Post #50 – The Lessons of Ebola

The battle against Ebola is in danger of being lost.  A top official of MSF (Médecins Sans Frontières, or Doctors Without Borders), the lead NGO in West Africa with about 3,000 people on the ground, said on October 16 that the organization has “reached our ceiling” in resources and that the disease was outrunning the capacity to stop it.  “70 in 60” is the latest warning from doctors who have visited Liberia and Sierra Leone: Unless 70 percent of those infected are isolated and in treatment within 60 days from now, the number of new victims will increase exponentially—by as much as 5,000-10,000 every week come December.  But stopping the disease is extremely risky: More than half the healthcare workers in West Africa who contracted Ebola have died.

As we are all too aware, epidemics can devastate societies and set back their development for generations.  Malnutrition has stunted the physical and mental growth of a generation of North Korean children.  HIV-AIDS has done the same in parts of Africa.  We can expect the Ebola virus to have a similar long-term impact on Sierra Leone, Guinea, and Liberia.  Thus, it is entirely apt to speak of Ebola as an international security crisis.  Without a dramatic worldwide response, the disease is bound to spin out of control and, as President Obama noted, “will spread globally.”

The fundamental drivers of the Ebola virus are grinding poverty and lack of preventive measures.  Both factors were cited by the heads of the World Health Organization and MSF in recent statements. Years ago I recall reading a study of global poverty in which the author said the main reason poverty is so difficult to halt is poverty itself.  That may seem like a silly statement, but it really isn’t—and the Ebola crisis shows it.  Impoverished populations, such as those living in the three countries most afflicted by Ebola, lack the money, education, and health care resources to deal with disease.  (One of the best indicators of the poverty-to-health care relationship is the ratio of doctors to population, and in these three countries that ratio is tragically low.  So many of their doctors have, of course, fled to richer countries.)  When a health crisis, or any crisis, erupts, poor people are least able to fight it.  And their vulnerability is passed on to the next generation, and the next. Ebola “isn’t a natural disaster.  This is the terrorism of poverty,” said Dr. Paul Farmer, famed for his humanitarian work in Haiti and co-founder of Partners in Health.

To make matters worse, the major industrialized countries typically only act when the crisis crosses borders and threatens them, as we see happening today.  Big Pharm—the major pharmaceutical companies—doesn’t emphasize research and development of vaccines that the poor cannot pay for.

In short, the rich-poor gap matters when it comes to international action, as Dr. Margaret Chan of WHO said.  The Ebola crisis, she observed, demonstrates “the dangers of the world’s growing social and economic inequalities.”  “The rich get the best care.  The poor are left to die” (www.nytimes.com/2014/10/14/world/africa/ebola-virus-outbreak.html).

Climate change may also be a factor in epidemics and pandemics. A just-released Pentagon report argues that health crises are among the many potentially destabilizing consequences of climate change (see 2014 Climate Change Adaptation Roadmap, www.acq.osd.mil/ie/download/CCARprint.pdf).  Even Secretary of Defense Chuck Hagel, a one-time climate change denier, now regards climate change as an immediate security challenge.  Few specialists have suggested a link between climate change and Ebola.  But we know that some consequences of climate change—such as rising sea levels, hurricanes, tsunamis, and drought—do play an important role in large-scale health problems as well as major social disruptions and consequent political instability.  In a word, environmental and social stresses are interrelated, and when government proves unable or unwilling to deal with those stresses, you can pretty well count on a political upheaval.

HIV-AIDS, SARS, avian flu, H1N1, and now Ebola—the list of local health problems that become global health crises is getting longer.  One of these days, some bright and courageous national leader is going to announce that, as a matter of national and international security, a significant portion of her country’s military budget is going to be shifted to confront global problems such as health care, climate change, and migrant labor.  But making that shift requires adopting a new paradigm of global community.  A high-powered group of former US officials, NGO leaders, and politicians, called Managing Global Insecurity, said as much in 2008 when it urged the US to embrace the idea of responsible sovereignty:

” . . . the vision necessary for a 21^st century international security system is clouded by a mismatch between existing post-World War II multilateral institutions premised on traditional sovereignty—a belief that borders are sacrosanct and an insistence on noninterference in domestic affairs—and the realities of a now transnational world where capital, technology, labor, disease, pollution and non-state actors traverse boundaries irrespective of the desires of sovereign states.  The domestic burdens inflicted by transnational threats such as poverty, civil war, disease and environmental degradation point in one direction: toward cooperation with global partners and a strengthening of international institutions.” (www.brookings.edu/research/reports/2008/11/11-action-plan-mgi)

          That critique points to a far greater investment by the richest countries than they are making now in WHO, in their own disease prevention and control organizations, and in health care in the poorest countries.  Unless and until that happens, new security threats such as Ebola will continue to be dealt with episodically, which means leaping from one crisis to the next without the all-out international effort of prevention and treatment that is essential.