A health worker at Sierra Leone’s specialist Ebola treatment centre in Kerry Town, which Save the Children managed (photo: Louis Leeson/Save the Children)
At the World Health Organization’s Executive Board in Geneva this week, the first two days show that the Ebola crisis continues to be a traumatic and defining experience for global health.
Ebola was a terrible crisis for families and communities in Liberia, Sierra Leone and Guinea. As we in Save the Children know, fighting a virus with a high death rate and which is relatively easily transmitted, including by contact with dead bodies, was hampered by terror and fear. There are countless stories of the bravery of health workers, burial staff and communities themselves, which took a stand, facing personal risk and stigma to turn around the outbreak and save their communities.
We also saw global terror and fear, with much less justification. The USA and Spain only had one case of transmission each; their health systems have plenty of nurses, doctors and money and were able to cope. Even so, there was terror that these cases might cause huge outbreaks of Ebola. While this global panic helped to get funding for what was happening in West Africa, it also led to stupid decisions such as the cancellation of flights to affected countries. This was in contravention of the International Health Regulations, which are supposed to guide global responses.
At the WHO Executive Board there is review of the International Health Regulations and how the WHO should reform to be better able to lead global responses to future outbreaks. The IHRs are thought to be fit-for-purpose but were not implemented properly. WHO’s delay in declaring a crisis was been heavily-criticised and there is strong support for building its capacity, although few member states are echoing the call for an increase in WHO’s membership core funding.
While Ebola killed thousands, it did not come close to the millions of unnecessary deaths and illness happening every year in countries with inadequate health services. Maternal and child mortality, for example, does not get on a plane but has the same root problem, the lack of universal health coverage. The lesson that good health systems are needed is getting some mention but not the main attention.
I have argued elsewhere that a panic about transmission of a virus (HIV) helped to build political attention for health in developing countries. Our hope, as part of No More Epidemics, is that the legacy of Ebola can be not just to identify and respond better to infectious disease outbreaks but to be a wake-up call to end the scandal of the denial of healthcare in poor countries.