The human health toll of the Ebola outbreak in Liberia, Sierra Leone, and Guinea is substantial. And now that it has established a foothold in dense cities in these countries, containing this outbreak will be neither easy nor swift. But from a broader perspective, the outbreak itself is only the tip of the iceberg. Food shortages, other untreated health issues, and violence are all now significant challenges in these countries. And they are trending in the wrong direction.
This cascading toll of disruption and dislocation highlights the need for a more holistic planning perspective and is a powerful reminder of the interconnected nature of cities, supply chains, and systems around the world. While it may not be possible to perfectly predict or prevent infectious disease outbreaks like Ebola, cities and systems can build resilience to these events. They can focus on the foundational elements of society like leadership and communication in a way that mitigates panic and despair and prevents the cascade of destruction we are currently witnessing.
Just as Mali discovered its first case, a cautiously optimistic sigh of relief could be heard in Senegal and Nigeria when they were officially declared ebola free. A prolonged outbreak in either of these two countries – both crucial economic and transport hubs in the region – would (and could still) be catastrophic, increasing this region’s isolation and reducing its access to critical resources.
But Senegal and Nigeria’s outbreak containment wasn’t necessarily ebola specific. Their success has been attributed to a mix of the public health basics: effective risk and health communication, strong leadership, and rapid resource deployment. To be sure, both of these countries are better equipped to respond. And they demonstrated resilience to this threat from a number of angles.
Social cohesion: While Senegal and Nigeria have not been free from unrest in recent years, they are not dealing with the lingering effects of decades of unrest as are Liberia, Sierra Leone, and to a lesser extent, Guinea. This legacy of conflict has undermined even the most basic institutions in these countries and has hamstrung response activities due to lingering mistrust and suspicion of leadership. In Dakar, where 100RC is currently working, I witnessed firsthand Mayor Khalifa Sall’s commitment to maintaining and communicating his city’s vigilance against disease spread while making sure panic didn’t set in.
Prosperity: the overall wealth and spending capabilities in Nigeria and Senegal are higher when compared to those in the countries hardest hit by ebola.
Health Systems: Nigeria and Senegal’s health systems, while overtaxed and under-resourced in their own right, are still more effective. Nigeria demonstrated its health system resilience by rapidly retrofitting its polio surveillance system to keep tabs on its ebola outbreak.
These examples reinforce the need for a broad-based approach to health emergency planning and response that: builds a community’s capacity during normal times; is able to adapt existing capabilities during emergencies; and remains flexible and cognizant of the wide range of shocks and stresses that it may face. When health emergencies occur, communities would thus be prepared to detect outbreaks early, respond swiftly, minimize spread and impact, and sustain normal services that support the general population.
This also pays dividends that are broader than just disease containment. When communities trust each other, their government, and the international community, the risk of civil unrest and instability during a health emergency decreases. And when individuals feel secure, economic opportunities, for businesses and individuals, increase and vulnerability to economic stresses - to business disruptions, food shortages, etc. - that are borne out of health emergencies decreases. In the communities most affected by ebola, this type of resilience building is an evolving, ongoing process that takes place over years, not months. And Nigeria and Senegal both remain quite vulnerable to an expanding humanitarian disaster similar to its neighbors that is sparked by a severe shock like an ebola outbreak. But their ability to stem this threat early has, for now, halted this potentially vicious circle.
It’s also important to keep in mind that this is West Africa’s first ebola outbreak. The next health emergency in West Africa may be something completely different, but it will likely call on similar foundations of resilience for an effective response.