The social and economic costs of fear

I wrote a post a few days ago in reaction to a line in a New York Times editorial on the US response to the Ebola outbreak that categorized many West African officials and workers as "incompetent and in some cases unable to use the temperature devices they have been given." This didn't sit well with me for many reasons and I find myself reacting similarly to much of the coverage of the Ebola epidemic. The tone is (understandably) fearful, but touching on xenophobic, including the many calls to stop all flights coming from affected countries. While this might seem reasonable at first glance, it ignores the effect it would have on those countries, both economically and in terms of stopping the travel of very necessary health workers.

But in response to my blog post, a friend sent along an article about Nigeria's successful containment of Ebola. The government devised a "war-like approach" to dealing with the disease when it appeared, putting in place a command center with the Nigerian Government in charge, but in cooperation with international organizations from the World Health Organization to the US CDC: "Together with these organizations, we sit in one place, co-location in a designated facility, and we do joint planning, agree on strategies to be used, and implement these strategies based on a clear understanding that people are comfortable to deliver on specific tasks." They put four teams into action to inform the population, screen people crossing borders, manage potential cases and to hunt down anyone who may have had contact with an infected person in "a way that ensured ruthless efficiency."

The doctor in charge of the effort is Faisal Shuaib, a Nigerian physician who completed his medical training in Nigeria and a doctorate in Public Health from the University of Alabama at Birmingham. He stepped away from his position heading the Nigerian Health Ministry's Polio eradication program to oversee the response to Ebola. He has been managing a team of over 500 public health workers and volunteers to monitor and contain the disease. As of October 9, more than a month had passed since the last Nigerian case had been discharged. 

I loved reading this story for a couple of reasons. First, as the person sending the link commented, "no incompetence noted..." It is a great example of the good work being done by affected nations to protect their people. But it also shows why the isolation response of "Quick, cancel all the flights!!" is so dangerous. Nigeria was so successful because of the competence of the doctor leading the charge, but also because of the coordination and cooperation among various international organizations and governments in the effort to stop the disease. 

Nigeria is wealthier than other West African countries and ranked higher on the UN's Human Development Index, so it may have been better positioned to respond to Ebola. But even so, they didn't respond alone. The government oversaw the campaign in cooperation with organizations that could supply expertise and with the funding support of the Gates Foundation that shifted $50 million to fighting Ebola. When asked what more must be done to protect people, Dr. Shuaib responded, "One thing that can change the outbreak is for nations to come together and deploy resources... Wealthier countries have to mobilize resources in a concerted manner, and they need to act now." 

Although it is mainly three countries that are being hit the hardest by Ebola, the response needs to come from the whole world. This is a humanitarian crisis that will have lasting economic and social effects, and it's not a Scylla-and-Charybdis rock-and-a-hard-place situation like Syria or the Ukraine. This is a tragedy killing thousands of people and gutting economies that were struggling to develop. The World Bank recently released a forecast that projects a loss of $1.6 billion in West Africa region if Ebola is contained but up to $25.2 billion if it continues to spread. I can't even begin to imagine what kind of long-term damage this would do to lives there even once the disease has been contained.

I don't live in a country affected by Ebola, but there is real fear that the outbreak will cause an economic contagion that spread beyond where the virus appears. As not everyone knows exactly how large and diverse Africa is, or how the disease spreads, there have been various panic responses. Planes have been quarantined because they were carrying passenger who got airsick and had been to "Africa," even if it was nowhere near the affected region. A friend who runs a non-profit selling crafts made in Uganda recently had a customer try to cancel an order for fear she could catch Ebola from the beaded necklaces. This kind of irrational fear could damage all African economies and create more prejudice against the continent as a whole, which does affect Mozambique. Addressing this possibility, the New York Times' recently quoted IMF managing director Christine Lagarde as saying, “We should be very careful not to terrify the planet in respect of the whole of Africa.”

So while it is very important for every country to screen very carefully anyone traveling from an affected area - Dr. Shuaib also emphasized this as a crucial step in stopping the spread of the disease - responding to the crisis by trying to pull away will have serious long term effects and won't help stop the disease, only coming together to fight it can do that.