Ebola: A wake-up call for Lead­ers

Africa Renewal - - Africa Watch -

The prog­no­sis for the af­fected coun­tries, which now in­clude Mali, is even more dire. In an ed­i­to­rial in The New Eng­land

Jour­nal of Medicine, Dr. Jeremy J. Far­rar of the Well­come Trust, a char­ity that funds re­search in health, and Dr. Peter Piot of the Lon­don School of Hy­giene and Trop­i­cal Medicine, who helped dis­cover the Ebola virus in 1976, write: “West Africa will see much more suf­fer­ing and many more deaths dur­ing child­birth and from malaria, tu­ber­cu­lo­sis, HIV/AIDS, en­teric and res­pi­ra­tory ill­nesses, di­a­betes, can­cer, car­dio­vas­cu­lar dis­ease, and men­tal health dur­ing and af­ter the Ebola epi­demic.” They warn of “a very real dan­ger of a com­plete break­down in civic so­ci­ety, as des­per­ate com­mu­ni­ties un­der­stand­ably lose faith in the es­tab­lished sys­tems,” adding that “with­out a more ef­fec­tive, all-out ef­fort, Ebola could be­come en­demic in West Africa, which could, in turn, be­come a reser­voir for the virus’s spread to other parts of Africa and be­yond.”

Back in 2001, African health min­is­ters signed on to the Abuja Dec­la­ra­tion pledg­ing to al­lo­cate at least 15% of their na­tional bud­gets to­wards im­prov­ing their health sys­tems. Ac­cord­ing to the World Health Or­ga­ni­za­tion ( WHO), a decade af­ter the dec­la­ra­tion was signed, 27 coun­tries had in­creased the pro­por­tion of their to­tal gov­ern­ment ex­pen­di­tures al­lo­cated to health, but only Rwanda and South Africa had achieved the 15% tar­get. More de­press­ingly, seven coun­tries had ac­tu­ally re­duced their health bud­get over the same pe­riod, and 12 had not made any progress. A dif­fer­ent score­card de­vel­oped by the Africa Health, Hu­man & So­cial Devel­op­ment In­for­ma­tion Ser­vices (Afri-Dev.Info), a re­search coali­tion, showed that by 2010, the top five coun­tries who had met the tar­get were Rwanda (23.3%), Malawi (18.5%), Zam­bia (16%), Burk­ina Faso (15.7) and Togo (15.4%).

In 2013, Africa had an es­ti­mated deficit of 1.8 mil­lion health work­ers. Per­haps not sur­pris­ing is the state of the health sys­tems in the af­fected coun­tries. Ac­cord­ing to Afri-Dev.Info, in 2014, with a pop­u­la­tion of 4.2 mil­lion, Liberia had only 51 doc­tors, 269 phar­ma­cists, 978 nurses and mid­wives, while Sierra Leone, with 6 mil­lion peo­ple, had 136 doc­tors, 114 phar­ma­cists and 1,017 nurses and mid­wives.

Slow global re­sponse

Re­gret­tably, Ebola struck at coun­tries whose health sys­tems were al­ready on their knees. This has not stopped an­a­lysts from ac­knowl­edg­ing that the re­sponse to the out­break was in­deed weak. Politico, a US pub­li­ca­tion, wrote: “The re­sponse to the Ebola out­break in West Africa will never be re­mem­bered as an ex­am­ple of good lead­er­ship. Not by the gov­ern­ments of the coun­tries in­volved, not by other na­tions, and not by the in­ter­na­tional health or­ga­ni­za­tion that says it’s there to deal with pub­lic health emer­gen­cies.”

True, the world was found want­ing in its re­sponse to the Ebola epi­demic, but it has been the World Health Or­ga­ni­za­tion, the main UN health arm, that has borne the brunt of the crit­i­cism. It was faulted for tak­ing too long to de­clare the out­break an in­ter­na­tional emer­gency. In­deed, it was not un­til Au­gust that it de­clared Ebola an emer­gency, and by that time the dis­ease was al­ready rav­aging the af­fected ar­eas. “Hind­sight is al­ways bet­ter,” said Dr. Mar­garet Chan, the head of WHO. “All the agen­cies I talked to — in­clud­ing the gov­ern­ments — all of us un­der­es­ti­mated this un­prece­dented, un­usual out­break.”

