Ebola: lessons unlearned

By Carlos Lopes
When in March this year Guinean authorities reported the first positive tests for Ebola in the West African region, the news came as a surprise for scientists and were treated passively by most. After all Ebola had killed over a period of thirty years more than two thousand people, since it was first discovered in Yambuku, in the DRC. Never did it surface outside the Great Lakes and it has never been perceived as a threat for an entire country.

About a century ago when the Spanish flu became a pandemic, it is projected that about 40% of the population was ill. An estimated fifty million died. People were fine in the morning and would die by the nightfall. Closer to our time we saw the reactions we got when HIV/AIDS was first discovered. It was total panic, with countries not issuing visas, putting ineffective controls in place and reacting as if it was transmissible though thin air. In fact, even closer to our times, we remember the SARS, or Severe Acute Respiratory Syndrome, alert, that came after an outbreak in China and Southeast Asia, about ten years ago. That syndrome was indeed prone to airborne contagion, yet nobody remembers airline crews refusing to fly to affected countries. A more commonly known transmissible airborne disease is tuberculosis. Again, nobody heard, even remotely, about measures being taken to quarantine people, let alone regions or countries due to tuberculosis.

The reason it is important to reflect on history is because the African continent cannot afford a serious threat like Ebola to be de-contextualized. It brings us back to the stigmatized Africa. In the process, there will be no focus on the efforts needed to deal with the issue. The economic and social consequences of such misguided perceptions are already devastating.

Why has Ebola hit so hard?

Ebola has been stopped every time an outbreak was announced, thirteen times in fact, except this time. It is important to understand why, as well as be bold about learning from the current mishaps that contributed to the emergency this time around.

These include the fact that the affected countries have poor health systems; information flow is poor; and there is an almost total absence of good communication. We can regret the decadent health infrastructure, particularly in remote rural areas. We can add our concern about the huge deficit of medical personnel available to combat any pandemic. Africans have to right to be outraged that only 1% of the pharmaceutical research is devoted to diseases that affect the continent, which carries 25% of the world’s disease burden. All of this is true and sadly well known.

The reason influenza only kills about half a million a year or that SARS only had about 12% death rate compared to Ebola’s 54%, is certainly the existence of a well developed capacity in Western of Southeast Asia countries. It is not because of the nationality or origin of the affected.

Today there are reported Ebola cases in seven countries, with over 2000 deaths and 20,000 estimated cases. There is nothing, absolutely nothing, in the current forms of dealing with the situation that can effectively impede say tomorrow, half the African countries having reported cases. For each African country putting in place draconian measures that are not medically justified they have to think of themselves being under the same measures, in a not so distant future, as a very likely possibility.

This brings us to the issue of solidarity!

More than solidarity, it is about common sense. Ebola can only be tackled through massive investment to address on an urgent basis the contributing factors to the outbreak. Countries in the epicenter are over-stretched and they need the whole of Africa to put a stop to misinformation and instead join the call for action for substantial funding of the outbreak control measures. The UN estimates the need at 1 billion dollars immediately. WHO has a clear roadmap for the process. The minimum to expect is that Africa comes in solidarity for this emergency package to be implemented without any more hesitations. Time is pressing. That is the real solidarity.

The economic impact

The economic impact of the Ebola outbreak will be significant. Estimates by the Economic Commission for Africa confirm that several points GDP reduction are to be expected in Guinea, Liberia and Sierra Leone, due to a combination of factors. These include significant reduction of mining operations, disruption of agricultural cycles with direct impact of upcoming harvests, restriction to domestic and cross-border trade, substantial reduction of air travel, postponement of already negotiated or foreseeable investments, spectacular diversion of public funding towards combating the epidemic, impact on fiscal space and, finally, inability to pursue initiated reforms.

Investors are influenced by the panic mode that has been spreading through the media. They think it is a risk to deal with entire countries. It is as if the Ebola bodily fluids transmissibility had gone from individuals to countries. This is fuelled by the concentric circles of quarantine, neighborhood shut downs and border closures, all highly publicized by the international media. The gear used by the medical personnel that can afford it reminds us of the images of Chernobyl and Fukushima.

Economic consequences are never far from the social ones. Humanitarian actors are complaining that instead of opening arms for their work they are being restricted. The ethnic or regional stigmatization has had tremendous costs for segments of the population that were already isolated geographically. Individuals suspecting the symptoms may not be sure they have Ebola, but are sure that the devil is in the hospitals. Behavioral issues such as what one eats, how one conforms to hygiene protocols or plain human right for care and decent death, require a humane and compassionate attitude. More than half of the victims have been women. Food price increases and local markets disruption or closure, are threatening fragile consumption patterns.

Africans are only going to win this fight if they deal with its spread. As much as vaccines can and should play their role, at this stage they are not at the centre of the response. The serum of the Ebola survivors is already being considered the most immediate resource for the victims that reach a medical unit. But even that commands considerable means and capabilities. We need to have such facilities first. There must be a special emphasis on containment, prevention and preparedness. It is unprecedented to have such a high number of medical personnel, as many as 120 so far, dying from a transmissible disease. It only becomes possible if one does not possess basic equipment.

The world is showing that it has unlearned from inflectional diseases, rather than learn from accumulated knowledge. Ebola is just the last episode in a long course on hysteria faced by the continent. This time around instead of succumbing to it Africans need to fight back.

An abbreviated version of this blog has been printed as an article in Jeune Afrique -publication no 2802 of the 21 to 27 September 2014
Carlos Lopes is the Executive Secretary of the Economic Commission for Africa, based in Addis Ababa, Ethiopia.