The ongoing Ebola outbreak in West Africa is shaping up to be a potential threat around the world. In August the World Health Organization (WHO) declared the outbreak an international emergency, the only third such declaration since 2005. In the same month, the U.S. Centers for Disease Control and Prevention (CDC) activated its highest alert level. The latest WHO and CDC figures indicate that nearly 8,100 individuals live with Ebola and more than 3,800 have died. These figures may not be accurate, though, as data collection is poor in the hardest-hit countries. The CDC estimates that Ebola data may be underreported by a factor of three or more.
What started as an index case in rural Guinea in December has now reached two continents, according to both the WHO and CDC. The first travel-related Ebola patient from Liberia diagnosed in the United States just died in Dallas, Texas. A Madrid-based Spanish nurse was the first person to contract Ebola outside of Africa after caring for two Spanish missionaries infected in West Africa. The WHO/Europe indicates that more Ebola cases in the continent are likely due to heavy travel between the two regions. The Obama administration is stepping up surveillance measures in five major U.S. airports for passengers from the three most affected countries in West Africa: Guinea, Liberia and Sierra Leone. Nigeria and Senegal, for now, have few reported cases.
The current outbreak is easily the largest since 1976, following scientific identification of the virus. It is also the first major outbreak active in densely populated urban centers. Previous outbreaks were mostly isolated in communities at the edge of the tropical rainforest in Central Africa. The epicenter of the current outbreak—Guinea, Liberia and Sierra Leone—has freer movement of people, goods and services across national borders due to centuries-old ethnic and tribal lineages.
Among the poorest nations on earth, Guinea, Liberia and Sierra Leone face a titanic struggle to contain the outbreak. As post-conflict countries, they must tackle the daunting task of implementing critical Ebola containment strategies, which includes providing supportive care to infected people while curbing further infections. Protecting health workers, managing waste disposal and basic sanitation, and moving goods and supplies all become logistical challenges. They must also widely disseminate information to educate the public about behaviors and practices.
The CDC estimates that an unchecked outbreak could lead to more than 550,000 Ebola infections by January. To halt the outbreak, according to the CDC, at least 70 percent of all cases should receive care in Ebola Treatment Units, at home or in community settings, which is an unlikely scenario in resource-poor settings. Another recent study in the New England Journal of Medicine suggests that as early as mid-November a runaway outbreak in the three severely impacted countries may record up to 20,000 new cases every week, severely outstripping current and planned domestic and international response efforts.
Furthermore, Ebola can negatively impact the economy of affected nations. The World Bank reports that a lackluster national, regional and international response may lead to nearly a $33 billion economic loss in West Africa by the end of 2015, severely undermining tentative global economic recovery efforts. A contraction of a national economy can disrupt expenditure on basic services, engendering fragile national security. As at-risk individuals avoid human contact to evade Ebola transmission, both public and private sectors will operate at low capacity, further damaging the economy.
Add weak health systems, poor national institutions, dearth of infrastructure, abject poverty and you have the makings of a disease outbreak with potentially monstrous impact, initially in West Africa and eventually around the world. The outbreak also exposes weaknesses in the Global Health Security framework championed by the United States and other industrialized nations. The near complete breakdown of health and social services in deeply impacted countries is another source of concern for global disease prevention and control efforts going forward.
Health systems in Africa face simultaneous financial, logistics, technical, mobilization and accountability challenges. Left on their own, it is highly unlikely that the West Africa Regional Economic Community and the Africa Union can mount a sustained response to the Ebola outbreak. It is also highly unlikely that any country in Africa can provide long-term, quality response against thousands of new Ebola cases emerging every week or even every month. Fortunately, the international response led by the United Nations, the United States and the European Union is underway.
The WHO and CDC currently provide critical technical leadership and work closely with national health authorities in West Africa. As shown by the effective, vigorous response in Nigeria and Senegal, West African countries can do more to contain the outbreak. As the global community ramps up response to the outbreak, close coordination of international emergency relief efforts with national and local efforts will become crucial. Multilateral agencies and Africa's regional institutions should coordinate response mechanisms and avoid duplication of services. In particular, coordinating international support for local and international NGOs already active on the ground is critical. Local populations in Ebola-ravaged areas know and trust these NGOs.
Meeting international financial commitments for an Ebola emergency response is imperative. Unfortunately, the United Nations and the U.S. State Department indicate that only two thirds of the nearly $1 billion needed to mount an effective emergency response is available. The organized private sector, especially global conglomerates and large regional businesses active in West Africa, should provide financial and logistics assistance.
The Ebola outbreak is exposing fragile health systems in deeply impacted countries, but it is also creating an opportunity for an international public-private partnership to rebuild health systems throughout Africa. Such a partnership could replicate the global consensus nearly 40 years ago that led to the establishment of primary healthcare systems in Africa. Partners could develop strategies for rebuilding and sustaining health systems in Africa capable of becoming a strong pillar of the Global Health Security architecture. With several sectors of public and private enterprise working together, a resilient, resourceful, transparent and accountable health system in Africa could become the enduring legacy of the 2014 Ebola outbreak in West Africa.