This summer we are throwing an oblique glance at Western Africa, once more, as a result of the detection of a new outbreak of the Ebola disease. And we are looking in this direction because this virus is increasingly of concern for various reasons: first of all and fundamentally, because of its large mortality rate -60% of sufferers die- and secondly, because it still has no known cure. All this, added to the fact that its contagion rate (i.e. the rate at which it is spread from person to person) is also rather high, and that it has come up in an area of Africa where it had not previously appeared. Thus, the matter becomes increasingly complicated.
The International community rapidly responded and is fighting this infectious disease in collaboration with the poor local African health care systems, trying to tackle its spread. But since March until present date around a thousand people have already died, and it seems that its control will take at least a few more months. The World Health Organisation (WHO) has just declared the Ebola virus outbreak in West Africa an international public health emergency, since the disease is spreading at a rate faster than it can be controlled. Therefore its eradication should be given all the appropriate means (i.e. material and human resources) in order to stop the disease from developing into a full-scale plague devastating Africa.
Well, everything is normal up until now, as far as an epidemic breaking out in a “poor” country is concerned, the strange thing is that this time, surprisingly enough, the case has created great social alarm, may be because, on this occasin, we have been aware of the fact that the disease is capable of “travelling” to other countries and regions and, above all, we fear the possibility of it affecting us. Diseases are, namely, reminding us all the time, that they have no frontiers, and especially in a highly globalized world like ours. And even though we may call the 2014 outbreak “the worst Ebola epidemic in history”, it is not comparable, as far as death rates are concerned, to those which, like malaria, are killing more than half a million people per year, mainly children, but have not been featured on most media cover pages in our countries, seemingly because they are not perceived as a present threat to our health.
When this outbreak ends, we should reflect on the importance we concede to worldwide health, understood as a whole. We must remind that, since the discovery of the Ebola virus in 1976, there have been 24 outbreaks, and, nevertheless, we apparently never took much interest in fighting neither the Ebola virus nor any other hemorrhagic diseases. Nonetheless, it would neither make much sense to envisage fighting every single disease, one after the other, when we still don’t have local health care systems capable of implementing those specific programmes, as it would be impossible to succeed.
Today’s main concern is the Ebola disease, but what would be tomorrow’s? Africa has the worst health indicators in the world. Its health is an open wound, very big, enormous, one through which the whole continent bleeds up, and we cannot heal it with plasters –one specific plaster for every specific disease– each time we consider a wound gets worse, or a particular infection may move to other countries. This is totally inefficient, and severely draining for those involved.
The solution to the problem is a medium- and long-term one. All countries should have a strong health care system, with appropriate Epidemiological surveillance systems which could rapidly respond to any health eventuality. However, there are still too many fragile health care systems in the world, with very few human, material and economic resources, in insufficient quantity and quality to meet the needs of the community in question.
Nevertheless, if we wish those systems to be efficient, not only should we bring them near the people, but also do in such a way that they use them. And, to that effect, local communities have to participate in the defining of health care priorities. It seems that in this specific outbreak, certain communities have refused to be treated, because they thought that instead of curing them, the care provided was aimed at spreading the disease. And this refusal to receive the care by health care personnel, hasn’t occurred for the first time. But in the middle of the epidemic it is practically impossible to integrate social and cultural patterns when fighting the disease, because those actions take time to show results. Thus this is a task which health care systems have to carry out in advance, provided that they will bring results in the medium and long term: i.e. gaining the community’s trust.
We need not only to eradicate an epidemic, but also and above all we need to prevent new worldwide health threats. And this can only be achieved if we consider health as a global public good, prioritizing health care interests to other interests such as those regarding economy or politics, and especially at present, while its need is questioned, by committing to an efficient health cooperation capable of bringing a positive long-term impact to health care systems through its reinforcement. The wound in African health should heal properly, and this is in our hands. In the hands of all of us.
Vice-president of Medicus Mundi Internacional
Translation from Spanish by Sílvia Aymerich