A Global and Shared Responsibility

MSF workers assist a patient with possible symptoms of ebola.

The number of people who died in the world’s poorest countries from malaria and tuberculosis on any given day in 2013 was greater than all those who have died from Ebola in the current epidemic. But neither of those diseases has strained the limits of the international health system as much as Ebola. As I write, all the media are covering the crisis in Madrid following the infection of Teresa Romero, the nursing auxiliary involved in the care of one of the repatriated medical missionaries with Ebola. Today, Spanish people are experiencing something of the fear and uncertainty that has gripped whole countries in West Africa for months.

Few issues so clearly reflect the precarious equilibrium of the risks affecting global health in the 21st century as ebola does

The statistics are imprecise, but it is estimated that over 7,400 people have been infected with the Ebola virus since March, and almost half of them have died.  The number of cases doubles every 15 to 20 days in Liberia and every 30 to 40 days in Sierra Leone. The impact of this epidemic on the health systems and economies of the countries affected is acquiring seismic proportions. Terrified of infection, people with malaria or malnutrition and women in labour are not seeking medical care in hospitals and clinics, a situation that has increased the collateral damage caused by a disease that has also halted the movement of people and goods. If the worst-case scenarios prove to be accurate, as many as 1.4 million people will be infected by mid-January 2015 and Ebola poses a real threat for the whole world.  

Few issues so clearly reflect the precarious equilibrium of the risks affecting global health in the 21st century. Everywhere—from laboratories in Europe and the USA to the most remote health care facilities in Guinea Conakry—Ebola highlights the need for a strategy based on shared responsibility. Both national governments and the international community have responded slowly and inadequately to a crisis that started long before last March, a crisis deeply rooted in poverty, the appalling state of health care systems in Africa, and in an obsolete model for medical innovation driven by the wrong incentives. Despite advances in recent years in areas such as childhood immunisation and nutrition, the place where a child is born still determines to an unacceptable degree the likelihood that he or she will reach five years of age and live a healthy life.

Development assistance for health represents less than 1% of the total expenditure that developed countries allocate to finance their own health systems

The primary responsibility for the future of the affected countries lies with their own governments, but it would be naive to ignore the role of the international community, whose interest in the outcome goes far beyond a purely ethical impulse. According to the Institute for Health Metrics and Evaluation, public and private donors gave $31.3 billion to support health in 2013, a total higher than that of previous years but well below the requirements set out in the Millennium Development Goals. Overall, development assistance for health represents less than 1% of the total expenditure that developed countries allocate to finance their own health systems, a rather disproportionate distribution in light of recent events.

This inequity gap has been a major determining factor in the search for Ebola treatments. Two vaccines—one based on adenovirus and the other on vesicular stomatitis virus—are currently at a relatively advanced stage of development. However, work on these projects has only speeded up in recent months following a long period of neglect that began in the 1980s and ended only when it started to appear likely that such treatments would become important for wealthy countries or potentially profitable for private pharmaceutical companies. In ISGlobal we have long experienced the same contradiction, fighting for years to attract resources to fund research into the diseases of the “poor”, such as malaria and Chagas disease. And this is something that could change in the wake of the present crisis.

The threat of an Ebola outbreak in Spain can only be averted if we work together to end the epidemic in the countries affected

Spain has ethical and practical reasons to engage fully in the fight against Ebola. Although in recent years we have seen a substantial reduction in development assistance for health and Spanish cooperation has withdrawn from the areas most affected by the Ebola crisis, our country has a great deal to offer if it chooses to engage and we put our shoulders to the wheel. In addition to increasing funding for the work of humanitarian organisations on the ground in its 2015 budget, the Spanish government can work with parliament, non-governmental organisations, European bodies and international institutions, implementing a strategy that will harness our capabilities in critical areas to find a solution to the problems: scientific research, strengthening public health systems, improving protocols and methods for evacuation, training health personnel, as well as technical, administrative, communications, and logistical support. The cases of Spanish people affected by the virus have rekindled a feeling of social solidarity that had never really disappeared even with the economic crisis. But this time we have to take the next step. The threat of an Ebola outbreak in Spain can only be averted if we work together to end the epidemic in the countries affected. A country that aspires to join the United Nations Security Council should be able to understand why this situation is everyone’s problem and a global responsibility. So let’s step up to meet our obligations and accept this challenge that may open up a future of opportunities in the fight for global health.