UNINTENDED CONSEQUENCES OF GLOBAL AND NATIONAL HEALTH STRATEGIES
Public policy in the area of global health is a mess, and the desperate scramble by our leaders to limit the impact of Ebola and to reduce its transmission is evidence of long run failure to address a set of public policy issues. It is rather late in the day for President Obama to call for additional resources and finance ‘to bend the curve of the epidemic’ in West Africa although these are going to be essential to limit the global impact of Ebola and save potentially many thousands of lives.
But this state of affairs is scarcely accidental and the Ebola virus was identified many decades ago by Peter Piot and other scientists in the 1970s. Thereafter not a lot of resources were focused on finding a vaccine or the development of drugs since the problem seemed to be confined to Central Africa – a long way away from the centres of population in the rich developed countries. But with increasing population mobility – globally and in Africa- and growing urbanisation it was inevitable that Ebola would spread and that everyone would in time be threatened. Indeed this is precisely what has happened and as Professor Piot noted in a Guardian interview last week the real difference now is that Ebola is no longer confined to relatively sparsely rural populations in remote parts of Central Africa but has now spread to dense urban populations across West Africa – and beyond.
What is evident in Sierra Leone for example is not only the daily loss of life but that the epidemic is undermining the economic and social framework of the country – schools are closed and the public health system scarcely functioning. Economic activity has been brought more or less to a standstill and what is now needed is a massive injection of resources – not just public health [doctors and nurses and other technical staff] but logistical assistance on a massive scale together with increased access to food as local production is destroyed. What is evident is that local health capacity in Sierra Leone, Liberia and Guinea was always totally inadequate not just because of the ravages of war and the post war failures of reconstruction but were always in desperate need of resources. At the present time the health response has been almost entirely dependent on NGOs such as MSF and the Red Cross given the lack of local health capacity with WHO at best providing a purely coordinating role.
How did we come to this state of affairs?
