actually are desperate for help.

[wavefunction]

You do realize _how_ isolated these villages are right? Like the only stranger they see in a month is an itinerant trader? How exactly are they supposed to safely get word out to the "civilized" world? That is assuming that they have already heard that there is a disease going around and what the proper precautions are...

[dredmorbius]

Mechanism and agents of infection weren't understood at the time of the Black Death. We know what causes Ebola, and how it is transmitted. We know how to selectively allow what we need for survival (water, food, other commodities) to transit between infected and noninfected zones.

No, not every individual knows or understands this, particularly in primitive areas. But the global system as a whole does.

As for the Black Death, there are instances of specific villages or households (or castle-holds) who sealed themselves off and had sufficient stores to see themselves through the plague.

[userbinator]

There's an interesting parallel of this with some of the discussions on (computer) security - if someone's machine is part of a botnet, infected with malware, or possibly running insecure software, does it give us the right to "invade" them and forcibly perform actions which we believe are "for their own good"?

The prevailing attitude there seems to be "yes", but the difference is that in those cases the worst that could happen is people lose money, data and maybe their personal information gets leaked; whereas here, with Ebola, people will actually die. Not that I'm advocating either side of the argument, but it's something to think about...

[joesmo]

I think you bring up some good points and I don't mean to discount the moral dilemma here, but in reality such moral considerations are hardly ever considered. I don't think the article is suggesting invasion, but if that was the best solution, I don't see a problem with it if it prevents an epidemic or worse, a world wide pandemic(especially if it mutates into airborne transmission). After all, the US has invaded many other countries for absolutely no reason. It'd be hard to justify not invading at this point given our history if this was indeed thought to be the optimal solution. We've invaded at least three countries illegally and started major wars but we ate considering the ethical implications of stopping a pandemic? I suppose such moral questions become quite easy once moral decisions have been discounted in favor of immoral ones repeatedly in the past.

[techdragon]

And given the level of equipment and training the military have with regard to doing their job while wearing full Nuclear/Biological/Chemical protection. I would honestly prefer that if the situation escalates and we see confirmation of airborne transmission, the situation be dealt with by prompt deployment of fully NBC trained military medical units and sufficient security forces to ensure that whatever those doctors say is law within the quarantine.

I do my best not to be a knee jerk reaction person, but an airborne ebola strain, is beyond question a deadly deadly threat. Ebola has an incubation period, there is a period of time where you are infectious, before its obvious, and if airborne your very presence places anyone in the room with you now has 50/50 odds of living. This isn't SARS, this isn't Spanish Flu. This is quite possibly the closest we can get to a disease threat strait out of a zombie movie. I don't feel we should violate the human rights of everyone in that region, but this is one of those things where its squarely a "The needs of the many, outweigh the needs of the few or the one." scenario. So if the army doctor says "that guy has ebola, stop him from running away", I kinda feel (presuming an airborne ebola) that the situation may (depending on how far away he's getting, indoor or outdoor, etc) warrant lethal force.

[justin66]

> And given the level of equipment and training the military have with regard to doing their job while wearing full Nuclear/Biological/Chemical protection. I would honestly prefer that if the situation escalates and we see confirmation of airborne transmission, the situation be dealt with by prompt deployment of fully NBC trained military medical units and sufficient security forces to ensure that whatever those doctors say is law within the quarantine.

I don't think the people speculating here understand how bloody military quarantine imposed by a foreign power could be - however well intentioned - compared to the mere 2,200 people who have died of the disease so far.

Send in a U.S. Marine division of 20,000 people (or maybe make it a "coalition" and send in a few hundred European troops as well to, ahem, share the burden) and tell them that they need to direct some people from one place to another, keep some people penned up, keep all these people fed, keep them from doing anything unfriendly to the nice doctors in the space suits, and everyone who resists - resistance here includes rioting or just not being able to follow instructions because, you know, the troops don't speak the language - needs to be taken into custody with that legendary marine gentleness while being treated as a potentially lethal disease carrier. Keep the troops mindful that if they err on the side of laxity they could get a disease that might cause them to die bleeding from their bodily orifices.

Multiple massacres should be the expected outcome of such an operation. The projected cost of the disease needs to pretty horrible before it becomes worth contemplating such a high-risk, low-reward action and we'd want to exhaust all other means of supplying these countries' civil authorities with what they need before we took such a step. We haven't done that yet.

[andygates]

It isn't SARS, it isn't Spanish Flu... it isn't airborne. And the way it's composed, it isn't a simple mutation away from being airborne.

Guns down.

