Ebola And Evolving Health Security


The Ebola epidemic, which has been rampant for 42 years, has surpassed yet another alarming milestone: on 7 March 2019, the WHO reported that the epidemic was responsible for 907 confirmed and probable cases, and 569 deaths in Democratic Republic of Congo alone. The disease continues to spread with moderate intensity, especially in the areas of the North Kivu and Ituri provinces; the probability of the outbreak spreading to Uganda and other neighbouring countries is also very high.

The African continent has had immense healthcare challenges. There are serious gaps in governance structures and inefficiencies in the process of allocating resources. These systems run parallel to weak information and management networks. Thus, because of factors such as a dearth of information, shortage of healthcare workers, unreliable supply systems, unaffordable prices, and variances in the quality and safety of products, the delivery of effective healthcare services has been non-existent for most of the population. To rectify this situation, the lack of investment in healthcare policies along with the lack of social safety nets to cater to people in need. This has been the need of the hour since the previous Ebola outbreak in Western Africa in 2014-2016.

Since the first outbreak of Ebola, the disease has been termed as one of the deadliest threats to peace and security; on 8 August 2014, the WHO declared Ebola a “public health emergency of international concern.” When it was first discovered in 1976, it was concluded that the disease was caused by two distinct viruses: Zaire ebolavirus and Sudan ebolavirus. When the epidemic re-emerged in 2013, it seriously afflicted Guinea and quickly spread to Liberia and Sierra Leone, and affected a large part of the population in all regions. The virus mainly spreads through if the affected patient comes into contact with others. To stymied its rapid spread, a mix of early diagnosis and patient isolation and care is necessary to control the infection. In 2014-2016, this prevention method was neglected; it was found that majority of the virus transmission (nearly 74%) happened through direct contact among family members.

Given the destructive power of the disease, and the scale at which it spreads, it is understandable that an effective, immediate response can be difficult. However, the general inadequacy of the barely standing public health institutions proves to be the hindrance in confronting the medical disaster. The lack of personal protective equipment and over-exposure to hazardous environments resulted in the deaths of more than 500 health workers. Of this number, 20% of lives claimed belonged to doctors, nurses and midwives in Liberia, Sierra Leone and Guinea. The serious shortage of the medical staff has only aggravated the health situations in these countries.

The pressing question is: when countries are unable to safeguard their health providers, how can they possibly secure their citizens?

The wave of problems that Ebola brought with it are not only limited to the countries that are directly affected by it; the disease has de-stabilised the global economy in many ways. For instance, travel restrictions, the shutting down of multiple social services, and border sealing has lead to occupational instability and created a massive hindrance for many workers in and around the region.

Moreover, since mid-2014, the three most affected countries of Guinea, Liberia and Sierra Leone, have experienced flat income growth, as the gains of the previous decade were eroded with the onset of Ebola virus disease in the area. The World Bank estimated that the virus has cost these nations a loss of over $2 billion, making the fiscal impact an estimated 5% of their combined GDP. Moreover, the WHO issued advice against conducting any trade practices with the affected countries till the virus is completely containment. This has resulted in loss of business for multiple airlines, cargo shipments, and barriers to new investors, especially in the field of mining.

Ebola is not just an “African health problem.” The threat of the virus entering countries like India is real.

We must address however, whether or not we are positioned to combat such a virus given our own healthcare system. In order to safeguard ourselves, it is essential that we put in place a plan of action in case the event occurs. This includes systematic answers to what its transmission dynamics may be. In this current era of globalisation, it is important for us to understand that both individual and global health security are closely tied with setting priorities and allocating resources to mitigate and recover from large scale calamities.

The Ebola outbreak is only the most recent illustration of how ill-suited the medical research and development model is when it comes to addressing the world’s health priorities. Research and development and access to diagnostics, vaccines, and treatments are crucial to health security, and cannot be left to market forces alone. The task of addressing global health security has become paramount.

The globalised world has not only provided a passage for people to cross borders but has also created a corridor for diseases to travel at rapid speeds. With a steady rise in the number of non-communicable diseases, as well as infectious disease threats, it has become urgent for us to build more resilient universal healthcare systems that prioritise prevention along with containment of such diseases.

International Health Regulations provide an internationally agreed upon framework to further the cause of collective health security. These regulations require reporting public health emergencies of global concern and real-time dialogues among affected governments. It urges organisations like the WHO to propose evidence-based actions at borders, and working with nations to strengthen their core capacities in public health for rapid detection and response.

The Ebola crisis has attracted much needed attention towards the importance of reducing the collective vulnerability against infectious diseases, and has highlighted the importance of individual health security that comes from access to safe, effective and affordable healthcare services. It is now upon us to realise that collective health security can only be achieved by ensuring individual health security. This can only be accomplished by providing equitable access and financial protection under the umbrella of a strong public healthcare infrastructure.

The views expressed above belong to the author(s).