Chris​ Simms: What can Senegal teach the West about dealing with Ebola?

Chris_simsTen years ago, Peter Piot (the discoverer of Ebola) wrote the foreword to a collaborative effort on HIV strategies by nearly 200 scientists. He warned that an effective country response to the epidemic requires adherence to the so called “Three Ones” principle: a single national strategy, coordinated by one agency, and supported by one monitoring and evaluation framework. This advice applies as much to the Ebola crisis as it did to HIV—in rich and poor countries alike.

For those who focused on west Africa in this volume, it would come as no surprise to learn that Senegal has reportedly stopped Ebola “dead in its tracks.” However premature or incautious this assertion may be, it is consistent with Senegal’s no-nonsense, science based approach to public health—one that builds on existing structures and clear lines of communication, while embracing full participation by civil society and reaching deep into local communities.

In 1985, even before the first HIV case was officially reported as HIV, Senegal’s national leadership, together with hundreds of community based groups, had mobilized against the HIV crisis. As a consequence, prevalence rates were kept very low and Senegal became recognized globally as a model of best practice—generously sharing its expertise across the globe.

Thus, when a young Guinean national infected with Ebola crossed into Senegal by road on 21 August 2014, he was quickly identified, isolated, and—while his 74 contacts were traced and tested—he was treated before being declared clear 42 days later. This was the result of resources, structures, processes, and protocols being put in place by a vigilant and proactive health system, which worked in concert with its global partners. Senegal again has lessons to teach the West, as well as its neighbors.

For in contrast, the West appears to have done just the opposite in some cases. Outwardly, the signs of its slow and ill prepared responses to Ebola are self-evident: no agreed upon strategy or coordination, contentious policies and protocol, and confused communication between various levels of government and would be partners.

Yet the West’s failure reveals something more worrisome: a disregard for the global perspective, along with its implied benefits and responsibilities. In particular, the notions that more can be achieved by working together than going it alone, and that self-interest may be better served by contributing to the common good.

For example, as Dr Anthony Fauci, from the National Institutes of Health, has warned that “the best way to protect Americans is to stop the epidemic in Africa,” it makes no sense to disincentivize badly needed health workers who wish to help fight Ebola in west Africa by subjecting them to across the board quarantines. Yet in the United States, state governors resisted this advice—prompted perhaps by surveys showing that 80% of the population wanted some sort of quarantine.

In a similar vein, Canada and Australia issued visa bans for people from the three west African countries hit by Ebola, which is contrary to scientific evidence that shows these actions make the detection and tracking of individuals more difficult, and dissuades countries from being forthcoming. These actions also run contrary to international law, the very laws that Canada helped draft in the wake of the SARS outbreak.

The World Health Organization asked Canada for an explanation, yet none was forthcoming except a tweet from a government minister that “we are a sovereign nation with a duty to protect our citizens”—a tone consistent with the government’s view that multilateralism is a weak nation policy, and its embrace of the principle of “sovereign self-interest.”

This rejection of the global health perspective also implies an underestimation of global threats from existing or newly emerging infectious disease (EIDs) that may occur naturally, accidently, or deliberately. As Larry Brilliant, who worked on the smallpox campaign, warned, “outbreaks are inevitable; epidemics are optional.”

We should remember that it took the international donor community until 2000 before it began to respond seriously to Africa’s HIV/AIDS crisis, by which time 30 million were dead or dying—a full 15 years after Senegal tackled the crisis head on. Piot says that the response to pandemics is a “political concern,” and it’s strong leadership that the global community will need. So far the west appears to be sleepwalking, as it quietly becomes increasingly vulnerable.

Chris​ Simms is a professor at Dalhousie University, School of Health Administration, Halifax, Canada; he spent many years living and working in Africa’s health sector.

Competing interests: None declared.