Liberia has lifted the Ebola curfew and re-opened its borders, confirming what we have known for the last several weeks: The country’s Ebola outbreak is being contained. This is a direct result of the global response to the epidemic, which included 3,000 United States military personnel who were deployed to build tents, train nurses, deliver supplies, and level swampy grassland. In fact, President Obama indicated on March 21st that U.S. troops will return home in 90 days.
We are moving from containment to eradication, according to Obama. This is a tremendous victory in the fight against infectious disease. We must be only cautiously optimistic, however, and use this outbreak as what Obama might call a teachable moment.
We’ve learned from the current Ebola outbreak that we cannot function in full emergency mode or battle pathogens one at a time. The World Bank Group Ebola Response Fact Sheet, released on April 17th, indicates that until we reach zero cases we remain at risk. The World Bank is currently developing a plan for a Pandemic Emergency Facility to enable the rapid flow of resources in outbreak situations. This facility will serve as a financing platform to contain outbreaks and prevent the escalating financial and human cost seen with this Ebola outbreak. Initiatives like this reinforce the fact that sustainable efforts must be made to ensure history does not repeat itself—yet again.
On March 31, 2014, when the outbreak began to spread in uncontrollable ways, Doctors Without Borders warned of the potential crisis and asked for help. One day later, the World Health Organization refuted these claims and stated the outbreak was not unlike those of the past. This statement resulted in slow response from international governments and organizations, and the outbreak remained uncontained for much longer than it might otherwise have.
It is almost 25 years to the day that the late Dr. Jonathan Mann resigned from his post as the director of the WHO Global Program on AIDS. His resignation was a protest against the United Nation’s failure to recognize the threat of HIV, and to prevent its spread and provide treatment. The efforts of Mann and countless others have resulted in an organized global response to AIDS, but not before the infection of over 30 million people and the death of 18 million.
Mann rightly believed that human health and human rights are interconnected, and that human rights violations result in adverse health effects. It is not surprising, then, that two of the three countries hit hardest by Ebola are recovering from recent civil war.
In the midst of recovery efforts, poor infrastructure and immense poverty in densely populated areas fuel outbreaks. Ebola’s spread in turn contributed to the violation of human rights—patients were turned away from care or unable to get to facilities for treatment.
Dr. Martin Salia’s is an unfortunate example. His wife flew him back to the U.S. after he was denied treatment in Sierra Leone, but the delay contributed to his death. Governments were obligated to ensure that quarantined persons had access to health care, water, and food—and these standards were often not met. Furthermore, as late as December 2014, Ebola-affected countries were still lacking supplies and treatment facilities. These are clear human right violations at the time of plague. And they raise a pressing question: Who should support improvements in infrastructure in resource-limited settings?
First World nations cannot take responsibility for others’ corrupt governmental systems, histories of bad governance, and civil unrest—all persistent problems in countries crippled by Ebola. Yet Ebola and the fear of its global spread are real. So what do we do? What are our responsibilities? As we know, vaccine development and trials are on the way. The successful eradication of Ebola is the primary goal, as with other infectious diseases. But vaccine development is only part of the answer.
As we move toward the 2030 Sustainable Development Goals, a set of proposed targets for international development, lessons from this Ebola crisis must be considered. Ebola highlighted the need for improved infrastructure. The SDG call for global access to safe and sustainable water, health care, nutrition, and basic functioning infrastructure. A tremendous goal, but Dr. Jeffrey Sachs believes it is possible for First World countries to support such efforts with our ongoing technological advances. In a piece published in the Lancet, Sachs indicated that social media and information technology had led to global inclusion and can serve as a platform for problem solving on a global scale.
This Ebola outbreak has also taught us that training and skill building of country-level workers, procurement supplies, and effective monitoring and evaluation are critical to an effective response. The SGD also call for the promotion of equitable education, economic growth, and employment.
Realistically, holding developing countries accountable is the only way to achieve sustainable approaches to long-term global issues. To facilitate this process, donor countries and organizations must anticipate and respond adequately to governmental challenges. Effective oversight of the allocation and use of donated resources must occur.
In November 2013, The World Bank’s International Development Association financed a project to improve financial control in Sierra Leone’s government by building a system of accountability through independent and public oversight of central public finances. More of these efforts are necessary, and their successes should be widely publicized.
In spite of the low threat of infection, the Ebola outbreak has been described to have weakened the sense of comfort in Americans. In November 2014, Americans listed Ebola as their third top health concern. In this Gallup poll Ebola ranked higher than cancer, obesity, and diabetes with one in six Americans indicating Ebola as a top national health problem. Now that things are calm, citizens must realize that few plans exist to prevent the next potential pandemic. If that’s ever going to change, advocacy is critical. Providing the support needed to improve global conditions is the responsibility of citizens as well as organizations.
We must demand that government officials support global efforts toward improvement. The President’s Emergency Plan for AIDS Relief, for example, has provided tremendous financing to combat HIV/AIDS in sub-Saharan Africa, and Americans can advocate for the creation of similar initiatives to combat Ebola and other infectious disease.
So yes, history has repeated itself, this time with a virus that is more virulent and more infectious than HIV. Ebola has AIDS activists saying here we go again but more importantly, it has them saying we can’t let it happen this time. Who wants to live one global epidemic crisis at a time? Working toward these goals will begin the transformation process. We should all be held accountable for the achievement of sustainable development—which will allow us to win the war on infectious disease.
