Public emergencies need public health


US nurses win better protection following strike

Californian nurses have won mandatory regulations for optimal personal protective equipment to be worn when treating Ebola patients. This follows a strike by over 100,000 nurses. It was the largest health and safety action in any industry in the US for the last 45 years.

For more details on the new California standards see


Ebola 2014 has dramatically highlighted the need for strong public health systems.

Ebola outbreaks are predictable and preventable and the virus is not highly transmissible: yet the 2014 outbreak has led to more than 5000 deaths and forecasts of 1.4 million infections by January 2015. Why?

This question throws a harsh spotlight on private versus public funding of health, medical research and even the UN’s World Health Organisation (WHO).

It has also led to calls for a rethink on how healthcare and research into vaccines are funded.

As private individuals with no public oversight become more powerful in deciding where health, aid and research money is being spent, governments that are subject to public scrutiny and accountability may find themselves less able to respond adequately to public health concerns.

According to Calestous Juma, Professor of the Practice of International Development at Harvard Kennedy School: “Those who believe the private sector can only function by shrinking the capacity of the public sector may be giving up their ability to protect citizens against public emergencies.”

This is being revealed now as America, the most highly-privatised health system in the world, scrambles to prepare for Ebola to arrive on its shores. In late October Reuters Press Agency reported that US health officials were still trying to establish a network of about 20 hospitals nationwide that would be fully equipped to handle all aspects of Ebola care.

In 2006, at the end of the Liberian civil war, that country’s healthcare system had fewer than 15 doctors – compared to 3000 at its prime – and was staffed mainly by NGOs and aid agencies that were concentrating on restoring basic health and training to the system. By 2012 the country’s 15 political subdivisions each had a government-run hospital with a Liberian doctor in charge, as opposed to only eight in 2006 and only three Liberian doctors.

In contrast, says Professor Juma, the key to successful containment of Ebola in neighbouring Nigeria was the strength of that country’s public sector.

On October 20 Nigeria was declared Ebola free: a country of 174 million people had just 20 confirmed cases and eight deaths, half the fatality rate of other countries involved in the outbreak.

Three days after the first case was diagnosed Nigerian bureaucrats working with WHO, Médecins Sans Frontières (MSF), UNICEF and the US Centre for Disease Control (CDC) had established an operations center to respond to the outbreak.

The CDC praised the collective effort: “Immediately, the [response centre] developed a functional staff rhythm that facilitated information sharing, team accountability, and resource mobilisation, while attempting to minimise the distraction of teams from their highest priorities” the agency wrote.

“Having all the relevant government and international authorities in one place helped streamline decision-making and ensured a rapid, effective, and coordinated response.”

Economic conditions for an Ebola outbreak

WHO was criticised for its failure to respond to warnings from MSF in April 2014 about Ebola in West Africa. WHO director general Margaret Chan has said that “donor interests” drive her budget.

She has also said: “The Ebola outbreak spotlights the dangers of the world’s growing social and economic inequalities.”

The Bill and Melinda Gates Foundation contributes $300 million to the WHO budget, more than the United States or the United Kingdom, and has announced it will donate $50 million to the Ebola effort.

Charitable giving by foundations is tax deductible.

“Philanthropy can be a potent instrument for ‘managing’ the poor rather than empowering them,” the Global Health Watch organisation said in a recent report. “Few grants go to civil rights and social movements.”

According to the Director of the Centre for Values and Ethics and the Law in Medicine at University of Sydney, Ian Kerridge, and the Clinical Professor in Medicine and Infectious Diseases at University of Sydney, Lyn Gilbert, writing for theconversation. com: “The likelihood of outbreaks of disease due to Ebola and other viruses that jump from animals to humans, increases when people are forced, by poverty, limited sources of protein, global capitalism and neoliberal market policies, into dangerous places and practices to survive.

“Unless we confront these structural problems, genuinely consider alternative policies and strategies, such as new forms of taxation and market economics in line with public health goals, pooling of intellectual property to facilitate drug and vaccine development, and different approaches to science and science funding, the problems highlighted by this outbreak will be endlessly repeated.

“The most difficult but important step is to critically examine the sociopolitical and economic conditions that create the environment for such outbreaks to occur.”

Pictured above: After receiving training, volunteers with the Red Cross Society of Guinea prepare to disinfect the hospital of Tahouay in Conakry, following an Ebola outbreak. Photo: ©afreecom/Idrissa Soumaré