The speed with which the current Ebola epidemic swept across parts of West Africa, claiming over 4,000 lives in the first six months and affecting millions more, exposed the extreme fragility of primary health care facilities in the region, the disproportionate impact on particularly vulnerable groups, as well as the increasingly globalized implications of the outbreak. Almost overnight, the “˜Africa Rising’ narrative from the August 2014 US-Africa Leaders’ Summit was replaced with the more familiar refrain of “˜death, destruction and disease.’
Ebola has laid bare significant deficiencies in Africa’s development path and highlighted the urgent need to emphasize the security and prosperity of the individual, as we laud successive years of real GDP growth across the continent. While substantial resources are expended to contain the virus, more attention should be paid to the profound socio-economic impacts of the epidemic that are made worse by entrenched and persistent inequality.
Although Guinea, Liberia and Sierra Leone were among the star macroeconomic performers on the continent since 2010, they are also among the poorest and least developed. Numerous scholarly publications and policy documents have been devoted to understanding and addressing the apparent paradox of high-growth, high-poverty economies. In reality, countries that fail to invest in their citizens and provide basic infrastructure for their citizens will always struggle to translate macroeconomic productivity gains into tangible and broad-based economic progress.
These countries were hardest hit by Ebola because rural communities were not well-educated, primary health care facilities were virtually non-existent, and relevant state institutions were poorly prepared. Unsurprisingly, existing health care facilities quickly crumbled under the weight of the resultant deluge of Ebola cases. In addition, decades of weak governance had sown the seeds of distrust between citizens and their governments, thereby making it difficult to reach the most affected communities expeditiously.
Consequently, Ebola is having dire economic ramifications in the affected countries. Lost productivity in Guinea, Liberia and Sierra Leone is expected to cost these economies more than $350 million in 2014 and $800 million in 2015. But the most severe economic challenges have been at the household level. In countries where over half of the workforce are minimum-wage earners in the non-formal sector, an epidemic incapacitates the bread-winners, worsens intra-community dependency, restricts market access, and seriously constrains household budgets.
Available evidence suggests that vulnerable groups, like women and children, are most affected because of persistent inequality. They are more susceptible to the virus and bear a disproportionate share of the costs of coping in Ebola-hit communities. In addition, entire agrarian communities will be forced to miss the annual planting season, putting next year’s harvest in peril. For many, the sharp downturn in household income will persist well into 2015 — even if the epidemic is contained by end-2014 (an optimistic scenario).
Ebola is also having a deleterious effect on household wealth, as beleaguered and isolated households liquidate assets (like jewelry and livestock) and incur debt in order to survive. Consequently, humanitarian interventions must be swift and focus on both income- and wealth-generation in affected communities. This calls for creativity beyond the business-as-usual approach to economic regeneration in crisis-affected regions.
Inter-group inequality has been a prominent factor in the recent Ebola outbreak. Stark rural-urban disparities in Guinea, Liberia and Sierra Leone facilitated and accelerated the transmission of the virus. The dearth of health care facilities in rural areas made it impossible to identify and isolate cases, and made it relatively easy for the virus to spread across entire communities unchecked. The resultant panic forced scores of infected people to the towns and cities where the few available facilities became overwhelmed.
The social epidemiology observed in the villages was quickly replicated in the low-income residential areas in cities, thereby compounding the problem. Overwhelmed health care workers in these countries had to contend with the epidemic on many fronts. This precipitated the virtual collapse of the health care system, which worsened the humanitarian crisis.
One of the lessons of this Ebola outbreak is that countries that ignore pronounced inequality do so at their peril. Not only are such societies more fractured and unstable, they are also less resilient to socio-economic shocks. Investing in basic primary health care and education facilities protects rich and poor, urban and rural, men and women.
Much more should be done to translate Africa’s commendable macroeconomic gains into productive social investments. Deeply unequal societies are more likely to be unstable and insecure. Moreover, the effects of inequality also play out on a global stage with travelers from Ebola-affected regions making their way to countries with appropriate treatment facilities. This is why world leaders have described the outbreak as a “global crisis.”
West Africa could easily become the epicenter of a global pandemic if immediate steps are not taken to contain transmission, care for the infected, and address resilience in currently affected communities and countries. Ebola is a complex global security emergency that demands much more than a focus on the virus, as we learn from theories of social epidemiology. Desperate people will find ways to leave affected regions.
Investing in resilient institutions and infrastructure is key because it helps establish a modicum of trust, provides some assurance of equitable socio-economic progress and helps stabilize communities. The United States’ decision to send some 4,000 troops to bolster efforts to contain Liberia’s Ebola crisis and similar initiatives by the British in Sierra Leone and the French in Guinea are commended, but for them to succeed they must be complemented by sustained efforts to strengthen resilience through the establishment of more credible primary health institutions, equitable wealth and income generating initiatives, and robust governance structures at national and local levels.
The construction of medical units would improve detection, treatment and public health education, but they could become overwhelmed if concomitant steps are not taken to reduce inequality, tackle economic malaise and social disruption caused by the Ebola crisis in both rural and urban areas.
This crisis is an ideal opportunity for African countries and their international partners to innovate and provide affected communities with balanced, targeted and sustainable assistance that goes beyond ameliorating the effects of the Ebola virus. First, there must be a multi-year commitment to invest in the provision of basic social services for all. Failure to drastically minimize inequality would undermine all efforts to build resilience.
Second, the international response should be supported with practical initiatives to stabilize national and local economies via targeted economic incentives. The focus must be on lives, livelihoods and wealth creation.
Third, steps should be taken to engage Africa’s growing business sector. This should go beyond philanthropy and humanitarianism. It should include partnerships for the provision of infrastructure and focused efforts to more meaningfully integrate local economies (for goods and services) into profitable global supply chains.
Fourth, measures should be put in place to forestall potential political instability and civil unrest. The politicization of the crisis in some regions could inflame underlying tensions. Inequality could be reduced through efforts to preventive action to improve inclusion and accountability.
In the spirit of the US-Africa Summit, such assistance should take the form of a partnership with the affected countries in West Africa doing their part to invest in their people and govern wisely.
Dr. Raymond Gilpin is the Academic Dean at the Africa Center for Strategic Studies, National Defense University in Washington D.C. Prior to this he was Director of Economics at the United States Institute of Peace.