Summary: Search for Common Ground Panel Discussion: Conflict and Ebola, 14 October 2014

This discussion, hosted by Search for Common Ground at the Johns Hopkins School of Advanced International Studies (SAIS).  The discussion featured three presenters, including Deb Rosenblum of NTI, and explored how conflict and trust/distrust have affected infectious disease, with a focus on the current Ebola outbreak.  A summary follows.

Chris Mahony, Georgetown University Law Center: The failure of the initial response to the Ebola outbreak in Liberia and Sierra Leone can be attributed in part to the military-oriented response to the outbreak in the 2 countries, as well as to a lack of collaboration among the affected countries. The long wars in Liberia and Sierra Leone and lower-level unrest in Guinea fueled distrust and destroyed the economies in the Liberia and Sierra Leone.  Ebola’s effect has brought recent economic progress to a halt and highlighted the destitution of the public health systems.  Moreover, an aid response from the outside world that extracts the region’s resources will only exasperate discontent and increase instability.  Moving forward, the three countries need to collaborate on border controls and economic cooperation

Richard Garfield, CDC:  The disease-exception response favored by many international donors and aid agencies has not helped the countries of West Africa build public health capacity.  While HIV rates have been lowered, the region remained vulnerable to outbreaks.  High rates of unemployment fueled the conflicts of the previous two decades in West Africa, and these must be addressed over the long term to produce broad economic and social improvements in these countries.   Regarding control of the current outbreak, the lab diagnostics are ok, especially compared to one month ago, but only about 30% of healthcare personnel is in place right now.   There has been a huge knock-on effect from Ebola for Under-5 mortality rates; estimates that U5 mortality has been set back 15 years.  Moreover, anti-malarial activities have largely stopped in 15% of the area impacted by Ebola.  CDC predicts increased incidence of polio and measles, due to decrease in immunization.  Cholera is another persistent threat that could suddenty emerge.  To combat the outbreak, there is a need to strengthen social systems that encourage people to train as healthcare workers and to stay in place when disaster strikes.  There is also a need to link vertical public health and governing structures horizontally.   During the Q&A session, he stressed the role of a strong social fabric in controlling previous Ebola outbreaks: churches, businesses, and media outlets acted in coordination with a simple message for preventing and treating the disease.

Deb Rosenblum:  Deb shared the experience of the Middle Eastern countries in collaborating on disease surveillance.  Since diseases do not respect borders, countries with histories of distrust and discord must learn to work together on sharing data and analyzing the data to collaboratively develop strategies for controlling diseases and outbreaks.  Government and academic exchanges can lead to real working partnerships that can process and disseminate data more quickly than if it comes from WHO.  What has worked in the Middle East has also worked for the countries of the Mekong Basin.  Through collaborative trainings, partnerships, and joint investigations, these countries have developed a platform for quickly and efficiently addressing disease outbreaks.  We’ve also seen this in Southern and East Africa, where development of trust, driven by consortia of universities and health-oriented ministries, has allowed the countries to give their populations reliable information on previous Ebola outbreaks.  This could be a lesson for the current outbreak in West Africa, as well as for future outbreaks.  During the Q&A, Deb emphasized the need to have a cross-border focus on controlling diseases.