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The global response to the current Ebola virus outbreak in West Africa is primarily focused on providing emergency relief, but it must expand to include creating sustainable, longer term health care infrastructure, according to Wharton health care management professor Ezekiel J. Emanuel. The creation of such infrastructure — including physical facilities and training for health care workers — is vital to prepare the affected countries to deal not just with Ebola, but also with other disease outbreaks in future.
“The basics [of disease prevention] and sustainability are key concepts” in the Ebola response Twitter , Emanuel said on the Knowledge@Wharton show on Wharton Business Radio on SiriusXM channel 111. (Listen to the podcast at the top of this page.)
Emanuel emphasized those concepts during his two-year stint (2009-2011) as special advisor for health policy to the director of the White House Office of Management and Budget. In that role, he helped shape the Obama administration’s global health initiatives.
The current Ebola outbreak is affecting four countries in West Africa: Guinea, Liberia, Nigeria and Sierra Leone. The U.S. Centers for Disease Control and Prevention (CDC) said in its latest update last week that there were 3,069 suspected and confirmed cases of Ebola and 1,552 deaths.
“In places like Sierra Leone and Liberia, they don’t have many [health care] workers, isolation facilities and basic things like latex gloves or masks. And that has fueled the spread of this virus.”
A Dire Need
“If you travel to these countries, there are no health facilities,” Emanuel said. “In places like Sierra Leone and Liberia, they don’t have many [health care] workers, isolation facilities and basic things like latex gloves or masks. And that has fueled the spread of this virus.” It is vital to look beyond Ebola, he added, because the affected West African countries “have just been decimated over recent decades and don’t have the infrastructure that is needed for the long haul.”
According to Emanuel, upgrading the health care infrastructure in the Ebola-affected countries has two big advantages. “First, it allows you to address outbreaks like Ebola as well as other outbreaks,” he noted. “[Second], it allows you to address the whole range of health care problems. One of the big issues of this outbreak is [that] people don’t trust the health care system. They view going to the health care system as sort of consigning someone to die.”
Many people in the affected countries do not regularly use the few existing health care facilities because they don’t trust them, Emanuel said. “The ability to isolate people and to have the local population trust the system is very, very important. And it will sustain much bigger improvements in health after Ebola.”
The development of the experimental Ebola drug ZMapp by San Diego, Calif.-based Mapp Biopharmaceutical is important, but it will not be able to address the needs of the current outbreak, Emanuel stated. ZMapp worked well on two U.S. health care workers who were infected with Ebola in Liberia and treated successfully last month at Emory University Hospital in Atlanta. ZMapp will not be available in sufficient quantities to deal with the latest outbreak, nor is its efficacy fully established, he pointed out.
“Whenever you have … a response to an emergency, you start dumping in a lot of resources, [but] not in the most cost-effective way, and not for the long term.”
Emanuel said the health care infrastructure he visualizes requires coordination among the various governments and agencies working to fight Ebola. “One of the things that drives sub-Saharan Africa and other countries receiving health assistance crazy is you’ve got different requirements for each country, [with] the money flows often overlapping some areas but leaving other areas with gaping holes,” he noted.
Coordination is also an important component to stave off what is called “donor fatigue,” according to Emanuel. “People … feel they have helped move the needle a little bit — or not at all — and they lose attention and walk way,” he said. He recalled such donor fatigue occurring in the aftermath of the 2010 Haiti earthquake. Even as billions of relief dollars flowed into Haiti to rebuild its infrastructure, such as roads and sanitation, the outcomes fell short of expectations.
“This is always a worry of mine: Whenever you have an emergency and a response to an emergency, you start dumping in a lot of resources, [but] not in the most cost-effective way, and not for the long term,” Emanuel noted. “That’s why I’ve long advocated the [creation of] basic infrastructure, the training of people, medicines, etc., that will address the emergency and will also address longer-term health efficiency.”