The latest Ebola outbreak has killed at least 1,200 people and probably infected 3,000 to 4,000 more across several West African countries, making it the biggest on record. From an initial start in Guinea, the focus of this deadly virus has shifted to Liberia and Sierra Leone (with limited numbers in Nigeria and Senegal), devastating populations and health care systems in its path. Despite millions in emergency funds donated to help save lives – with the Gates Foundation recently committing $50 million – efforts to contain the virus are falling short. Fear, dread and exaggerated risks have led to panic and declarations of national and global emergencies by some countries and the World Health Organization (WHO). What has ensued are collapses of weak health services; patients with AIDS, malaria, diarrhea and hypertension not receiving medications; and accelerated uses of unproven treatments. It has also led to increases in economic losses for vulnerable economies; restricted travel and trade from affected countries; and powerful examples of weaknesses in global health governance. I touch on a few of these issues in this note.
Is Ebola a serious threat to global health?
Ebola spreads between humans by direct contact with infected blood, bodily fluids or organs, or indirectly through contact with contaminated environments. Ebola is a direct threat in countries where access to effective health systems is weak, where there is a lack of primary care health workers, and where supplies of several products are unavailable. Liberia and Sierra Leone exemplify the problem as they are ranked among the lowest in Human Development Indices, have only one or two doctors available for every 100,000 people, and have suffered from years of war and poor governance. There are not enough beds to treat Ebola patients, particularly in Liberia’s capital, Monrovia, with many people told to go back home, where they may spread the virus, per news reports. Margaret Chan, Director-General of WHO, notes that poverty underlies the scale and severity of the Ebola outbreak in these countries.
Ebola is not a direct threat when health systems are robust and supported by a cadre of trained health workers and facilities equipped with basic infectious disease control supplies. Four US aid workers who were infected with the deadly virus in Africa were transported to a hospital in Atlanta for treatment; two of whom have since recovered.
What are the most effective means of stopping this epidemic?
Jim Yong Kim, President of the World Bank and the earlier architect of the WHO AIDS treatment response, succinctly summarized what is needed when he stated that “skilled health care workers with the right equipment can snuff this out.” This message was echoed by one of the world’s leading infectious disease control experts. Tony Fauci, who heads the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, said that “drugs under development will not be a big part of the solution. The real focus should be setting up medical infrastructure to provide sick people with basic medical support.” Implementing this is not going to be easy, given the massive neglect of public health by the most affected countries.
The European Union has announced funding worth $180 million to help the governments in West Africa strengthen their health services – and to help local people by securing food and water supplies. And the US government has spent more than $100 million in response to the outbreak, including funding for more than 100 extra African health workers to help run treatment units in Liberia, Guinea, Sierra Leone and Nigeria.
What are the most effective means of preventing future epidemics?
The recent Lancet Commission on Global Health (led by Dean Jamison and Larry Summers) upgraded the economic case for investing in health. The Ebola outbreak shows what happens in the absence of such investment. Donors have been active in Liberia and Sierra Leone for years, but have rarely focused on tackling basic health needs before other issues with higher PR potential are addressed. Tony Blair’s Africa Governance Organization is an example of this. It claims to address the critical development needs of Liberia, Sierra Leone and Rwanda. In the midst of the world’s worst Ebola outbreak, AGO appears to be absent in the field, despite two of the three focus countries being the most affected.
Larry Gostin recently stated that a Health Systems Fund should be rapidly created to support the essential needs of health systems in affected countries in a very well-argued piece. Before considering such an initiative, it would be prudent to enhance national governance for health and review the roles of WHO and the World Bank. WHO has virtually no operational capability but must lead in defining norms and calling for action. A new UN-wide capability is needed with capacity to rapidly deploy. UN Secretary General Ban Ki-moon’s recent appointment of David Nabarro to head a UN-wide response to Ebola is a step in this direction. The secretary will also hold a meeting on the crisis on the sidelines of the UN General Assembly this month.
What are the underlying determinants of Ebola?
Sierra Leone is ranked as one of the top five producers of rutile (a titanium ore) and a major producer of iron, diamonds and gold. Palm oil and forestry products are additional major exports. Liberia is similarly a mineral-rich country and has increased deforestation to expand palm oil production. This has in recent months led to conflicts over land rights with indigenous communities that have been largely ignored by the government. Guinea is the world’s second-largest producer of bauxite and has rich deposits of diamonds and gold. These three countries are resource rich, but governance poor.
Deforestation for mining and agriculture take people deep into tropical rainforests with increased risks for exposure to infectious diseases whose lifecycle usually occurs in wildlife. Humans become a casualty of stepping into such ecological zones. Entire ecozones are destroyed with potentially more serious consequences for health to come. Ebola – the primary reservoir of which is likely to be fruit bats – is a sentinel indicator of the future as natural environments are disrupted and destroyed.
What can investors do?
Investors need to be better informed about the underlying determinants of Ebola that fall within their decision-making orbit. Many investors are involved in agricultural and mining efforts in the affected countries. Their investments will be threatened by continued failure to address Ebola. But the major interventions lie in the hands of governments and WHO. It serves the self-interests of investors to steer companies in the affected countries to be far more active in working with governments to invest in basic health services and to ensure that funding from mineral profits are plowed back into national development. The links between taking that route and the long-term profitability of investments is extremely strong. Unprecedented optimism on Africa’s growth potential – as reflected by Standard Bank’s analysis on strong growth in Africa’s rising middle class and by President Obama’s US-Africa Leaders’ Summit – may be threatened by the failure to rapidly address the current Ebola outbreak and the determinants of future health crises.Derek Yach is the Executive Director of Vitality Institute, Chairman of the Board at Cornerstone Capital Inc. and former World Health Organization Executive Director and SVP Global Health & Agriculture Policy at PepsiCo. You can follow him on Twitter @swimdaily or the Vitality Institute @VitalityInst.