To be fair, WHO has suf­fered from se­vere fund­ing cuts in re­cent years. Its two-year bud­get for 2014-2015 is about $4 bil­lion, hav­ing been cut by $1 bil­lion in 2011, ac­cord­ing to re­ports. This has crip­pled its ef­fec­tive­ness in han­dling global health emer­gen­cies. The New York Times re­ported that WHO’s “out­break and emer­gency re­sponse units have been slashed, vet­er­ans who led pre­vi­ous fights against Ebola and other dis­eases have left, and scores of po­si­tions have been elim­i­nated — pre­cisely the kind of peo­ple and ef­forts that might have helped blunt the out­break in West Africa be­fore it bal­looned into the worst Ebola epi­demic ever recorded.” Notwith­stand­ing, global health ex­perts say that even if WHO had had bet­ter fund­ing, it is nei­ther an emer­gency-re­sponse net­work nor a di­rect provider of health care ser­vices, but a tech­ni­cal agency that pro­vides ad­vice and sup­port.

The af­fected coun­tries too have to shoul­der some of the crit­i­cism. They waited un­til it was too late to re­quest in­ter­na­tional aid. When gov­ern­ments are re­luc­tant to ask for help, So­phie De­lau­nay, the ex­ec­u­tive

di­rec­tor of Doc­tors Without Borders, told Politico, “they be­come re­spon­si­ble when the sit­u­a­tion de­te­ri­o­rates.” There are, how­ever, rea­sons why coun­tries are not quick to re­quest help or try to sup­press bad news. In many cases these have to do with na­tional pride and the fear of scar­ing away tourists and in­vestors. And these fears are not un­founded. African tourism has borne the brunt of the Ebola fear fac­tor. Fran­cisco Fer­reira, the World Bank’s chief econ­o­mist for Africa, said the Ebola “fear fac­tor” pre­vents tourists from vis­it­ing even coun­tries such as Kenya and South Africa where there had been no cases of the virus.

Stigma­ti­za­tion

In ad­di­tion to the eco­nomic, so­cial and po­lit­i­cal im­pact of Ebola is the stigma at­tached to it. Nige­ria’s fi­nance min­is­ter, Ngozi Okonjo-Iweala, cau­tioned against lump­ing all African coun­tries to­gether to avoid hurt­ing the economies of non-Ebola coun­tries. “If you scare away in­vestors by lump­ing the con­ti­nent into one big mass, what good does it do? It will take an­other decade to re­cover.”

Politi­cians around the world have sounded the same warn­ing, wor­ried that Ebola was cre­at­ing a con­ta­gion ef­fect on African economies. “We have to iso­late the dis­ease, not the coun­tries af­fected,” said UN Sec­re­tary-Gen­eral Ban Ki-moon.

Vac­cines and prof­its

The ab­sence of any drugs or vac­cines against the scourge of Ebola has been the main source of fear among the pub­lic. Ac­cord­ing to Time, a US weekly mag­a­zine, the scarcity of drugs and vac­cines is not due to a lack of in­no­va­tion. “Drugs have been in de­vel­op­ment for years, but since phar­ma­ceu­ti­cal com­pa­nies have had no fi­nan­cial in­cen­tive to fund them, re­searchers have hit walls.”

Dr. Chan makes the same point, adding that the drug in­dus­try’s drive for profit was one of the rea­sons there has been no cure yet for Ebola. “A profit-driven in­dus­try does not in­vest in prod­ucts for mar­kets that can­not pay,” she told del­e­gates at a con­fer­ence in Cotonou, Benin. Test­ing on healthy vol­un­teers in the US and some African coun­tries has started on ex­per­i­men­tal vac­cines and re­sults are ex­pected dur­ing the first quar­ter of 2015.

The time will come when the de­ci­sion-mak­ers will take stock of the state of health­care sys­tems in many African coun­tries, how the out­break un­rav­elled and the ef­fec­tive­ness of the global re­sponse. Nev­er­the­less, even as the epi­demic is sta­bi­liz­ing in some parts of the af­fected coun­tries, it’s spread­ing in oth­ers, es­pe­cially Sierra Leone, and to a lesser ex­tent Mali. “Now is no time to let down our guard,” warned the UN Sec­re­tary-Gen­eral. “A gap any­where in the re­sponse leaves space for the virus to spread dis­ease, kill peo­ple, de­stroy fam­i­lies and threaten the world…We must keep fight­ing the fire un­til the last em­ber is out.”

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