[joe_the_user]

It's just ugly to see an eagerness to think about invasions when not even simple supplies are not coming through.

Liberian President, Ellen Johnson Sirleaf to Barack Obama: "I am being honest with you when I say that at this rate, we will never break the transmission chain and the virus will overwhelm us"

"The dilemma" of invasion and whatnot is beside the point. The Liberian state is desperate. Johnson Sirleaf also recently fired 10 government ministers who had fled the country. Any nation with resources that wants to take over? The Liberian state would eager for the help. Things are that bad.

http://www.nytimes.com/2014/09/13/world/africa/liberian-pres...

[techdragon]

This is more than just a supply issue.

http://reliefweb.int/report/democratic-republic-congo/update...

  "One of the patients hospitalised at the HGR Boende had managed to escape before being recovered by the services deployed to the field."

That is why if this situation escalates we will need people with guns, both medical and security personal with full Biological Warfare training and equipment. We are staring at a disease where scared infected people, are trying to ESCAPE and become extremely dangerous disease vectors, risking the spread of the disease to anywhere from dozens to hundreds, to thousands. When that is what is going on, I don't think the word we should use is "invasion", its something other than that. Best I've got to describe it, is a martial law quarantine, enforced by UN armed forces and medical personnel provided by the nations who have the capable personnel and equipment.

[joe_the_user]

Uh, that's exactly the supply issue. I have read a number of reports of that incident.

The guy escape because he was starving - he went immediately to the market to buy food. If he had food in the isolation ward, that wouldn't have happened (or would be a good deal less likely).

And uh, the idea of shooting people infected with Ebola shouldn't be first or second resort considering you would be straying their infected blood over a significant area. Not to mention guaranteeing no else would want to be treated, etc.

[techdragon]

Yes, the man was starving, but thats also another thing the military forces are good at, supply chains. Also, the idea of having armed security forces, is less about shooting people with regular ebola, I do try to point out in my other comment that I'm in favour of armed forces when talking about a hypothetical airborne ebola strain.

[joesmo]

You misunderstood. I'm not saying that invasion should happen or that it is even a proper choice at this time, only weighing in on the morality of it in light of American invasion history if at some point it happens to be the best choice.

[gbhn]

Agreed. There's no 'invasion' when you're being invited in on a humanitarian mission. People need help.

[x0x0]

I'm sure the folks we point guns at will agree. No, better -- they'll welcome us with open arms and throw flowers at us!

(In case you're dense, just like the last time we tried to bomb a country into freedumb.)

[oldmanjay]

you seem to have never been taught the lesson that clever wordplay doesn't prove your arguments

[rwallace]

I will suggest that given the historical data of "the US invaded many other countries, and it generally turned out to be a really bad idea," the correct conclusion is not "so let's go ahead and invade a few more countries," particularly when there is plenty of specific reason here to believe such action would make things worse not better.

One of Liberia's biggest newspapers recently ran an editorial claiming the Ebola epidemic was deliberately created by the US government. If that's the sort of paranoia that exists now, what do you think it's going to be like if thousands of Americans with filter masks and machine guns start flooding into the country? In addition to all the usual bad results, you're going to get a lot of people hiding and running - carrying the virus with them.

[maxerickson]

This episode of Frontline is informative as to the situation:

http://www.pbs.org/wgbh/pages/frontline/ebola-outbreak/

[davesque]

Yeah...it's heart breaking. One of the people interviewed in that episode died after it was filmed. And, of course, there will be thousands more like him.

[lotsofmangos]

"what moral authority allows us to overrule that belief?"

Statistics on mortality.

[Afforess]

Let's just say not all of us believe in Utilitarian theories of Ethics.

[lotsofmangos]

Ethical theory is not much use once you are dead.

[Afforess]

All of the world religions disagree with you.

[Padding]

That you have been downvoted is very telling of the crowd that CS people are. We pretend to be all rational professionals on our high horses, decorated with degrees and what not..

And yet, when something manages to hit us on an emotional level we falter.

What Afforess said is a statement of fact and relevant to the discusssion. Thus it's a valid counterpoint.

You may not like it and you may not agree with it .. you may even discard sprituality as a whole .. but none of it makes the satement any less true.

[vdaniuk]

I would recommend you to stop making such sweeping generalizations about "CS crowd" and educate yourself on deontological vs consequentialist ethics debate. Yes, religions are firmly in the deontological camp and it showed during the millenia of superstition, witchhunts and obstruction of scientific progress.

Btw, as far as I see the only one on the high horse in this comment thread is you.

[lotsofmangos]

It isn't actually a statement of fact though.

