In a recent interview with the CSIS Global Health Policy Center in Dakar, the Senegalese minister of health, Dr. Awa Marie Coll-Seck, used a familiar term to express her commitment to expanding access to family planning—“yes we can.” That is a bold proposition in such a conservative country, in a region with some of the world’s highest maternal mortality and unmet need for family planning. Her leadership reflects an important moment in Senegal.
Sekou Toure Referral Hospital is a public facility serving the population of Mwanza Region on the shore of Lake Victoria in western Tanzania. Set in Mwanza Town, the regional capital, the hospital is a sprawling collection of low buildings arranged around courtyards planted with shady trees. Compared with the hustle and bustle of a fast-growing city and hub of Tanzania’s fish-export industry, the hospital is an oasis of calm, with white-coated doctors and nurses in blue dresses attending patients of all ages.
On Wednesday, November 19, the CSIS Global Health Policy Center hosted a discussion focused on the economic impacts of the Ebola epidemic in West Africa. Panelists included David Evans, Senior Economist at the World Bank Africa Region, and Abebe Aemro Selassie, Deputy Director of the International Monetary Fund African Department. J. Stephen Morrison, Director of the CSIS Global Health Policy Center, moderated the discussion.
The risk that any particular person in the United States will contract Ebola is truly infinitesimal. Over two million people in the United States will die of all causes this year—600,000 of them from heart disease—and so far one has died of Ebola. Yet a great number of people in the United States are afraid, in some cases very afraid, of Ebola. Why have they spent psychological and political energy fearing a fate so unlikely?
J. Stephen Morrison, director of the Global Health Policy Center here at CSIS, got my attention when he described the Ebola outbreak as a two-front war: a public health battle in plague-like conditions in West Africa, one, and a communications battle against fear and overreaction in the United States, two. Government officials, wrote Dr. Morrison, “failed to appreciate just how swiftly a small number of Ebola cases in Dallas could ignite fear across the nation, raise the risk of panic, and begin to erode public trust.”
The latter were not the only critics he faced while in the United States. He also met with multinational CEOs unhappy with India’s commercial regulatory environment, including those of pharmaceutical giants Merck and Hospira that have longstanding complaints about India’s application of its patent laws. Modi’s business-friendly election platform has created hopes that he will reverse what multinationals perceive to be an unfair competitive environment in India. For U.S. and European pharmaceutical companies, India’s emergence as the leading supplier of low-cost generic drugs has been particularly galling.
While prevention messages are critical, a lesson from the struggle against HIV/AIDS is that women’s and girls’ risk of infection is compounded by gender disparities and inequalities, and many U.S. programs lost precious time before realizing that A, B, and C were often not within a woman’s or girl’s power to control. Similar concerns might apply to the Ebola crisis.
The Ebola epidemic in West Africa has taught us many lessons, among them that weak health services anywhere are a potential threat to everyone everywhere. While even the most advanced countries have been challenged by the virus, the fact that the outbreak is occurring in some of the frailest health systems in the world led to the enormous size, scope, and death rate associated with the crisis.
Most remarkable, within a month the controversy surrounding the threat of Ebola to Americans had mushroomed into a political emergency for the Obama presidency itself, only a few tense weeks before the November 4 elections. Calls escalated for the appointment of an Ebola czar and a travel ban on persons originating in Liberia, Sierra Leone, and Guinea, the root sources of the Ebola emergency. A special measure of criticism was reserved for the Obama administration’s lead face in the U.S. response, Dr. Thomas Frieden, head of the U.S. Centers for Disease Control and Prevention (CDC). In the words of one observer, this week became full of “recriminations, political showboating… and panicked overreactions.”
For several days, news helicopters have flown in great arcs around the East Dallas neighborhood known as Vickery Meadow, which includes the hospital complex as well as a dense, highly diverse neighborhood of Mexican and Central American immigrants, resettled refugees from Southeast Asia and West Africa, and others. The Ebola patient, identified as Liberian national, Thomas Eric Duncan, had reportedly been staying at the Ivy Apartments located there. Just this past September, the John D. and Catherine T. MacArthur Foundation awarded one of its prestigious “genius grants” to Texas artist Rick Lowe, who has overseen high-profile projects to install art galleries and public art in Dallas’s “Own United Nations,” as Vickery Meadow has been called. If that news hadn’t already catapulted the neighborhood to national fame, the recent coverage of Duncan’s background and activities in Dallas by CNN, The New York Times and other international media certainly has.
Ebola has overwhelmed the containment and treatment measures attempted thus far, and is seriously threatening nearby and neighboring states. Research and development of treatments and vaccines has accelerated, but the speed with which the Ebola virus is mutating has complicated the quest to identify new tools quickly.
The myriad of challenges contributing to the persisting spread of Ebola in West Africa – the biggest Ebola outbreak since the viral haemorrhagic fever was discovered in 1976 – echo some of the biggest obstacles which continue to challenge the global efforts to eradicate polio.