Wanted: Farsighted African Leadership against Ebola

Few emergencies in modern history have cumulated an endless list of frightening superlatives in such a short period of time. Within a couple of months, the West African Ebola Virus Outbreak (EVO) has been qualified as: public health emergency of international concern, extraordinary event, uncontrollable, fatally inadequate, exponential in growth, unprecedented, catastrophic, worst ever and greatest peace time threat. Since the outbreak ten months ago, it is only now that the international community seems to wake up albeit in panic to the ravaging scale of the epidemic.

The response so far, has revealed an epic failure of collective actions at the global level for addressing African health challenges— something akin to a ''Rwandan moment'', when the international community fatally underestimated, misread and dithered to avert genocide. But a lack of farsighted leadership by Africa has not only mishandled the epidemic but also squandered a chance to show the world that the continent is capable to hold its act together, however terrifying the challenge may be.  

Every one for themselves

African countries both individually and collectively have displayed solidarity in reverse. Without a doubt, more could have been done by the countries at the epicenter of the outbreak-- Guinea, Sierra Leone and Liberia-- to contain the virus from getting out of control. A recent article in the top rated New England Journal of Medicine notes that the exceptional scale of the outbreak is man-made and not wickedness of the virus (Bruce etal, 2014). It took four months, for example, since the first confirmed case of the outbreak in Guéckédou, a district in Guinea to be reported to the World Health Organization and public health measures mobilized to halt its spread.

But few African countries could have done better. In a recent statement at a regional health ministers meeting in Nairobi, WHO noted that only Algeria and Ethiopia have the minimum required capacity to effectively deal with an outbreak of the scale of west Africa[1]. And in the most up to date review of the International Health Regulation, a set of minimum core competencies countries must put in place to fight ravaging epidemics like Ebola, African countries scored very poorly across key competencies, with only 29 percent of  them having minimum requirements to fight epidemics at the ports of entry. In fact, when all ports of entry were taken into consideration, no country reported to have put in place minimum surveillance and response measures in all its national border crossing points (World Health Organization , 2014).

Yet most African countries were the first to cast a stone of stigma at the affected countries. Ebola virus outbreak has unleashed a dark side of Africa, turning on its head, the narrative of a continent joint up together by an unprecedented match forward to economic renaissance.While it is understandable, that the reaction of any government in the face of a highly contagious health crisis like EVO is to protect its citizens first, but without a rational evidence-led approach, the unintended consequences of responses could even be worse than the disease itself.  Even against a WHO warning about the uselessness of panic-driven blanket measures, African countries have displayed shamefully a no show of solidarity. Even countries as far away from its epicenter like South Africa, Kenya and Equatorial Guinea have all rushed in a herd-like fashion to barricade citizens and passengers flying from the affected countries. For neighboring countries, their reactions have even been more punitive. Ivory Coast has blocked even ships with humanitarian supplies from transiting through its ports to the affected countries. Football, the most popular and unifying sport in the continent was not spared. Ivory Coast opted for suspension rather than host an African nation qualifier against the ebola-hit Sierra Leone in Abidjan.

Not all African countries have been indifferent too. In the name of solidarity, some have provided token financial, human and material support to the virus-stricken countries. But curiously, most have offered assistance with one hand while taking away the rug under the feet of afflicted countries-- making it extremely difficult for them to cope, on the other hand. Kenya a major air bridge to the Ebola-hit countries has provided more than 2 million dollars as well as health personnel,  while at the same time banned flights from Nairobi to those hardest-hit countries. Those same countries are the ones going around blaming the West for the failed collective response to the disaster (3).

The consequences of paranoia have not only limited critical emergency supplies, but more so taken the wind out of much needed economic growth. In a recent report, the World Bank reckons that fear-based actions impact far more on recovery than the virus itself. The report infers that panic-inspired runaway behavior could account for up to 90 percent of the economic effects of the outbreak which is projected to wipe off over $805 million on average from the three hardest hit countries combined, in the worst case scenario by 2015 (World Bank , 2014). This is almost what the UN urgently requests to bring the virus under control.

Too little too late

So far, myopia has marked responses in countries. But even more surprisingly, at the continental level, leadership has been a no show. While WHO, as the world’s health agency with the primary  responsibility for sounding the alarm and mobilizing global collective actions against the epidemic has failed fatally, with little far sight, the African Union could have better anticipated proactive measures to avert or mitigate the secondary impact of the outbreak, in particular holding the rope against potential regional disintegration tendencies. Since the outbreak was formally announced in March, it took almost five months for the African Union to release an official statement on Ebola.

