The dark cloud that is the Ebola epidemic hanging over West Africa, and moving into Europe and the United States, could have a silver lining if global leaders have the wisdom and courage to act. This is a strategic opportunity to replace the existing reactive, ad hoc global health response system with a more proactive, targeted response to outbreaks of infectious disease.
That was among the conclusions of a recent Wikistrat crowdsourced simulation on the Ebola crisis (the full report is available here). Over 60 analysts worldwide explored a range of outcomes from regional containment to global pandemic, as well as the potential for both negative and positive results. Their key conclusion? The spread of infectious diseases such as Ebola demands a new response paradigm that is less passive and more proactive.
Impacts of Ebola -- More than Medical
There is no denying the medical cost of an infectious disease outbreak such as Ebola, but the damage goes much further. Much of the analysis in the simulation centered on how the progression of the epidemic -- and the nature of the global response - - creates the potential for increased instability and conflict, both in West Africa and around the world.
Reliance on international and donor organizations for prevention and care further erodes the links between national governments and their people, giving extremist groups the opportunity to fill the void. Foreign efforts to assist lead to prevention and treatment procedures that are unsustainable when those organizations eventually leave. The ad hoc nature of the global response also inhibits national and regional efforts to develop a sustainable, indigenous response capacity.
Efforts to halt the spread of Ebola can hurt as much as they help. Quarantines and border closings put people at risk of starvation and economic dislocation. The regional and national economic implications of attempts to isolate the virus could have consequences lasting beyond the end of the epidemic. The effort to fight Ebola absorbs resources needed to combat chronic infectious diseases, such as malaria, HIV and tuberculosis. These mitigation efforts must be balanced against the disruptive impact they have on a fragile region led by fragile governments. There is no question that waiting until an outbreak is established before initiating a response has high costs beyond the human toll of the virus.
Containment Model Is Broken
Previously, especially with Ebola, it was thought that the virulence of the virus itself helped to contain it to small regions. That concept has been blown apart by the 2014 experience, where Ebola has spread regionally and globally and lasted for nearly a year, so far. The isolated emergence of Ebola in Europe and the United States in travelers from West Africa forecasts what might occur if a larger outbreak from a domestic source were to occur. The politicization of the issue, combined with public fear and stigmatization of affected populations, would only be magnified with an outbreak of a wider scale.
If Ebola emerged in the West as a result of deliberate actions by a terror group, the reaction would be much more forceful. The deliberate use of Ebola as a bio-terror weapon would galvanize the developed world to eradicate those responsible. It would also likely cause support for such a group to evaporate, as the scope of a bio-terror event could not be controlled and would certainly include innocent civilians. Groups such as Boko Haram and ISIS are the most likely to turn to Ebola as a terror agent. Whether by natural or man-made means, if Ebola or any other virulent infectious disease were to migrate to the developed West, the social, political and economic implications could be devastating.
The Silver Lining?
The dark cloud of Ebola does, however, contain a possible silver lining. If the world community, with strong political leadership from Western donor nations, can craft a proactive, deliberate and planned response capacity to infectious disease outbreaks, much of the damage they inflict could be prevented.
Previous outbreaks of Ebola were isolated in one country. The regional scope of the current epidemic mandates an interdependent response. Successful efforts to prevent the spread and treat those affected within the region will raise confidence in local governments. A regional focus allows for an increase in capacity and authority for regional public health structures. The Economic Community of West African States (ECOWAS) could emerge as a continental leader in providing medical and health services.
Additionally, a regional response would establish sustainable procedures and regulations that could outlast the current relief effort and prevent or mitigate future outbreaks. This is essential to creating a prevention and treatment framework that can survive without international donor involvement. The multinational scale would motivate West African nations to collaborate to create such a framework and sustain it when there is no epidemic to focus attention.
Internationally, the epidemic provides an opportunity for international aid providers to promote sustainability as well. It provides incentives to create a global public health system with the authority and resources to act. New players are entering the game. If Ebola emerges in Asia, or if large numbers of ex-patriot Chinese citizens are victims in Africa, Beijing could become a major player in global public health care. Its interests and resources would drive a global response. China could create that response if the West squanders its chance to establish it now. If so, it will also serve Chinese interests.