It was foreseeable that if an Ebola outbreak in an impoverished African country moved from rural to urban areas, the existing heath care systems would be unable to treat everyone or prevent further transmissions. Years of conflict, lack of education, corruption, distrust of government, and chronic underinvestment in the health care system would take their toll.
People in West Africa are dying of poverty and the Ebola virus is the instrument of those deaths. While any outbreak of Ebola would lead to some deaths, there are steps that can be taken to stem the spread of the virus once its presence is identified. A robust response of the health care system acting in concert with strong public health policies and practices that are rooted in human rights principles can be effective in preventing further infections. Such a response must prioritize effective identification and treatment of people with the virus, contact mapping and monitoring of people who may have been exposed to it, accessible information campaigns, strong protections for health care workers, and measures to ensure that all people can access health care without discrimination. When such an outbreak occurs in countries that do not have adequate resources to undertake this response, including people with the proper expertise, the international community must provide assistance in a timely manner.
Given the lack of investment in the health care systems of the three hardest hit countries in West Africa (Liberia, Sierra Leone and Guinea) – investment that requires domestic political will and resources from the international community – the spread of Ebola was inevitable. Major missteps by the World Health Organization (WHO) and the delayed and frankly indifferent response of wealthier countries have exacerbated the situation. It is worth repeating: people in Liberia, Sierra Leone, and Guinea are dying of poverty.
The belated and parsimonious response of governments that could have acted sooner to provide much-needed expertise and resources reflects an apparent willingness to allow thousands of Africans to die – so long as the virus did not leave West Africa. Former UN Secretary General Kofi Annan articulated this critique when he described himself as “bitterly disappointed” with an international response that is lackluster at best and counter-productive at worst. The delay in responding to the outbreak has caused the death of thousands of people who could have been saved. Rather than prioritizing treating those who have Ebola and preventing further transmission, developed countries seem more concerned with preventing Ebola from spreading outside of West Africa.
In fact, most governments – with a couple of notable exceptions – were only spurred to take necessary action commensurate with the extent of the crisis when Ebola cases were identified in the Western world. Indeed, Cuba, a country that continues to suffer the effects of decades-old economic sanctions by the United States, has been a leader in responding to the crisis.
We have become too accustomed to living in a world where developed countries do their best to keep their walls up and outsiders at bay. But a virus is much more like freely-flowing capital – it can more easily cross borders and no walls can keep it out.
From this Ebola outbreak, the international community must learn that the only way to protect the right to health of the privileged is to invest in the right to health of all people. The price we are paying to learn this lesson – the deaths of thousands of West Africans – is already too high.