Globe and Mail, September 18, 2014
by Thomas Homer-Dixon
World leaders finally seem to be waking up to the gravity of the Ebola threat. Like the rest of us, they’ve been distracted by the Islamic State’s rampage in Syria and Iraq, the Ukrainian crisis, and even the mini-drama of the Scottish independence referendum. An outbreak of disease in Africa elicits yawns. The news resonates with the world’s worst stereotypes about the continent. Many people assume that what happens there, no matter how tragic, can’t matter much here.
Wrong. If the Ebola epidemic isn’t addressed with huge resources – and fast – it could make all the rest of the world’s crises seem trivial.
On Tuesday, U.S. President Barack Obama announced a dramatic surge of aid to Liberia, the country where the situation is most critical. With logistical support from the U.S. military, the U.S. will help construct 17 treatment centres with around 1,700 beds. China will soon have nearly 200 medical personnel on the ground in Sierra Leone, while the Red Cross has just opened a 60-bed facility in Kenema, the epicentre of Ebola in that country.
Will this help be enough? Quite possibly not. The epidemic’s growth trajectory, especially in Liberia, could easily continue to outstrip the world’s response, largely because policy-makers and commentators haven’t yet grasped the biggest risk.
Just three weeks ago, the World Health Organization estimated that the epidemic could ultimately afflict more than 20,000 people – a forecast that The New York Times called “dire.” But in the last few days, specialists have acknowledged that the epidemic is now growing exponentially. With the number of reported cases passing 5,000 (many more are likely unreported), and with this number apparently now doubling every three weeks, the total will surpass the WHO’s recent projection as soon as the end of next month. After running infectious-disease models, U.S. scientists are now talking about the possibility of hundreds of thousands of infections.
If Ebola affects hundreds of thousands of people in West Africa, the epidemic will stop being a health problem, narrowly defined, and will instead become a problem of international security, because the epidemic will tear the worst-affected societies apart.
This isn’t hyperbole. Last week, Liberia’s President Ellen Johnson Sirleaf wrote to Mr. Obama imploring the U.S. to act. “I am being honest with you,” she wrote, “that at this rate … the virus will overwhelm us.” She continued: “In a country that has barely emerged from a 30-year period of civil and political unrest, with the presence of a large youthful (mainly unemployed) population, some of whom were child soldiers, this health emergency threatens civil order.”
Ebola’s characteristics make it a potent threat to social cohesion, especially in impoverished societies with health resources spread thinly and weak state institutions – and especially now that it has reached the poorest and most crowded districts of Monrovia, a city of more than a million people. The disease may be quite hard to contract – requiring direct contact with the body’s fluids – but this mode of transmission means that exhausted health-care workers and family caregivers are most at risk. The disease is also deeply terrifying, because it causes the body’s fluids to gush out, and because 50 to 90 per cent of those infected are likely to die. So not only does Ebola rapidly deplete a fragile society’s finite reserves of health expertise, it can also shred its social capital, the networks of trust and reciprocity among people that communities need to function effectively.
Controlling Ebola requires a lot of money for equipment and facilities and to support the large number of personnel needed to educate communities; treat cases using the right infection-control precautions; identify, counsel, and track contacts; and properly dispose of bodies. This is money the worst-affected West African countries don’t have, especially as their economies buckle under the epidemic’s pressure and increasing international isolation.
At some point, these countries, especially Liberia, could reach a tipping point. Citizens with means will send their families abroad, before fleeing themselves. Soldiers and police will leave their posts, financial institutions will close, and the provision of basic services – like food, water and electricity, already scarce in many areas – will start to collapse. International health workers could be forced to evacuate.
These countries would then become persistent reservoirs of Ebola. Unchecked within desperately vulnerable populations, Ebola could more easily mutate to become transmissible by air. If that happens, Africa’s problem will be the world’s.