Global Insider
West African Ebola Outbreak Shows Difficulty of Coordinating Effective Response
By The Editors, July 16, 2014, Global Insider
An ongoing Ebola outbreak in West Africa, already the deadliest in the history of the disease, continues to spread, with 964 confirmed cases and 603 deaths. In an email interview, Jeremy Youde, associate professor of political science at the University of Minnesota Duluth, discussed the international response to the disease, led by the World Health Organization, in Guinea, Liberia and Sierra Leone.
WPR: What conditions have enabled the ongoing Ebola outbreak in West Africa?
Jeremy Youde: Environmentally, deforestation and increased mining activity may have pushed humans into greater contact with bats and monkeys, both of which are suspected vectors of transmission for Ebola. A 2012 article in Onderstepoort Journal of Veterinary Research finds links between environmental changes caused by human activities and Ebola outbreaks. Epidemiologically, Ebola moves quickly, and it takes a long time to extinguish an outbreak. Control measures that seemed effective in containing the outbreak in April and May 2014 may have been lifted too soon, allowing the disease to regain its foothold. Politically, the governments of Liberia and Sierra Leone have announced punitive measures against “holding suspected Ebola cases in homes or prayer houses.” While the intent may be to reduce the disease’s spread, the practical effect is to drive people underground and away from the health system, increasing the chance of spreading infection further.
WPR: How would you evaluate the responses of the World Health Organization and other international agencies to the outbreak?
Youde: Under the current version of the International Health Regulations, suspected cases of Ebola must be reported to the WHO within 24 hours, and the WHO can assume a role in coordinating an international response. In the current global health governance landscape, the WHO can act as a central information node and provide a forum for bringing affected parties together. What it can’t really do is deploy resources and personnel; it simply does not have that capacity. Furthermore, the WHO is hardly the only organization involved, making it tricky to coordinate an effective response. Doctors Without Borders has taken a leading role in providing medical personnel on the ground in West Africa, but it recently described the outbreak as “out of control.” The Economic Community Of West African States made Ebola a top issue on the agenda for its annual summit and created a “solidarity fund,” but it’s not yet clear how those funds will be distributed or spent.
The difficulty when international actors enter a situation like the current Ebola outbreak is that they often don’t integrate well into the communities in which they work. Without having an understanding and appreciation of local customs and beliefs, outsiders run the risk of offending communities or disregarding locally important practices. That, in turn, can lead to suspicion, conspiracy theories and attacks against health care workers, which we are seeing in this current outbreak.
WPR: What are the political obstacles to treating Ebola in the most affected countries, and what can West African governments do to be better prepared in the future?
Youde: In the immediate term, governments need to remove the threat of punishment and partner with local and international organizations to increase access to health care and conduct resonant information campaigns. Longer term, improved health care services and surveillance capabilities would certainly help, but none of the affected countries have the resources to make such investments. Liberia and Sierra Leone already have the two highest total expenditures on health as a percentage of GDP in the world. Strengthening health systems and surveillance capabilities will necessarily require external assistance from donor states.
Photo: Healthcare workers from Doctors Without Borders prepare isolation and treatment areas for their Ebola operations, Gueckedou, Guinea, March 28, 2014 (AP Photo/Kjell Gunnar Beraas, MSF).
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