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Just about everyone agrees that the Ebola outbreak in West Africa is out of control, but no one wants to take responsibility for controlling it.
Nearly 4,300 cases have been reported in Liberia, Guinea, and Sierra Leone since March, with 2,288 deaths, according to the latest estimates from the World Health Organization. Nearly half of the total number of cases have come in the last three weeks.
WHO has projected that the number of people infected could grow to 20,000 in coming months.
"Right now the prognosis is grim," said Josh Michaud, associate director of global health policy at the Kaiser Family Foundation. "In the absence of all this aid that's proposed but not yet provided, it seems like the epidemic is on a growth curve, not a downward curve, with more and more cases appearing every week, and more and more deaths.… It's hard to see far out in the future, but if current trends continue and there's no change in the way the world, region, countries are intervening, it's hard see how it won't just increase, creating greater disruption."
WHO has estimated that it will cost at least $600 million to get the epidemic in West Africa under control in six to nine months. That number could rise as the outbreak worsens.
Yet the international response has been hesitant and slow-moving. What's urgently needed now is increased funding and better coordination.
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The three countries hit hardest by the disease are among the poorest in Africa, and they don't have the resources to combat the largest Ebola outbreak in history, which is unlike any that's been seen before.
International organizations seem to finally be catching on to the gravity of the situation, with increased monetary contributions from major players in recent weeks:
- The United States is the biggest donor thus far. A representative from the National Security Council said the U.S. has already provided $100 million to relief efforts. The U.S. Agency for International Development last week announced an additional $75 million contribution, and the White House has requested $88 million from Congress as well. If those all come through, it would put U.S. contributions above $250 million.
- The World Bank pledged $200 million last month, some of which it says has already been used to airlift medicine into Sierra Leone. The organization did not respond to questions regarding how much of the pledge has been donated, or the timetable for delivery.
- The European Union has pledged $140 million euros, or $180 million dollars.
- The Bill & Melinda Gates Foundation pledged $50 million on Wednesday, the largest sum it has committed to a single outbreak.
- Doctors Without Borders says it is currently budgeting $30 million euros, or $39 million dollars, in 2014.
Smaller pledges have come from other countries and nongovernmental organizations.
If all of the promised money came through, WHO would exceed its $600 million target. But that's a big if—many of the pledges have not yet been fulfilled, or have been delivered piecemeal.
"[The money] doesn't exist, in the sense that nothing has been firmly signed or sent or committed. There are conversations, but checks haven't arrived," said WHO spokesman Daniel Epstein. "I'm really guessing that's straight bureaucracy. It's hard for government agencies to say, 'OK, here are 100 million dollars.' "
The gap in funding and resources in turn amplifies the personnel-shortage problem.
"Imagine going into treatment centers—going into hotbeds of the Ebola outbreak—and not having the resources to deal with it," said Anne Liu, associate director for health systems at the Earth Institute at Columbia University, who notes that many workers have gone on strike as a result.
It takes about 200 health care workers to take care of 80 Ebola patients, according to Dr. Margaret Chan, the director-general of WHO. The projected surge in infections puts the demand for personnel well into the thousands.
These needs are far greater than the affected countries are equipped to provide. At the onset of the outbreak, Liberia had one doctor to treat nearly 100,000 people in a population of 4.4 million, WHO says. About 152 health care workers have been infected and 79 have died in the country thus far, while hundreds more have been infected in the other countries.
"Even before Ebola hit, [the affected countries] wouldn't be able to provide that number of personnel," Michaud said. "Now that it's killed or scared off many health care workers, it's made [the situation] more problematic. The only solution it seems would be to bring in others from outside countries."
Yet health care workers have largely been deployed by the hundreds, not thousands. The Centers for Disease Control and Prevention has sent around 100 people to work on the ground in Liberia, Guinea, Sierra Leone, and Nigeria. The African Union said it will send 100 as well. Doctors Without Borders currently has 1,856 staff on the ground, according to the organization, which has emphasized the need for a stepped-up international response.
The U.S. State Department on Wednesday announced a "surge" of federal workers into the Ebola-stricken countries, saying around 1,400 U.S. government employees are in the area now with an unspecified number on their way. The department is awarding a six-month, estimated $4.9 million contract to an air-ambulance evacuation company for aid workers who might become infected.
Better Organization
If it seems like no one is in charge of the Ebola response, that's because no one is really in charge. The result is what has seemed like a chorus of calls for help, with limited action.
The United Nations system, and WHO in particular, has taken the lead in coordinating the international response and working with donors. But the organization remains firm that it is the West African countries that hold the reins in dealing with the outbreak.
"The people in charge of what's going on are the [affected] countries themselves, their health ministries," WHO's Epstein said. "We're working with them to help bring the outbreaks under control, and mobilizing resources. [But] there's no kind of supra-national agency that can come into a country and say, here's what you're going to do. We can say here's what we recommend."
But as the outbreak continues to spread exponentially, it's clear the governments need a lot of help.
"The reality is these countries have weak governments and post-conflict states that have difficult times in normal circumstances," Michaud said. "Now they have a lot of difficulty coordinating their own responses. What this leaves, up until now, is fragmented leadership of the response; it may be partly to blame for why there hasn't been a better-coordinated response.
"[What's needed is] the E.U., the U.S., the U.N., and WHO, the countries, and [Doctors Without Borders] ... coming together and working on a plan going forward. It's not clear that's happened."
(Image via Sergey Uryadnikov / Shutterstock.com)