Ebola Is A Symptom Of Our Compounding Failures

Mozambique 2014

By Tara Haelle

November 05, 2014

Also published by Forbes

As the WHO Director-General addressed the Regional Committee for Africa two days ago, I was visiting BoaneHealth Center in southern Mozambique, a country in the southeastern corner of Africa. It’s very, very far from the Ebola outbreak – more than 6,000 miles from the three countries devastated by the disease. However, much of what I read in Dr. Margaret Chan’s addressregarding the outbreak rang true for conditions here.

She highlighted two arguments of the WHO that “have fallen on deaf ears,” the reality of which have been starkly revealed to me while I have toured health facilities in Mozambique in the last week and a half. The first is “the urgent need to strengthen long-neglected health systems.” The health system here in Mozambique is so neglected and under-developed that in many provinces, just one pediatrician serves more than a million residents. And that’s just a tiny sliver of the deprivation of basic health care here.

But it’s the second argument that really struck home: “Ebola emerged nearly four decades ago,” Chan said. “Why are clinicians still empty-handed, with no vaccines and no cure? Because Ebola has historically been confined to poor African nations. The R&D incentive is virtually non-existent. A profit-driven industry does not invest in products for markets that cannot pay. WHO has been trying to make this issue visible for ages. Now people can see for themselves.”

Indeed we can. But we only started worrying about it in the U.S. when a Liberian man whose compassion killed him arrived on our shores. And then we suddenly noticed that more than 4,000 West Africans have died from a virus with a vaccine sitting untested on the shelves for years.  Even then—judging from the news cycle—the nation primarily cared about whether we might catch the virus ourselves. Our paranoia has led to irrational behavior that threatens our ability to help West Africa fight the disease. And if medical facilities in West Africa look anything close to what I’m seeing here in Mozambique, it’s abundantly clear that West Africa cannot beat Ebola on its own.

But Chan’s point – that a disease only catches the world’s attention when it threatens us directly, rather than those “others” in Africa – has been seen again and again.

I spoke to a woman yesterday who spent a week in the hospital some years ago, convinced that her son would not survive cerebral malaria. The only thing atypical about her story is that her son did manage to survive. The mosquito-borne illness is the leading killer of children here – 36,000 children die each year from malaria. That’s about 100 children* a day. Every day. In just one country.

But the Global Malaria Eradication Program launched in 1955 was abandonedless than two decades after it began. By then, the disease was gone fromEurope, North America and much of Asia, but the project ended due largely to the “technical challenges of executing the strategy especially in Africa.” And now we have only a subpar vaccine still in trials with an effectiveness below 50 percent while local organizations desperately pass out mosquito nets and spray homes with DDT.

New viruses and new health emergencies will continue to emerge, and the only way we can conquer them is to recognize that what happens in Africa and other developing nations across the world is not isolated and far-off. It matters because people are suffering, and it matters because it threatens the rest of the world as well. It’s great to see companies like GeoVax clamoring to beat out bigger players like GSK in the race for an effective Ebola vaccine, and to see the U.S. government’s request from labs* with Emergent BiosolutionsNovartis and GlaxoSmithKline Plc for plans for producing the experimental Ebola drug ZMapp. But we have waited too long, and for the worst reasons.

The hospital I visited two days ago offers prenatal care, maternity services, postpartum care, well-child and (HIV) at-risk child consultations, family planning services, cervical and breast cancer screening, HIV care and treatment, tuberculosis services and gender-based violence services. It sounds great on paper. In reality, almost 200 women waited for hours to (hopefully, if time allowed) get screened for cervical cancer (in a country with one of the highest rates in the world), get contraception, get HIV treatment or get their child’s immunizations – after walking dozens of kilometers early that morning. They squat behind the outside waiting area wall to use the bathroom because the only public toilet is too covered in excrement to walk into. The toilet in the labor and delivery ward had no seat, no toilet paper and no trash can but at least two dozen (likely malaria-carrying) mosquitos—less than 15 feet from a woman in active labor. In the next room, a woman rested with her day-old baby.

These health systems cannot keep up with diseases like HIV and malaria, much less outbreaks of fast-moving viruses like Ebola. As Chan said, “Without fundamental public health infrastructures in place, no country is stable. No society is secure.” That means that the destitution I’m witnessing here, also present in West Africa and much of the rest of the continent, is a threat to all of us. There are organizations working to change that, but they are not enough. We need to do more, now, before the next public health emergency commands our attention.