On March 31, 2014, Médecins sans Frontières (MSF) declared that an unprecedented Ebola outbreak had hit Guinea, with Liberia registering its first case at the same time.
On June 24, 2014, MSF, which had been the only organisation providing care for Ebola patients in Liberia, declared that the epidemic was out of control and the organisation had reached capacity.
They called on other organizations, including the WHO, many times to send support; however, it was not until over four months into the outbreak that WHO, the United Nation’s branch responsible for coordinating international action in crises like Ebola, announced the Ebola outbreak in West Africa as a public health emergency of international concern.
As of early September 2014, with more than 1,800 confirmed Ebola-related deaths, there was still no coordinated global response. The WHO reluctance to declare the Ebola outbreak in Liberia an emergency, and therefore coordinate all the help, partnership, and infrastructure needed to save lives is an example of structural inequality in international disaster response. Would the response have been the same if the outbreak had struck Switzerland or Singapore?
The Ebola outbreak in West Africa is a reflection of the consequences of long-term ineffective health systems, insufficient health workers, poor and scarce health facilities, and limited equipment, which if scrutinized further are ramifications of colonialism and neoliberalism.
Pandemics, particularly those from zoonotic diseases,which are diseases that are transmitted between animals and people (like Ebola for instance), are a threat to our world. In the current state of our globalized and intricate world, a person infected with the Ebola virus from Freetown,Liberia can get to Vancouver,Canadaunder 24hrs, potentially spreading the virus at each leg. Or a person infected with the Middle East respiratory syndrome coronavirus (MERS) could fly from Jeddah,Saudi Arabia, to Helsinki, Finland within 9 hours. Just think about, the number of people from different corners of the world that one person from Freetown could meet along the journey from Freetown to Canberra, and the global risk of a pandemic that could ensue. In one day alone, 61,000 passengers pass through Vancouver International Airport, traveling to 125 cities around the world.
The fears of the next pandemic are real, and justified, and will not be mitigated until local health systems in Africa and around the world are sufficiently strengthened to be able to address what could possibly happen.
The challenges of the recent Ebola outbreak in West Africa will be magnified with a wider-spreading pandemic. The best way to prevent a global pandemic is to contain an outbreak at local level. This is best done through two means: early detection and rapid response.
At a country level, governments should adequately finance and invest, with good governance, in what Dr. Paul Farmer of Harvard medical school has referred to as “the 4S’s”; Staff (health care professionals), Stuff (equipment),Space (health centers/hospitals/clinics), and well-designed health care Systems. African countries that are more advanced in disease surveillance and response should coordinate with neighboring countries who are struggling most. Whereas at the global level, countries should cooperate to develop more point of care diagnostics, expedite development of vaccines, and work on financial mechanism such as tiering and pooling to ensure universal access of those vaccines.
Additionally, last mile delivery is a difficult challenge, and needs to be considered and addressed well before the next pandemic. Delivering medications to a cordoned-off neighborhood in Liberia, or the polio vaccine to a rural village in Pakistan are emblematic of these challenging last mile delivery problems.
Another critical point is that the prevention of pandemics should be viewed through a One Health lens, and put in place cooperation and coordination mechanisms to endorse the collaborative efforts of multi-disciplinary teams to jointly address a pandemic. For example, if governments put in place the infrastructure to merely improve the health of people whilst not investing in disease surveillance in animals, the risk of a pandemic in human beings persists because an emerging or re-emerging zoonosis might circulate at animal level for a long time before subsequently reaching the human level, further increasing length of diagnosis. Therefore, early detection in both animals and humans allows suitable preventative measures.
As a young African global health professional, I’m calling upon my colleagues throughout this continent to advocate for intra-African partnerships in disease surveillance and rapid response.
In addition, most African countries have been registering a steady GDP growth rate for the last ten years or so, that growth must be matched with allocating more monies all along the value chain of pandemic preparedness (community awareness, data collection, health care workers training, diagnostic capacity building, rapid response,…). Finally, in order to efficiently implement these solutions, we need good governance and leadership that ensures accountability and follow up of agreed-on plans to prevent a pandemic locally – which is the gate to prevent a global pandemic. Pandemics don’t stop at borders; an epidemic anywhere is a threat everywhere.