Ebola Epidemic in West Africa
The most recent Ebola epidemic in West Africa in 2014 – 2015 had a weak international response and was a moment of crisis in global health leadership. Certainly, the outbreak was catastrophic, with a total of 28,000 cases and 11,000 deaths, which totaled more than all previous outbreaks (Camacho, 2014). As a result, there was a downturn in the economy and the impact of those lives lost was felt by those who survived the epidemic. As argued by Piot, the extent of the outbreak in the West African region was the result of a perfect storm: weak health systems, not enough properly trained health personnel, weak trust in government, and burial practices which contributed to the spread of the disease (Piot, 2014).
Although this was not the first case of an Ebola outbreak, this particular outbreak was massive in scale and led to a major global public health threat, crossing international boundaries rapidly. While the most of the cases were concentrated in Sierra Leone, Liberia, and Guinea, there were other cases in Nigeria, Mali, Senegal, Spain, the UK, the United States, and Italy (Wenham, 2017). As we are living in a time of porous international borders, the lessons from this outbreak should not be lost on us, especially those of us working in public health.
As the outbreak mounted in severity, it became rapidly evident that there was an intense need for improved global health security and leadership. In particular, the World Health Organization (WHO), an international United Nations specialized agency, should have assumed this role, and received significant criticism for its poor stewardship during the outbreak. This criticism has largely cited the WHO’s delayed reaction, lack of organization, and poor communication and cohesion with the affected countries. For one, although the first patient died of the virus in December 2013, it took nearly 4 months before it was confirmed to be Ebola (Coltart, 2017). Despite the weak and delayed response demonstrated by the WHO, the extent of the outbreak is not entirely the fault of the organization, but can be attributed to a weak international mandate and the constraints of financial and operational factors. Notably, the WHO is the only UN agency with a focus on promoting and maintaining health.
As outlined by the 1946 Constitution of the World Health Organization, the WHO is meant “”to act as the directing and coordinating authority on international health work and “”to assist governments, upon request, in strengthening health services (WHO, 1946). Of course, in the wake of the Ebola epidemic, the international community looked towards the WHO for leadership and a strong response. However, the WHO lacked the proper funding, financing, and political backing to provide the response expected from them. Dr. Margaret Chan, the Director-General of the WHO at the time of the outbreak, stated that “”It was a fantasy to think of the WHO as a first responder ready to lead the fight against deadly outbreaks around the world. (Fink, 2015). If changes are not implemented, this will remain a fantasy. We now live in a world where it is conceivable for an outbreak to spread from remote villages to complex urban centers and across the globe. It is critical that the WHO takes into account the criticisms it received during the Ebola outbreak, but also that it be given the proper financing and resources to prevent another outbreak so it can be a strong source of leadership in times of global public health crises.