Continental diplomacy in fact has failed to even catch up talk less of influence or lead politics at the country level. No country has lifted the ineffective blanket travel bans. The African Union’s position against the solidarity breaking bans came too late, when fear had already triumphed over evidence of low risks of contagion by air travel. In a forward looking manner, a Special Envoy could have successfully lobbied key countries earlier on, away from putting in place punitive wave of bans against the Ebola-afflicted countries. Because the bans were politically inspired, they seem to have taken a life of their own— difficult to remove them now, even after the insistence of UN Security Council and the World Health Organization.

To be fair, the African Union has reached out to affected countries albeit with modest support in comparison to the needs and scale of the outbreak. The Commission has pledged financial as well as human and material resources to the fight against Ebola.  One million dollars, has been pledged to the fight and a team of over 30 military and non-military medical personnel deployed to the affected countries. But most importantly, the Commission has reconfigured its crisis fighting toolkit, to include response to health emergencies, of state-collapsing dimension. It remains unclear whether the change was just an add-on or far reaching enough to integrate human security dimensions better in the African Peace and Security Architecture.  

Lesson unlearned

Against an exponential spread as well as upwardly revised case fatality rate[2], a jargon, Africa cannot afford to improvise its way out of the crisis. The virus may live with us longer than imagined.  Recent research has warned of a risk of continued expansion of the outbreak and the prospect of the virus becoming endemic— able to be transmitted at low levels in humans (Bruce etal, 2014) The US Centers of Disease Control has estimated that the virus, in the worst case scenario, could infect up to 1.4 million peoples in the region by early 2015. This calls for the most forceful implementation of current tested and proven control measures and for the rapid development and deployment of new drugs and vaccines. Fear of the virus mutating in a way that could spread easily by air has been voiced in the medical community, too (Maron, 2014).

Given the changing nature of the virus, without a visible forward-looking leadership, Africa would further mishandle the outbreak at a scale comparable to the HIV/AIDS.  Strategic priorities like potential access to experimental therapies and drugs, intellectual property rights seem to have been pushed to the backburner, with likely catastrophic consequences. While life-saving treatments for HIV/AIDS were around during the 80s, it took more than two decades for African countries to wake up and push those issues up the international security agenda, at an appalling cost of over 20 million lives lost to the disease, because of unaffordable drugs (World Health Organization , 2000). That is almost the population of the three most affected Ebola countries.

Stepping up the game

A massive surge in resources both human, material and financial  are required to bring the outbreak under control, and the international community seems to be waking  up to the challenge. But without a strategic approach, Africa is not going to leverage its own resources optimally in addition to international support, and do so in a way that could immediately bring a halt to the spread as well as prevent future outbreaks. And because of a dearth in continental leadership, Africa is unable to put in place mechanisms that could prevent the external militarization of responses to the epidemic from creeping into other important policy spheres like economy or upset regional geopolitical balance.

Africa, indeed, cannot afford to be a bystander in the setting of global health security norms. Going forward, the continent would need farsighted leadership to come up with a common position on global health security, something it has not done. What values should guide an African own global health security agenda? What are the priorities and mechanisms for its effective implementation?    A High Level Continental Forum on Global Health Security would be crucial to start talking about those issues. The African Health Strategy, up for revision next year could provide an opportunity to bring the health systems strengthening agenda with that of global health security, and doing so in a way that reflect Africa’s long-term needs and capacities.

  

Works Cited

·      Bruce etal, B. p.-M. (2014). Ebola Virus Disease in West Africa —The First 9 Months of the Epidemicand Forward Projections. The New England Journal of Medicine.

·        Maron, D. (2014). Will the Ebola virus go airborne? Nature.

·      World Bank . (2014). The Economic Impact of the 2014 Ebola Epidemic:Short and Medium Term Estimates for Guinea, Liberia, and Sierra Leone. Washington: The World Bank.

·        World Health Organization . (2000). HIV Surveillance Report For Africa. WHO Africa.

·     World Health Organization . (2014). International Health Regulations (2005): Summary of States Parties 2012 Report on IHR Core Capacity Implementation. Geneva: World Health Organization.

---

[1]  http://newscontent.cctv.com/NewJsp/news.jsp?fileId=260425

[2]  Due to the limitations of previous methodologies, the  case fatality rate, that is the chances of dying after an attack of Ebola has been revised from 50 to 70%. 
(3)http://www.nationnewspaperkenya.tk/2014/09/uhuru-kenyatta-accuses-west-of-slow.html