This September-October issue of Foreign Affairs carries an essay on the Ebola outbreak that hit West Africa in 2014. It gives an account of how the fatal epidemic originated and spread, the efforts of different agencies to fight it, and the way in which the World Health Organization (WHO) apparently “mishandled the crisis”.
The epidemic originated in parts of a rainforest where borders of Liberia, Guinea, and Sierra Leone met, in December 2013. It then quickly spread to other parts of the three countries, through the people who cared for the sick and buried the dead bodies. WHO and a few other organizations slowly realized the gravity of the situation and initiated measures to fight it. However, the pathetic health infrastructure of these countries, demonstrated by non-paid health staff right from the field to the Health Ministry; absence of doctors, nurses, midwives, hospitals, and beds; and basic facilities of water, sanitation, electricity, and medical supplies made the fight hard. None of the agencies involved had the necessary financial strength to succeed. Precautionary measured by other countries which included ban of travel to and from the affected countries added to the plight by limiting the much needed human resources.
By March-April 2014, it appeared as if the disease was contained. In the affected countries, governments returned to business as usual. This relief didn’t last for more than a few weeks; by June-July, it was realized that the epidemic was still spreading, causing panic and despair among the locals and foreigners engaged in the fight. In August, the WHO declared the Ebola situation a “public health emergency of international concern”. By then, Liberia, Guinea, and Sierra Leone had reached points of collapse; “riots broke out, bodies were hidden, health-care workers were attacked, and food supplies dwindled”.
By September the disease had crossed continents and claimed its first victim in the US and contracted a nurse in Spain, through infected people who travelled from Africa to the US and Europe. This development caught the attention of the international community. The UN Security Council declared Ebola as an international threat and president Obama announced financial aid and deployment of military personnel. The local communities, having realized the seriousness of the issue, gave up their customary treatment and burial practices, and implemented quarantine of visitors and returnees from affected areas. The village chiefs took control, “ordering families to bring out their sick and dead, commanding safe burials, and searching for ways to feed quarantined households”.
The manner in which the WHO handled the crisis invited fierce criticism. Some experts maintain that it should have declared a public health emergency under the International Health Regulations long before August 2014. Critics also point out that it should first have a clearer mandate, and then the required funds and more competent staff. They also call for cooperation, not competition with other key international players like the World Bank. Other suggestions include streamlining the chain of command and proactive reaction to warnings of outbreaks. However, no one contests WHO’s position as the “world’s central authority on global health issues”, because “there needs to be one, and it has the most legitimate claim to perform such a role”.
Any lessons for India? Yes, there are. First and foremost, we need solid infrastructure in place- hospitals and personnel; and safe drinking water, electricity, and sanitations facilities for ALL. We should stop counting the number of VILLAGES electrified and instead focus on number of HOUSEHOLDS electrified. We should stop feeling happy when politicians make grand promises of basic amenities for all, instead we should be willing to keep a track of their delivery. If and when fatal epidemics like Ebola strike, we should be prepared. The other lessons related to funding and leadership don’t seem to be critically pressing concerns, as India has a big economy, at least in terms of absolute numbers, and health institutions at the central and state governments are well established, although their performance is a matter of concern.
For more and updated information on the fight against Ebola, click here.
Please note that the text in double quotes have been taken directly from the aforementioned essay in Foreign Affairs. The image is taken from http://ebolaresponse.un.org/guinea. The copyrights of the text and image belong to the respective original sources.