Ebola as the “Katrina moment” that highlights global health inequity

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Georgetown University Professor Lawrence Gostin’s new book Global Health Law examines the causes and consequences of the vast inequities in access to health between rich and poor around the world, so when Gostin came to the Center for International and Strategic studies on Tuesday, the talk naturally turned to the ongoing and escalating Ebola outbreak in West Africa.

This was the same day that U.S. Centers for Disease and Control Director Tom Frieden, having just returned from a tour of countries where the virus is continuing to spread, told of the survivors, mourners and health workers he had seen and who, he said stayed with him still, but said that what he hadn’t seen disturbed him still more. “I didn’t see enough beds for treatment,” he said, “I didn’t see data coming in from large parts of the country where Ebola might be spreading. I didn’t see the kind of efficient management systems and support and transport and jeeps that are essential for a rapid and effective response. That is the situation now.”

It is a situation that fuels a devastating, sweeping, deadly outbreak across poor countries of a disease that can be contained quickly in wealthier ones, Gostin said. It is the reason that two “global health narratives” — one of great achievement and progress, and one of impoverishment through disease, hunger and malnutrition, unsanitary and unhygienic conditions that spread preventable illnesses can exist side by side. Both narratives are true, he said, and together they tell the story of how the injustice of inequities remains the biggest challenge facing the future of global health endeavors.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who has watched and fought the AIDS pandemic for more than three decades, and who joined a panel at CSIS Tuesday to talk about Gostin’s book, has a similar take, a different word.

“There would not Ebola outbreaks that devastate countries if there were not absolutely stunning disparities,” he said, describing the swift response that will follow when, sooner or later a passenger on a flight from Africa lands in the United States with symptoms of Ebola, how that person will be treated, tracked, and isolated and contrasting that to the systemic gaps that make that response impossible across the affected West African countries.

Stephen Morrison of CSIS asked the panelists if Ebola is a “Katrina moment” — one that highlights an embarrassing and destructive lack of preparedness for and even awareness of predictable threats. In that case, he asked, who plays the role this time of the U.S. disaster officials caught off guard by the impact of the hurricane that destroyed much of New Orleans?

“There are several candidates,” Gostin said, pointing to the “complete mismatch” between the global burden of disease and the budget for the World Health Organization. He suggests a fund, like the Global Fund to Fight AIDS Tuberculosis and Malaria dedicated specifically to strengthening health systems.

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