Last month, a senior African Union (AU) official claimed international news media such as CNN and BBC had “overlooked Africa’s role” in combating the recent Ebola crisis in West Africa. Olawale Maiyegun, the AU’s social affairs director, also said Africans “are better placed to fight infectious diseases in their continent than outsiders.”
At first glance, these statements may seem peculiar to international observers. After all, wasn’t it the inability of West African nations—particularly the three most-affected countries of Guinea, Liberia, and Sierra Leone—to halt the spread of Ebola that compelled the massive international response in the first place? Many African leaders and public figures were also responsible for some of the heaviest criticism of the initial response to the crisis.
Nevertheless, it is clear that regional and sub-regional organizations do have potential to play a significant role in combating the ongoing threat of Ebola, as well as future health emergencies. The Ebola crisis could therefore provide a unique opportunity for regional actors such as the AU, the Economic Community of West African States (ECOWAS), and the Mano River Union (MRU), as well as other African nations, to assert themselves. This remains true even as the World Health Organization (WHO) officially declared Liberia free of Ebola last week.
As Dr. Maiyegun suggested, there are important advantages when regional organizations take ownership of health emergencies. This was confirmed by a major report by the United Nations Development Programme (UNDP) released earlier this year, which concluded that a “regional perspective could have greatly enhanced the effectiveness of the response” to Ebola. The report recommended measures such as joint investigation missions, sharing of best practices between bordering districts, and establishing a biosafety protection level four laboratory—the highest available—in the region.
On a continent historically skeptical of outsiders, regional actors are more likely to be perceived as legitimate and gain the trust of the local population. Here it is worth remembering that in the early stages of the recent outbreak, the influx of foreign medical teams, combined with the prevailing climate of fear, prompted some communities to speculate about a Western conspiracy to harm Africans.
Pan-Continental Ebola Response
Despite an initially sluggish response, some major African institutions now seem to be pulling their weight in combating the Ebola virus. Together, the AU and ECOWAS have deployed 840 healthcare workers to West Africa to assist medical efforts there. This accounts for over a third of the approximately 2,500 personnel belonging to foreign medical teams in the region. The African Development Bank has also pledged an estimated 525 million USD to the Ebola response, making it the fourth largest donor after the World Bank, the United States, and the United Kingdom.
The Ebola crisis has galvanized the establishment of the long-awaited African Centers for Disease Control and Prevention (CDC), which will be an important part of any pan-African system for infectious disease surveillance and response. In addition to providing technical guidance, the CDC will serve as a regional listening post for infectious disease outbreaks and is charged with coordinating a pan-continental response to epidemics. Crucially, it will receive technical and financial backing from the US CDC.
Sub-regional collaboration is also expected to play a role in this new architecture. The World Bank and MRU countries of Liberia, Guinea, and Sierra Leone have agreed to foster measures to strengthen sub-regional disease surveillance and response, such as cross-border information sharing and joint border management in rural areas where animal-borne diseases are most likely to emerge. There is also a proposal under discussion to establish a West African CDC.
Barriers to Cooperation
Yet, while an important foundation has been laid, the continent is far from having the kind of coordinated response needed to take the lead on managing future disease outbreaks. There are few parameters in place for collaboration, when what is needed is an instrument akin to the Association of Southeast Asian Nations plan for animal and pandemic influenza, where a joint health security framework for Southeast Asian nations shares information and expertise on outbreaks of H1N1, or bird flu.
Another impediment to regional cooperation is that West African nations possess markedly different institutional and bureaucratic cultures, themselves a product of varying colonial legacies that continue to influence national development priorities today. During the Ebola crisis, there was little in the way of effective health coordination among the three most-affected countries. Their health ministries were slow to coordinate, while early warning systems focused on traditional security threats such as conflict and did not integrate with health ministries.
While policies and procedures can be developed, it will be more difficult to overcome entrenched practices and behaviors. The Ebola crisis was characterized by a lack of trust between governments and their citizens, as well as infighting between political parties, corruption, and mismanagement of public funds. As a result, the Ebola-affected countries will have to overcome decades of poor practices to find a way to work together to ensure effective governance and adequate oversight and accountability measures in the health sector.
According to Amesh Adalja, Senior Associate at the Center for Health Security at the University of Pittsburgh Medical Center, the prospects of establishing a viable African system of health security are still “very good.” Having threatened regional and even international security, the Ebola crisis was a wake-up call for the international community about the importance of stamping out outbreaks before they take on global dimensions.
For this reason, securing adequate resources and funding are unlikely to be a major barrier to implementation. Nonetheless, Dr. Adalja cautioned it may take several years before such a regional architecture will be operational.
“It may take a while to identify the proper roles and responsibilities of different actors, including the African CDC and the World Health Organization,” he said. This means “avoiding duplication of efforts and integrating well” as part of a multi-pronged approach to global health security.
There is also a risk that regional initiatives could be overlooked in favor of more globally minded reforms. For instance, in the aftermath of the Ebola crisis, some have questioned whether a new supranational health organization with clear command and control structures is needed. Others have argued for a strong, reformed WHO. Yet if WHO reform is not politically feasible, as has been argued elsewhere, it may well fall on regional actors to prepare for the eventuality of health emergencies.
One option that regional organizations could take to promote effective governance and accountability in the health sector is to establish norms and structures to address those gaps that led to corruption and mismanagement in the first place. The AU’s diverse array of frameworks and review mechanisms in other areas—i.e. democratic governance and the rule of law—could provide a possible model.
In addition, with their regional perspective and scope, these organizations would be well-positioned to identify lessons learned from other countries that successfully faced down Ebola. Why, for example, were Nigeria and Mali able to mount an effective Ebola response? Capturing these comparative lessons will be an important part of ensuring that reforms to the healthcare sector are carried out in accordance with the best models and practices. These reforms should be aligned with global instruments aiming to prevent infectious disease outbreaks, such as the 2005 International Health Regulations.
All of this is contingent on strong leadership and management skills to push forward an ambitious reform agenda and wisely allocate development funding. By doing so, Africans can play a leading role in managing disease outbreaks on the continent and look back at the Ebola crisis as the turning point that brought about an era of pan-African health cooperation.