During the most recent Ebola outbreak, that Ebola is actually a fairly common disease in Africa has often been overlooked. In fact, since 1976 there have been twenty-eight outbreaks, but the current one has killed four times as many people in one year than the previous fourty (CABI, 2015).
Ebola is normally easily contained and confined to rural areas. Although it has reached large cities, such as the capital of Zaire in 1995, now the Democratic Republic of Congo, the virus was quickly reported and suppressed. This time, Ebola has spread throughout West Africa, and into Europe and the US.
So why is this outbreak so different and who should have stopped it spreading so far and killing so many? More importantly, what can be done to prevent this happening again and who should lead this challenge? These are extremely important questions to consider as the current epidemic wanes. But if conclusions are not drawn, there is nothing to prevent this happening again.
Deciding who should be governing a response to a potential global pandemic is difficult. The contemporary global system is in ‘anarchy’, whereby independent nation states recognise no higher authority. To overcome this, there are forms of governance, for example international law, but no formal government to direct global health governance.
This confusion is important considering we live in an era of globalisation. The concept of globalisation is debatable, but the current Ebola outbreak, which has spread through international air travel, has proved that globalisation is a very real phenomenon.
There is of course the World Health Organisation (WHO). The WHO was created in 1903 and was part of a breakthrough in international health law, later the International Health Regulations. These regulations required states to notify other states if they had a disease outbreak, limit the measures placed on states experiencing an outbreak, and create an international, representative organisation dedicated to health: the WHO.
But the WHO was unable to lead the international Ebola response. Why? Blame is often placed on the WHO being disorganised and overstretched. However, states and their resources ultimately control the WHO. In recent years, particularly after the financial crisis, states have severely reduced their contributions to the WHO, and also to the pharmaceutical industry to develop vaccines for diseases like Ebola. Moreover, the WHO’s power lies in its regional offices, not Geneva. If a country does not want to comply with the WHO, this will limit what the WHO can achieve. During the 2003 SARS outbreak, for example, China refused to cooperate at first, which greatly exacerbated the situation.
The main leaders of the current Ebola response have been MSF and a consortium of other NGOs. Undoubtedly, they have done an amazing job and saved thousands of lives. Nevertheless, when NGOs take control of health systems in developing countries, this can fragment weak public health systems even further. This is precisely what happened in Liberia and Sierra Leone after the civil war. As there was little to no healthcare after the war, NGOs became highly prevalent, but did not give ownership of healthcare back to the government. When Ebola emerged, the Liberian and Sierra Leonean governments were completely unprepared for an Ebola outbreak because they have little control over public health. The current system is therefore extremely unsustainable.
Thus, the current system of global health governance is fractured and lacks leadership. The recent outbreak exposed the limitations of global health governance, as it emerged in an area of Africa that has a particularly fraught economical, political and social history and had never encountered an Ebola outbreak before. This made for a particularly potent combination.
So what can we learn for the future? It seems that ultimately, despite globalisation that has led to disease become a global as opposed to national issue, states are still very much in control. When states have control of public health, this provides a far more sustainable and effective way to deal with issues, such as Ebola.
Of course, in the current global system, some states are for more powerful than others and control the current global health agenda, often to the detriment of other states. If however, states were to strengthen the WHO so it could become the fully representative body it was intended to be, the contemporary unequal system could be partly mitigated.
It would be a small step, particularly when capitalism and market efficiency prevails over social justice. But if the worlds less powerful nations were provided an opening to gain equal footing, combined with the emergence of new superpowers such as Brazil, Russia, India and China, we could begin to see the current and highly unequal system begin to change.