From AIDS to Ebola, Why Is Global Health Security Failing?

Illustration for article titled From AIDS to Ebola, Why Is Global Health Security Failing?

Amid news that the number of Ebola cases had reached more than 6,000 in West Africa, public health and international security experts from around the world gathered in Washington, DC last week for a candid discussion of how the global community failed to contain the disease—and what lessons still needed to be learned.

Science writer Sarah Zielinski has just published a thorough overview of the conference that is worth reading in full. Among the key issues discussed was the international response to the outbreak, or lack thereof:

"The Ebola crisis right now is one of the clearest illustrations that [of] the link between the conditions on the ground — the lack of public health resources and infrastructure — and the importance of addressing that as a threat to global health security," said Scott Gordon, director of the Window of Opportunity Project at PATH, an international non-profit organization working on global health innovation.

Speakers agreed that the international response to the ongoing epidemic has been inadequate. "We just can't deny that the response was very late," said Ron Waldman, an epidemiologist at George Washington University. But he warned that any efforts implemented now should be tailored to the epidemic as it currently exists; measures that might have worked in June to contain the disease, such as building a few large hospitals, may be ineffective now….

Preventing a future crisis like Ebola requires better diagnostic tools and disease surveillance networks so that outbreaks can be identified and stopped before they get out of hand….More complex tests being developed can be useful but only if the people using them have the necessary knowledge and support. ….And, any new tests will have to be able to work in environments where resources such as electricity and refrigeration may be in short supply…..Past efforts to provide help in developing countries have not always taken into consideration those limitations.

But, even with all the ideas and a great willingness among people in the international community to help, there was concern that maintaining these efforts over the long term may be difficult. "One of, if not the, greatest challenges in terms of developing the health security agenda," noted Keiji Fukuda, assistant director-general for health security at the World Health Organization "is that we go through an emergency, there's a great deal of attention, there's a lot of words said about how important it is, then it tends to evaporate."


The Reglobalization of Disease

Fukuda's warning, in particular, stands out for me. I've heard such global calls to action repeated time and again, in the aftermath of AIDS, SARS and H1N1. Our attention to global health often fades once the immediate crisis passes. And, the truth is, we are still relatively inexperienced in dealing with infectious diseases at the international level.

David Fidler, an expert in international law and infectious disease, wrote an insightful essay for Foreign Policy back in 2001, which, unfortunately, remains relevant today.

Illustration for article titled From AIDS to Ebola, Why Is Global Health Security Failing?

Back in the 19th century, Fidler explains, international governments were very proactive in dealing with public health. The expansion of travel and trade raised concerns in Europe and North America about the importation of diseases from Asia, Africa, and Latin America. Overcrowded living conditions, inadequate sewage systems, and unclean drinking water made those living in Europe and North America vulnerable to contagion— a fact underscored by periodic cholera epidemics that swept through their cities between the 1830s and 1890s. Realizing that national strategies, such as quarantine, were useless without international cooperation, European governments launched a series of international sanitary conferences and treaties that spanned the second half of the 19th and first half of the 20th centuries. Outside the arenas of war, diplomacy, and trade, infectious diseases provoked perhaps the earliest and most intense process of internationalization.


In the latter half of the 20th century, great-power interest in international infectious disease control waned. For developed countries, international cooperation largely took the form of the technical humanitarianism of the World Health Organization and nongovernmental organizations. At first glance, this decline in disease diplomacy seems counterintuitive. The speed and volume of global trade and travel continued to grow, creating unprecedented opportunities for pathogens to spread worldwide. But industrialized countries had (literally) cleaned up their acts and regained national control of public health through sanitation reforms; their cities were no longer breeding grounds for cholera epidemics or tuberculosis. Moreover, scientific research led to advances in drugs and vaccines that helped industrialized countries reduce the ravages of dreaded diseases such as polio and tuberculosis.

Yet, as fear of infectious diseases declined in industrialized nations, every year pathogenic microbes and parasites continued to kill millions of people in the developing world, where poor socioeconomic conditions provided a fertile incubator for tuberculosis, malaria, acute respiratory infections, measles, and diarrheal diseases, as well as new scourges such as AIDS. And the situation is getting worse…..As a result, developing countries harbor deepening reservoirs of dangerous diseases that the forces of globalization can spread with ease.

Today, developed countries— like the aristocratic courtiers in Edgar Allan Poe's Masque of the Red Death who believed that crenellated castle walls would protect them from the pestilence without —are belatedly realizing the cost of their complacency about infectious diseases...The "reglobalization" of public health is well underway, and the international politics of infectious disease control have returned.


Have we made progress in the nearly 15 years since that essay was published? Clearly, not enough. The latest initiative, launched by the United States in consultation with dozens of other countries is the Global Health Security Agenda (GHSA)—a series of "action packages" that include specific targets and indicators that can be used as a basis to measure how national, regional and global health capacities are developed and maintained over the long-term. In an effort to sustain commitment and provide accountability, an independent watchdog will assess the progress of the initiative.

Meanwhile, in the days since the international conference was convened in Washington, the number of Ebola cases has grown to nearly 7,500.


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Can any government actually respond to a crisis on this scale effectively without absolute control over the infrastructure. I've always been a firm believer that the first line of defense in any health/safety situation was a well educated population. Can we realistically achieve something like that on a planetary scale without a world government?

Without the entire population of the planet working towards similar goals, sharing resources, wealth and goods... without that, how do we manage to turn things around? I don't think we could have a planetary scale republic - the bureaucracy is just too much for any kind of scaled or tiered government. Besides, representatives on that scale, in order to keep things "manageable" would be very susceptible to corruption.

I've always been more of an advocate of a global democracy through internet communications - a global agora if you will. We could have an executive council that handles the day to day operations planetwide, elected from the population by a proportional weighted random lot proportional to the composition of the House of the World. Approximately 9 individuals who each have equal say in executing the laws of the planet. Each person chosen sits on this council for 9 years. Every 3 years, 3 of the members are reselected. The three out-going executives will sit as backup advisers for the newly selected individuals for the period of their term. A group of 108 individuals who suggest laws for the whole planet (A Planetary Senate) chosen from the House of the World who would be selected by random lot. A person would sit on the senate for 9 years, with a four year stint as an advisor when their term is up. Every 3 years, a group of 33 would be selected anew, and the outgoing members would serve as advisers. A group of ~7,000 people (1 for every 1,000,000, the House of the World) to act as a legislative body to test the ideals of laws before going to a vote of the full population - elected by the whole. People elected to the House of the World could serve for up to 40 years or a maximum age of eligibly of 65 years old. There would be a vote for 1/5 of the House of the World every 2 years and outgoing representatives would be required to advise the incoming representatives for 1 year. They would only have power to make laws and decisions if a matter was urgent and could not allow for a full planetary voting cycle - and all laws and decisions made by the house must be ratified by at least 60 percent of the House, and have the approval of 60% of the senate and 5 out of 9 of the Executive and then upheld by a majority vote of the planetary population when time allows. And each major decision or law is voted upon by the entirety of the planet. No corporate personage. And it would be interesting to see how corruption would work when vast numbers of individuals would need to be bought off to implement favorited laws.

I just pulled this out of a dark corner of my head. So take it with a grain of salt.

But we will not see an end to these kinds of failures so long as a majority of the planetary population lives in abject poverty and ignorance. And I don't trust any directly elected government to effectively govern in the name of the people.