Friday, October 31, 2014

Stopping the next Ebola outbreak in Africa (Lancet)

On the one hand, what's below is a damning indictment of the health effects of conflict, slavery, poverty, political instability and neglect of public health in Liberia and Sierra Leone.

On the other hand, it tells me that Ebola -- even without a vaccine or proven effective drug treatments -- can be stopped in countries with well-developed health systems and infrastructure such as running water. Indeed, Newsweek just concluded that:

An examination of health, economic and education data help explain why the disease escalated so severely in these three nations [Guniea, Liberia and Sierra Leone]; they also show why Ebola won’t rage in richer countries and what is required to not only halt this outbreak but prevent it from happening at this scale again.

Check it out [emphasis mine]:

Ebola has all but destroyed their health care systems. Before this crisis, Liberia had just over 50 doctors for its population of 4.3 million people; Sierra Leone had about 95 for its population of 6 million. After this crisis, when the temporary treatment centres are taken down and emergency response teams move on, there will be even fewer.

Yet of the hundreds of millions of dollars that will be spent battling Ebola, little to none of it will go into lasting infrastructure or ensuring effective systems are in place for next time. These nations must be supported to build up their health, water and sanitation sectors, so that they might have a fighting chance at managing their next crisis.

This is a difficult sell to international donors. It is much easier to celebrate the opening of a village’s new water tap, or a group of children successfully vaccinated against disease, than to talk about the long-term partnerships and financing necessary to create effective national sanitation and water coverage.

But what is needed is partnerships and financing to build management systems as well as infrastructure. Support for national and local governments to become capable of managing their own affairs is more important than ever if we are to avoid a repeat of this terrible epidemic. It will cost far less in the long run.

Of course, we in the West and the U.S. in particular can say, "It's not our problem. We'll just close our borders." But this isn't realistic or humanistic. The world is global now. Especially if Ebola jumps to other countries, such as India or Pakistan, that also struggle with public health and sanitation, then that would make it that much harder to contain Ebola's spread. Think how many Americans and Britons travel to/from those two countries alone.

By Mariame Dem
October 31, 2014 | The Lancet Global Health Blog

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