Nicholas Kristof

Tragic ripple effects of Ebola epidemic

Health workers taking blood samples to test for the Ebola virus at a hospital in Sierra Leone. Instead of a small cost in money and lives, there will be a huge price to pay for the mishandling of the epidemic by the affected countries and rest of the
Health workers taking blood samples to test for the Ebola virus at a hospital in Sierra Leone. Instead of a small cost in money and lives, there will be a huge price to pay for the mishandling of the epidemic by the affected countries and rest of the world, says the writer. -- PHOTO: REUTERS

The Ebola epidemic in West Africa is a tragedy. But, more than that, the response to it has been a gross failure.

It's a classic case where early action could have saved lives and money.

Yet, the world dithered, and with Ebola cases in Liberia now doubling every two to three weeks, the latest worst-case estimate from the United States Centres for Disease Control and Prevention is that there could be 1.4 million cases in Liberia and Sierra Leone by late January.

We would never tolerate such short-sightedness in private behaviour. If a roof leaks, we fix it before a home is ruined. If we buy a car, we add oil to keep the engine going. Yet, in public policy - from education to global health - we routinely refuse to invest at the front end and have to pay far more at the back end.

We know how to confront the Ebola virus. In Uganda, an excellent US-backed prevention initiative trained local health workers to recognise the virus and stop it from spreading. So, in 2011, an Ebola outbreak there stopped after just a single case.

We also know from our catastrophic mishandling of Aids a generation ago - or the mishandling of cholera in Haiti more recently - that it is imperative to stop infectious diseases early.

However, the reaction to the Ebola outbreak after it began in December in Guinea was a global shrug. It was mishandled by the affected countries and by the rest of the world. So, instead of a tiny cost in money and lives, we will now all pay hugely.

If the worst-case scenario comes to pass in West Africa, it may become endemic in the region and reach the West. Ebola is quite lethal but not particularly contagious, so it presumably would not cause an epidemic in countries with modern health systems. This entire tragedy is a failure of humanity.

As donor countries scramble to respond - the effort may cost US$1 billion (S$1.3 billion) in the next six months, according to the United Nations, although nobody really knows - the risk is that they will raid pots of money intended for other vital purposes to assist the world's needy.

Advocacy group One executive director Jamie Drummond said he worries that governments may try to finance Ebola countermeasures with money that would otherwise buy childhood vaccines or ease emerging famines in Somalia and South Sudan.

Vaccines are a bargain. Since 1990, vaccines and other simple interventions, such as treatments for diarrhoea, have saved the lives of nearly 100 million children, according to Unicef.

Gavi, the Vaccine Alliance, is now in the middle of trying to raise an additional US$7.5 billion to subsidise vaccinations for 300 million more children around the world.

On top of the US$2 billion it has, Gavi says the additional funds would save five million to six million lives and produce economic benefits of US$80 billion to US$100 billion.

Such an investment should be a no-brainer. In the 21st century, we have the resources to fight more than one fire at a time.

"I am worried," said Mr Seth Berkley, the chief executive of Gavi. "You wouldn't want to reduce immunising children around the world to deal with an emergency, even one as severe as Ebola."

The US invests vast sums to address national security risks that have a military dimension, hence President Barack Obama's decision to renovate the US nuclear arsenal at a cost that could reach US$1 trillion over three decades.

So, let's remember that infectious diseases can also constitute a national security threat.

Our short-sightedness afflicts so many areas of public policy. The US spends billions of dollars fighting extremists today but does not invest tiny sums educating children or empowering women, even though that's the strategy with a solid record of success at reducing extremism in the medium term, and even though we can finance at least 20 schools for the cost of deploying one soldier abroad for one year.

At home, the US does not invest adequately in family-planning programmes even though pregnancy prevention initiatives for at-risk teenagers pay for themselves many times over. We don't invest in early education programmes that have a robust record in reducing later criminal behaviour, preferring instead to pay for prisons.

Indeed, this is such a market failure that new financial instruments - social impact bonds - address it.

The bonds pay for job training or early education programmes and then earn a financial return for investors when the government saves money.

Yet, the worst consequence of our myopia isn't financial waste. It is that people are dying unnecessarily from contracting Ebola. It is that some children in the US grow up semi-literate.

And it's the risk that the cost of leaders' mismanagement of Ebola will be borne by children going without vaccines.


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