Ebola Is Not Over Yet [analysis]

The announcement by Liberia’s President Ellen Johnson-Sirleaf that children will be returning to school, and that borders with neighbouring countries will reopen, comes as a huge relief to everyone around the world alarmed about the Ebola outbreak. At one stage last year, some thought that it would take much longer – even up to the end of 2015 – for the epidemic to start slowing down.
In Liberia, once the epicentre of the disease, only 10 people are now being treated for Ebola and there has been only one new case in the seven days up to 22 February. This is certainly good news, but in neighbouring Guinea and Sierra Leone infection rates have been going up for the past three weeks. There have been 35 new cases in Sierra Leone and 63 in Guinea in the week up to 22 February, according to the latest figures from the World Health Organisation.
Even in Liberia, aid workers warn that one new case means there is still an outbreak and that emergency measures need to stay in place. ‘It’s the 101 of managing outbreaks,’ says Jens Pedersen, Humanitarian Policy Advisor at Médecins Sans Frontières (MSF) in Johannesburg. ‘We must be very cautious of talking about zero infections in the next two weeks,’ Pedersen told ISS Today earlier this week.
With the world’s spotlight moving away from those affected by the dreaded disease, the citizens of the Mano River countries could well be left to deal with the aftermath of the tragedy on their own. Almost 9 500 people have died in the three most affected countries.
The question now is not only how Africa and the wider international community could best help these countries to completely rid them of Ebola, but also how such already fragile states be assisted in the longer term.
Figures of donations to global tragedies are often very hard to come by. World leaders tend to make exorbitant pledges, but no one keeps track of what help has actually come through. A new report by the United Nations Economic Commission for Africa (UNECA) however, gives an interesting glimpse of what was actually been given, and by whom.
The report states that by 13 January this year, the international community had donated US$1,16 billion. The biggest individual country donors are the United States (US$816 41 million paid out by 13 January), the United Kingdom (US$280 million) and France (US$136 million). Countries like Germany, Japan and China have also pledged huge sums, but those coordinating the effort have reportedly not yet received these funds.
Africa’s contribution, by comparison, has been negligible. The biggest African country handout came from Nigeria (US$5 million pledged) and Equatorial Guinea (US$2 million). Kenya, Namibia, Algeria, Côte d’Ivoire and Senegal also pledged US$1 million each to the fight against Ebola, according to UNECA. In comparison, there is Bill Gates’ Gavi group, which has so far contributed US$100 million, and the Paul Allen Family Foundation, which has paid out US$55 million. For Africa, the figures of actual funds received versus those pledged were regrettably not available.
Pedersen says organisations like MSF fear that help will now filter out given the perception that the Ebola epidemic is over. ‘My biggest concern is that Ebola will drop off the radar,’ he says. ‘The rainy season is starting, [which poses] huge challenges in terms of access.’ MSF has around 4 000 health workers in the three countries and is also involved in treating other illnesses, like malaria. Health services have been dealt a heavy blow by Ebola due to the high number of health-care workers who have also died from the disease.
The UNECA report says that the economic impact of curfews, the loss of lives, border closures and sporadic lockdowns will be felt for a long time to come. The disease has meant a loss of tens of millions of dollars of state revenue, and UNECA predicts that the gross domestic product (GDP) in these countries will slow down by 2% to 5%. Both UNECA and the African Union (AU) are now advocating for the cancellation of the debt of Liberia, Sierra Leone and Guinea to help them mitigate this financial loss.
Carlos Lopes, Executive Secretary for UNECA however slams those who said the Ebola epidemic would be catastrophic for all of Africa. In the report, he says the Ebola epidemic did not ‘fundamentally disturb the “Africa Rising” economic narrative,’ despite the pessimistic predictions. In October last year, for example, the World Bank said the loss for West Africa due to Ebola will be up to US$33 billion in the next two years. Many experts criticised this alarmist view and pointed out that Guinea, Liberia and Sierra Leone in fact only contribute 2.42% of West Africa’s GDP.
The World Bank then revised its prediction to US$3 billion. ‘Africa’s rise is not under much threat from Ebola itself, but more from misinformation and ensuing misperceptions,’ says UNECA.
The challenges now facing the Ebola-affected countries are huge and complex. The social cohesion in the societies struck by Ebola, for example, has been dealt a severe blow. People who survived the disease return home to be shunned by their neighbours. Orphans are sometimes left unattended. How do you fix things after fear and suspicion have permeated every level of society?
All these countries have been through war and political upheaval, but this is an unknown challenge. ‘In a way, it is worse than the war [in Liberia],’ says an experienced Africa reporter, based in Dakar, who is still covering the story. ‘During the war, at least you could figure out what direction the shots came from and run away. But with Ebola you don’t know.’
UNECA says that to help people with their immediate needs, social protection and safety-net programmes for the families of victims are crucial. Food aid should also be given to the most vulnerable, especially children. ‘Once a member of a family is lost to Ebola, the whole household is affected,’ warns UNECA. Sustained aid is clearly still needed.
In retrospect, help for the countries afflicted by Ebola only trickled in when the disease was first diagnosed in March last year and improved when the disease was detected in West Africa’s giant, Nigeria. Infections in the United States and Spain also spurred the international community on to help. Aid to the Ebola effort has also been in kind. South Africa, for example, gave little money, but a field hospital with 40 beds, ambulances, 4x4s and 100 motorcycles. Countries like Cuba and the Democratic Republic of Congo sent health workers.
The AU’s effort came only by mid-2014, but helped to mobilise just over 800 African health workers. The AU mission also placed the fight against Ebola in the spotlight. Its fundraising efforts among the private sector in Africa produced pledges of just over US$32 billion; this amount is also negligible compared to other private sector companies.
Importantly, the AU has now placed the emphasis on lessons learnt and on strengthening health services and disease control on the continent. A decision was made at the 24th AU Summit in Addis Ababa last month to set up the African Centre for Disease Control and Prevention by mid-2015. A coordination office will initially be headquartered in Addis Ababa. This could be one of the lasting legacies of the Ebola outbreak of the last few months.
Over the long term, the outbreak has many other lessons for Africa, says Lopes in the UNECA report. Nigeria’s success in tackling the outbreak showed, for example, that decentralisation could work against such an outbreak. ‘Local authorities did not have to wait for a green light from the central government to impose quarantine and other containment measures,’ he says.
The Ebola outbreak in Liberia, Guinea and Sierra Leone is clearly not over yet and the disease can still crop up elsewhere on the continent. Efforts to make sure that it doesn’t spiral out of control again are slowly being put into place. This is certainly the time that Africa should say, ‘never again’.
Liesl Louw-Vaudran, ISS Consultant