Public Health in the Age of Ebola in West Africa

Abstract

The Ebola epidemic, with its fast-growing toll and real potential for spreading into much of Africa, including major cities, has the makings of a “Black Swan” event. Such events, using the term coined by Nassim Nicholas Taleb, are: 1) unpredictable, outside the realm of regular expectations; 2) have a major impact, and; 3) are rationalized after the fact as being explainable and predictable. We have learned from this outbreak the potential for an infectious disease to be politically, economically, and socially destabilizing, and that what kills us may be very different from what frightens us or substantially affects our social systems. This has important implications for resource allocation. Health threats like Ebola may not have historically have not killed large numbers of people, but because of possible scenarios under which they can have a devastating impact, require a greater share of limited resources, such as for developing a vaccine. More creative imagination is needed in considering future infectious disease scenarios and in planning accordingly. Further, this Ebola epidemic could transform global governance for health. It demonstrates the need for fundamental reform at the WHO, including for greater funding, as WHO's response – unable to mobilize sufficient funding, too slow to declare this a Public Health Emergency of International Concern – indicates that the Organization is presently poorly positioned to fulfill its constitutional role as the global health authority. Meanwhile, the leadership role that the United Nations is assuming suggests the emergence of an era of direct United Nations engagement in health threats that could destabilize nations and regions.