It has been more than six months, and there is no sign that the number of cases in the West African Ebola epidemic will decline. In fact, its spread may have been accelerated in some parts of the region. According to the World Health Organization (WHO), as of September 26 more than 6,500 cases had been reported, which included over 3,000 who have died from the virus.
The outbreak has reached its current scale largely due to the inadequate public health infrastructure and general lack of social trust in the government. This is especially apparent in Sierra Leone, Guinea, and Liberia, where the outbreak is particularly troublesome. The presence of vastly underreported cases was just another indication of a governance crisis in the region., The most affected countries still suffer from internal strife, and most critically do not have the necessary human, financial, and organizational capacities to break the negative spiral of death, destitution, and destruction.
Years ago I attended a meeting with President Ellen Johnson-Sirleaf of Liberia, and was told that when she took office in 2006, she had access to a budget of merely eight million dollars. Despite the growing international assistance in fighting other infectious diseases outbreaks over the past three decades, most took the form of stand-alone, “vertical” programs that have fixated on particular diseases such as HIV/AIDS and malaria. These programs have proven difficult to significantly contribute to overall health system capacity building at the horizontal and institutional level. Also, because major disease outbreaks such as SARS and H1N1 have thus far largely spared Africa, combating acute infectious disease outbreaks has not been the top of policymakers’ priorities. It came as no surprise that countries in West Africa were caught off guard when Ebola hit the region in full force.
Like Ebola, the SARS virus led to a similar governance crisis in China in the first half of 2003. While SARS killed no more than 800 people, its profound and negative impacts on development and stability made the outbreak the largest socio-political crisis in China since 1989. But once the issue reached the top of the political agenda, the Chinese state was able to rapidly mobilize the society and the bureaucracy to cope with the crisis. Furthermore, in the wake of SARS China moved to invest tremendously in the health system capacity building, which has been crucial in handing other disease outbreaks, including H5N1, H1N1 and H7N9.
China’s relatively robust capacity in disease surveillance and response is built on a strong state that emerged as – in the words of late University of Chicago Professor Tang Tsou – a “totalist” solution to the comprehensive social-political crisis in the 20th century. While the post-Mao state rebuilding and economic reform fail to fundamentally change the state-society relationship (which continues to bedevil policy effectiveness in China), they strengthened the fiscal sinew of the central state, making it easier for Chinese leaders to mobilize necessary resources in crisis management compared to their African counterparts.
Given that the Ebola crisis reduces state capacity in Western African countries when ever-increasing capacity is needed to tackle the crisis, purely endogenous solutions are unlikely going to work in addressing an immediate crisis, and resources will have to be imported from external sources in the form of massive foreign aid. It is therefore imperative for international community to support Ebola-hit countries by delivering critical medical supplies and safety equipment and dispatching enough health workers to provide healthcare services and raise awareness of the disease. China has responded to the WHO’s call for international aid with unprecedented generosity. It has sent nearly 200 medical experts and pledged an aid package of more than $42 million. By contrast, Japan thus far extended $5 million in emergency aid grants and four medics to the region (Japan is currently negotiating with the WHO to send 23 additional experts).
With adequate emergency aid, the ability of Western Africa countries to fight Ebola can be beefed up, which could lead to the effective containment of the virus in the coming months. But foreign aid is unlikely to provide a viable and sustainable solution to future disease outbreaks. The requisite institutions, skills, and capabilities fundamental to effective health governance take time to develop, and have to be developed independently and domestically. In order to avoid another Ebola-type crisis in the future, countries in the region should start planning for investment in their national health systems in general, and disease surveillance and response capacity in particular. China’s experience in the post-SARS era has proven that this is the first step in the right direction.