NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Friday, January 16, 2015

As Ebola’s death toll surpasses 8,000 people, well-intentioned individuals have been suggesting different strategies to contain the crisis. Many of these recommendations have included the use of modern technologies like cell phones, coupled with innovations such as a global rapid response team. But more than anything, what Africa really needs is simply more investment in its people and its basic health care infrastructure, along with reduced corruption—making sure that the money sent to lay the foundations of public health actually goes where it is supposed to.

This is not to say that the wonders of modern technology do not have their place. Some devices, such as cell phones, have proven their worth as tools for disease surveillance and control. In 2008, for example, after a major earthquake in Sichuan province disrupted the electronic disease monitoring system, China’s federal and local health care offices set up an emergency system that used cell phones to report any outbreaks of infectious disease. (Water-borne diseases such as cholera and leptospirosis are a potential byproduct of earthquakes, the result of contaminated drinking water, broken sewage systems, and crowded refugee camps with minimal sanitation, among other factors.) This improvised emergency system allowed health care agencies to rapidly detect and attend to these diseases before they could turn into epidemics in the earthquake-hit region.

But an easily overlooked aspect to this worthy approach is that China already had a well-developed public health infrastructure in place to take advantage of the technology. After all, any cell phone surveillance effort is only as good as the public health infrastructure using it. Such technology-heavy approaches do little good if the underlying public health systems don’t exist. And in contrast, sub-Saharan Africa suffers from a poorly developed infrastructure for public health, so any cell phone-based surveillance efforts there are small-scale and fragmented.

With this in mind, it was short-sighted for Jim Yong Kim, a physician and the president of the World Bank, to recommend that a global health reserve corps be set up to rapidly respond to outbreaks. While such an approach may sound good on paper, in countries such as Guinea, Liberia, and Sierra Leone, there is simply no medical or public health infrastructure to properly identify outbreaks of diseases such as Ebola, which means that the virus can propagate unrecognized for days or even weeks before the crisis is even properly identified. By then, it has spiraled far out of control. And waiting even the littlest bit longer for a global health reserve corps to be mobilized and parachute in would cause even further delays in response—unnecessarily costing additional lives.

A better solution is to invest in putting into place a public health care infrastructure in Africa. Unfortunately, there has been inadequate funding for basic public health in many African countries, as Oyewale Tomori, a veterinary virologist and president of the Nigerian Academy of Science, has observed. And while African scientists have the expertise and the cultural understanding to make them the best resources to refer to in order to solve Africa’s problems, African leaders continue to prefer to seek solutions from outside, Western experts—who all too often appear briefly during crises, make recommendations, then return home. In some cases, Western countries have been known to partially build high-tech laboratories, only to leave them uncompleted and useless—further hindering African scientists’ abilities to put their expertise to good use. It would be much better for African leaders to invest their countries’ money, time, and labor in building their own solid, reliable public health care infrastructures from the ground up in their native lands.