A Key Lesson From Ebola: You Can't Forget About Politics
The Ebola virus marks a milestone this month – it's been two years since the first case was confirmed in West Africa, the start of a devastating epidemic that claimed over 11,000 lives. The anniversary is making health workers think about what the world has – and hasn't – learned from the experience.
Today, the International Rescue Committee is issuing a new report on the epidemic and its aftermath. (Actually it's an analysis of previous Ebola reports from the World Health Organization, Bill Gates, the Tony Blair Africa Governance Initiative and others.) The idea was, with so many reports already out there, let's see what issues are being raised — and what's not being raised that should be part of the discussion of lessons learned.
We interviewed the IRC's senior health director, Emmanuel d'Harcourt, about the recommendations in the group's report – and its focus on the importance of understanding local and national politics when responding to a medical crisis. And later this week we'll share an essay by a nurse who worked on the ground during the epidemic and her perspective.
This interview has been edited for length and clarity.
The world seems to have moved on from Ebola. Do you think that attention will be paid to the IRC report?
I probably have a distorted perspective working in the field I work in, but my sense is it still has some traction. But even if the general public has moved on, I think there are influential people in the world of global health who are willing to learn. Certainly the issue hasn't gone by.
The IRC report says that previous reports on Ebola have a weakness — "the erasing of politics." What do you mean by that?
For us politics can be defined as who gets to make the decision, where the money goes, and how people work things out. We all know there's local politics and politics at the national and international level. At just about every one of those levels, politics played a really big role in the Ebola epidemic, and that dimension seems to have been erased or de-emphasized from reports with exception of the Overseas Development Institute report, which is all about politics.
Can you give an example of a political issue that needs to be considered when discussing the response to Ebola?
One enormous thing during the epidemic is the problem of trust. The way it's portrayed in the report, it's almost like an accident [that the people of West Africa didn't trust the authorities], for some reason relating to culture or superstition. Mistrust is being presented as something that just happened whereas in fact it's the consequence of choices. If, for example, a local elite doesn't really listen to people, gets money for themselves and doesn't build public services and don't show any interest in the common good, when it's time for them to [tell the citizens of their country] that Ebola is real and this is what you need to do, they're not going to be trusted. And that's politics.
Did the International Rescue Committee make any political mistakes?
We responded too quickly to calls to get foreign medical teams in, and I think we didn't appreciate how much work was already being done by our own national staff [in West Africa]. If we were to do it again, from my perspective we would give a lot more resources, put a lot more emphasis, give more authority to our national staff to lead the response.
And by national staff you mean people who stationed in West Africa or who lived there?
Local people from the countries involved.
Any other errors in judgment?
At times we made the assumption that if somebody is from Liberia or Sierra Leone, they know the community and know how to speak [to them] and that's not the case. Some of our [local] staff had better connections with the communities than others.
Should American or international groups get involved in local politics?
It's not our country. For those of us on the international side, it is not appropriate to start getting involved with the politics of Liberia and Sierra Leone. But if we pretend politics doesn't exist, we're setting up for the same situation as Ebola, where billions were poured [into West Africa] and we didn't get a great return on the investment because political realities undercut what we were doing.
Are there other kinds of politics that need to be addressed?
Anthony Banbury [a U.N. assistant secretary general for field support who's now left the organization] just published an op-ed in The New York Times ("I Love the U.N., but It Is Failing"), and he talks about another kind of politics — the politics of human resources. That phrase won't launch a thousand ships but boy, does it matter.
He said the U.N. has too much bureaucracy and can't get rid of employees who aren't effective. Is that on point?
Oh, he was absolutely on point. What's important about the Tony Banbury piece is that he says we're not going to have change in the U.N. if it doesn't change the way it hires and fires people.
Anything else that the previous reports on Ebola didn't point out?
Those reports are saying we need a new global alert and response system [for outbreaks]. But people on the ground are saying we're not going to make progress if health workers don't get paid.
Has the Ebola experience had any influence on the response to the outbreak of Zika virus in Latin America?
I think people now realize that the most exotic, remote-sounding epidemic could be affecting you in a few weeks. Before Ebola, it's quite possible all this talk about Zika and microcephalic babies might have been on page 7 of the newspaper, whereas now it's more likely to be on the front page. It's unfortunate that that's going to generate more anxiety, but it's a positive thing that people are more interested and realize even a remote small outbreak could be an international catastrophe.
What else needs to be changed in the public way of thinking about disease?
People just imagine that medicine is a technical field. They don't like to think medicine and public health is very mixed in with politics and economics.
So the perception is, you're health workers, come on in and fix things.
It's simplistic. But it's very appealing.
The IRC report uses the phrase "never again" regarding epidemics. But is it really possible to stop future epidemics before they even start?
We can't say there will never be an outbreak, but I think we can prevent diseases like Ebola from killing thousands of people and shutting down the economies of three countries. That's something I think we can do.