 I'm Salvatur Babonis and today's lecture is Ebola – Whose Problem? The Ebola epidemic of 2013 to 2015 caused at least 11,500 deaths, probably many more, mostly in the poor West African countries of Liberia, Sierra Leone, and Guinea. Ebola itself is a hemorrhagic fever, meaning that it's one of a class of diseases like yellow fever that both cause fever and cause people to hemorrhage body fluids, blood from the cuticles or from the ears or from around the eyes. Body fluids leak out of the body and contact with those body fluids can spread the disease. It's native to West Central Africa where it is endemic in local bat populations. The disease is spread from human to human through contact with bodily fluids, even after the deaths of those infected. So handling dead bodies without proper precautions can result in transmission to survivors. As its distribution makes clear, it is as much a disease of poverty and war as it is a disease of the tropics. All three states that were the center of the Ebola epidemic lack even the most basic public health infrastructure. The epidemic started in rural Guinea. Guinea had just emerged from a year, not exactly of civil war but of serious civil conflict. Guinea did not want other countries to know about the disease because Guinea's economy was extremely fragile and if it had let the world know about the presence of Ebola in Guinea, of course other countries would have closed their borders which would have been and ultimately was catastrophic for Guinea's economy. So suspicions about the disease were quashed initially to prevent any panic among Guinea's neighbors. The disease quickly spread from Guinea to Sierra Leone and Liberia. The worst epidemics were in Sierra Leone and Liberia where the infrastructure was even worse than Guinea, completely destroyed in civil wars that ended in 2002 and 2003. In Guinea there were some 4,000 deaths and much larger numbers of deaths in Sierra Leone and Liberia. Historically Ebola has been most closely associated with the Democratic Republic of the Congo, the most failed of all of Africa's failed states. Like these states of West Africa the DRC for decades now has lacked even the most basic public health infrastructure and when I say basic I mean like this. This is an Ebola treatment unit of JFK Hospital. You see the Ministry of Health and World Health Organization logos proudly printed on the sign that is hung to mark the hospital and there's a body, it's unclear whether it's a living or dead person being dragged through the mud into this treatment center. Now this is public health infrastructure, that is this is a place in Sierra Leone that actually had a treatment unit of some kind, never mind most villages which had no public health infrastructure whatsoever. Hospital or you might call it clinic conditions were so bad in Liberia and Sierra Leone that healthcare workers actually went on strike in the middle of the epidemic and it's no wonder they went on strike. Death rates among healthcare workers were the highest in the country. The surest way to die of Ebola was to be a healthcare worker trying to help people with Ebola. Workers lacked even the most basic safety and sanitary equipment like gloves and masks. Workers weren't being paid, the strikes were a response to a simple complete lack of payment. I mean being asked to put your life on the line in your job may be the call of duty but being asked to put your life on the line as a volunteer, which is effectively what you are if you're not even being paid is a very big ask for people who are already doing a lot to try to help their countries. In Guinea there was a slightly better functioning healthcare system but in Guinea government healthcare workers were actually murdered by villagers who didn't want them coming into their village looking for signs of Ebola because if a village was found to have Ebola people might be quarantined or their bodies, dead bodies might be forced into immediate burial when people wanted to wait to bury them and conduct proper ceremonies. So asking people to be healthcare workers when they might be, well certainly at risk of contracting Ebola and might even be murdered by people who are angry about their treatment in the Ebola epidemic, again it's a big ask to ask people to do for little or in many cases no pay. Now there is a new Ebola vaccine that is being trialed. All signs are that the vaccine seems to work. This vaccine in the future will insulate rich countries from future outbreaks because health workers who go to poor countries can be vaccinated before they go. Most of the people who spread Ebola back to Spain and the United States were health workers who had gone as volunteers to work in West Africa and then brought the disease back with them. Of course these people will all be vaccinated before the next breakout of Ebola and I don't want to be completely cynical, populations will be vaccinated against Ebola and there's a very good chance that Ebola vaccine will prevent or control or reduce the impact of future outbreaks of the disease. Ebola might be quote unquote defeated in the same way that we defeated smallpox and are on the verge of defeating polio. But vaccines don't get at the root of the problem. The root of the problem is a complete lack of local public health systems, a lack of national government capacity, irregular pay for health workers, alienated populations who feel completely unrepresented by their own governments. These are the real causes of diseases like Ebola or antibiotic resistant tuberculosis or malaria which are killing many, many more people around the world than Ebola killed in the most recent epidemic. Look health NGOs are doing great work but ultimately what the countries of the world need are effective government institutions. Now we've seen the creation of effective government institutions when it comes to financial institutions. This is a photo of Liberia's central bank. Now that is not the United States flag that's the Liberian flag which is very similar to the US flag flying over the bank but most of the countries of the world have effective central banks staffed by well trained western staff who are paid on a regular basis, who wear suits to work, have functioning computers. The anthropology that's been done in African countries around bureaucratic systems has shown that the best funded, best trained, actually functioning bureaucratic system in most countries is their central bank. Well that's perhaps no surprise. If you want to find money where do you go, you go to the bank. But we have put a place, a big priority on ensuring that developing countries have robust central banks and the capacity to undertake financial regulation, we have made nothing like the same level of effort to make sure that poor countries have functioning health ministries and public health systems and basic healthcare for the entire urban and rural populations. I'm Salvatore Bobonis, thank you for listening. You can find out more about me at SalvatoreBobonis.com where you can also sign up for my monthly newsletter on global affairs.