Not all religious sects have an afterlife and some, like Calvinists, believe in predestination, so nothing you do affects where you are going anyway.

edit - The position of respecting other beliefs as the number one priority is basically saying that it is better to let someone die than offend them. However from a religious perspective you wouldn't normally give a shit about offending other people's beliefs as other religions are generally regarded as heresy. There are exceptions, such as the Baha'i, but generally the idea of trying to respect all beliefs is largely a secular position.

[lotsofmangos]

Most of them do, however they disagree in a lot of different and often entirely contradictory ways.

So given the problem of doing something about a disaster, trying to keep all the different belief systems happy at the same time will just stop you from doing anything. You can't keep all the different belief systems happy when there isn't a disaster and lives to save, trying to do it when there is seems to be just setting yourself up to fail from the outset.

Also, given the context of disease, stopping it spreading is not a wholly altruistic act. This is about self-preservation as much as anything else and most of the world's religions are pretty clear on what you are allowed to do to others when the tribe is threatened. The religious reaction to this in many cases would be mass slaughter.

[Crito]

In all of my years on this planet, I have never seen religion benefit a corpse. The living may find comfort in it, but the dead are indifferent.

[dredmorbius]

Not all, but many, yes, probably even most.

[joe_the_user]

Now, both countries' government are already engaging in the rather extreme preventative measures that's your talking about. But both also lack basic, basic supplies. It's hard to know whether this event can controlled. It seems obvious it would be more likely to be controlled if more resources are flowing in.

And while I'm pretty cynical as rule, it seems cynicism and despair at this point could actually hurt people.

[wyager]

I agree that invasion is wrong, but why isn't a large-scale quarantine viable? It's not like you have to lock everyone in; you just allow those who are willing to be subjected to medical treatment passage, and deny passage to anyone else. Seems like it could help those who wish to be helped while not infringing on the right of the superstitious to reject medical treatment.

[dredmorbius]

Understanding systems effects (see Donella Meadows Thinking in Systems) is hugely important for understanding complex interactions.

The factors feeding into the Ebola crisis, and emerging from it, are sobering both in their interactions and how they tend to lead toward a fairly inevitable conclusion.

As for whether or not this is possible to avoid: human population and impacts on the world are unsustainable. Something is going to happen to bring numbers down. Voluntary population control, disease, starvation, war, social disruption, or other catastrophe, are pretty much the only real operators.

In that sense, yes, I'd argue that the general concept is pretty unavoidable.

I'm not saying Ebola (or this particular outbreak, or even necessarily disease) is "the one" and that the End Times have come. But it's a bit like an old-school video game. The challenges will keep coming harder and faster until we fail one.

[zachrose]

It's a very important question, but I wonder how accurate and widespread this picture of West Africans is. Practically, I am concerned that there aren't enough treatment/care resources for those that want them.

[djcapelis]

That is documented fact in Liberia right now, especially in Monrovia.

This release from WHO sharply highlights this issue: http://who.int/mediacentre/news/ebola/8-september-2014/en/

[polarix]

Perhaps we could quarantine air & sea travel.

[lettergram]

Even with air and sea travel the chance of someone being infected outside those areas is minimal (unless they give you a nice bloody hug or you are feeling frisky). Much less an outbreak or something of that nature.

Most of the infected cannot even afford to travel.

[swombat]

Most.

You only need a handful propagating a suddenly airborne version of the disease to London, New York, Paris, Tokyo, Beijing...

Most is not good enough.

[zvrba]

Related; an example of efficient government action: http://en.wikipedia.org/wiki/1972_outbreak_of_smallpox_in_Yu...

Somehow I don't believe that an action like this is possible in a democracy :/

[Asparagirl]

Oh yes it is:

- 1924-1925 smallpox outbreak and mass vaccinations in Duluth, Minneapolis, and St. Paul: http://www.mnopedia.org/event/smallpox-epidemic-1924-1925

- 1947 smallpox outbreak and mass vaccinations in New York City: http://www.virology.ws/2009/12/22/smallpox-in-new-york-city-...

[gear54rus]

They didn't hesitate to send troops for some bullshit reason, why hesitate now when it's actually beneficial (assuming it is executed correctly which may or may not be the case)?

Right, because it is not beneficial right now (it's not like there is oil in there) and we can always take action later when it gets closer and more serious.

[saryant]

There's lots of oil in that part of the world. Nigeria is a major producer and there are lots of promising fields off Liberia and Sierra Leone.

https://lukoil-overseas.com/press-centre/7059.php

http://www.chevron.com/countries/liberia/

http://www.bbc.com/news/world-africa-17115042