The outbreak of Ebola in West Africa has put the international community on alert. Observers have described one of the scenes as a state of war. The crisis could no longer be handled by line ministries and affected governments have been forced into a state of emergency.
The immediate sources of the crisis are medical. But lasting solutions will have to be sought in the wider economic context in which health care functions. The roots lie in at least two major weaknesses in Africa’s current development trends: poor infrastructure and limited investment in public health.
The Ebola strain ravaging West Africa and putting the international community at risk has not changed since the first outbreak in the Democratic Republic of the Congo and Sudan in 1976. But Africa’s rapid urbanisation has by far outstripped the capacity of public infrastructure and health services to stem the spread of disease.
Two of the countries that are most severely affected (Liberia and Sierra Leone) endured long periods of civil war that destroyed or stalled planned infrastructure and public health development. Guinea has an equally long history of low investment in infrastructure.
As Professor Richard Olds dean of the School of Medicine at the University of California (Irvine) says, the outbreak has occurred in regions that are “much more densely populated, much more urban in their nature and those populations are much more mobile.”
The development of infrastructure needed to provide improved quality of life, employment and security has lagged behind demand. In fact, such infrastructure limitations are partly responsible for the slowing rate of urbanisation in many part of Africa.
The same poor infrastructure that is limiting economic opportunities is also critical for improved public health. The limited availability of basic amenities such as clear water and sanitation adds more pressure on the stressed health services.
Infrastructure and public health are intricately connected. In fact, a functioning infrastructure (such as transportation, energy, water and sanitation) is the foundation for improved public health. Most of Africa’s urban poor live in slums where such services are limited.
The Ebola outbreak is therefore not just a medical emergency. It is a clear sign that Africa’s current growth patterns cannot be sustained and can easily unravel as a result of disease outbreaks. The promise of cities as centres of creativity, innovation and growth cannot be realised when nearly 70 percent of the urban population lives in slums.
Africa’s rapid urbanisation is occurring in the age of climate disruption. The projected ecological changes arising from global warming as well as local deforestation are sources of additional concern. Indeed, the displacement of bats carrying the Ebola virus through deforestation may have contributed to spread of the disease. Africa’s infrastructure for development will therefore need to include a strong health research component.
Over the last decade African leaders have put considerable emphasis on the importance of funding agricultural research. There have been modest gains and a lot more needs to be done. But the Ebola outbreak is grim reminder on the urgency to pay urgent attention to the importance of biomedical research.
The basis for strengthening Africa’s health innovation systems already exists in national and regional institute of higher learning across Africa. Much of this work focuses on finding cures for local diseases. The challenge, however, is that they have hardly received the political attention that is commensurate with their public importance.
The debate over whether Africans can have access to experimental drug from the United States raised important ethical issues. However, it also distracted attention from the urgent attention that African leaders collectively need to pay to the crisis.
What appeared to be an isolated outbreak has quickly turned into an economic concern across the continent. Unlike famines which have tended to remain localised, public health emergencies respect no borders. Long-term responses will need to build on regional and continental capabilities.
Africa has learned through addressing famine that moving from one crisis to another is untenable and is now focusing on long-term agricultural transformation efforts. Similar thinking will need to be applied to health research. The Ebola outbreak is not an episode; it is a wake-up call for strategic political action.
The basis for bringing high-level political attention to the challenge already exists. The African Union recently adopted a 10-year Science, Technology and Innovation Strategy. The strategy envisages addressing critical challenges such as health through infrastructure development, higher technical training, and entrepreneurship.
One of the first measures that African leaders will need to undertake is to be better informed about emerging trends that are likely to undermine the economic gains they have so far made. Leaders in most of the other parts of the world are supported by networks of scientific advisers. The main task of such advisers is precisely to examine the risks posed by events such Ebola outbreaks.
It is notable that despite the complex technical issues that African presidents have to address, not a single country has a dedicated office of science and technology advisory. A few have individuals serving as advisors but they lack the legislative, financial and administrative capacity to be of any value. Such advisory offices will complement the support that is provided to presidents by chief economic advisers.
Establishing such presidential science advisory office will make it easier for African scientists and engineers to contribute their expertise to human improvement. This can be done through channels such as the Network of African Science Academies (NASAC) which has been in existence since 2001.
NASAC includes 19 academies that can support high-level decision-making but their effectiveness is limited by the absence of presidential science and technology advisory offices. Science speaks. But it cannot be heard unless political leaders are listening. They do so not through experts whispering in their ears but by relying on robust offices of science and technology advice.
The Ebola outbreak is a crisis of immense proportions. But it is also an opportunity to facilitate building basic infrastructure, putting in place public health systems and establishing offices of science and technology advice. Those who continue to lead without the help of scientific and technical advice can hardly see far. Doom awaits them and their followers.
Calestous Juma is Professor of the Practice of International Development and Faculty Chair of the Innovation and Economic Development Program at Harvard Kennedy School. During the 2014-2015 academic he will be Dr Martin Luther King Jr Visiting Professor at the Department of Urban Studies and Planning at the Massachusetts Institute of Technology. He is author of The New Harvest: Agricultural Innovation in Africa.