East African leaders today acknowledged that West Africa's Ebola virus outbreak is unprecedented in severity and scope, and too big for that region to handle by itself. Yet at a gathering in Kenya the main focus was on measures to keep the virus out of their nations.
“This outbreak has transcended beyond the scope of any one country or community,” said Dr. Khadijah Kassachoon, principal secretary of health for Kenya, at a conference of regional nations and international nongovernmental organizations. “Ladies and gentlemen, we are in uncharted waters. This is a severe health crisis.”
The case made in Nairobi is reflected in the White House's announcement of aid for affected countries amounting to $763 million over the course of six months, including 3,000 troops, the training of another 500 health-care workers, and the construction of 17 health facilities.
Yet at today's meeting of East African Community member states, neighboring Ethiopia, and international health professionals, there was no discussion of more assistance to West Africa or for an end to the travel bans to Ebola-affected regions that have stymied the delivery of humanitarian aid.
Each country proposed detailed Ebola-fighting plans that included measures like isolation centers, screenings at all points of entry, and information campaigns. Yet all had one common challenge: money.
Whatever their rhetorical support for West Africa, other African states seem unlikely to pony up assistance. Most are having trouble providing for themselves, and a Kenyan donation of nearly $1 million this summer for combating Ebola isn't about to be topped up.
Six months into the worst Ebola outbreak in history, only two African nations – Ethiopia and Algeria – are adequately prepared to handle the potential arrival of the virus, according to the World Health Organization. Nineteen countries are partially prepared, and 20 were described as not prepared at all.
On paper, Ebola isn't an expensive disease to treat. There are no costly vaccines yet approved for distribution. Responders require fairly basic supplies: beds, low-grade protective clothing, basic screenings.
Indeed, in its presentation today, the WHO said that for the next six months, during which it predicts 20,000 patients, what it needs are 1,515 more beds and 13,660 more health workers at a modest cost of $500,000.
Yet on a continent of cash-strapped health systems, giving money to one region means less for your own. And watching West Africa’s death toll climb, East Africa is worrying about its own potential needs.
Lockdown vs. open borders
Ethiopia, the only country in East Africa deemed ready to handle an Ebola outbreak, is also the only one that has kept up regular flights to West Africa.
Nairobi, along with Ethiopia’s capital, Addis Ababa, are East Africa's two biggest air transport hubs; both typically have several fights daily to West Africa. But while Ethiopian Airlines has continued to fly, Kenya Airways has suspended its flights to Liberia and Sierra Leone.
The two approaches illustrate the two sides of the debate: Lock down the borders in hopes that Ebola will stay a problem elsewhere, or keep borders open with the idea of combating and ending the outbreak sooner.
Dr. Jean-Clément Cabrol, director of operations for Doctors without Borders (MSF), one of the lead responders in West Africa, says the lack of flights has become acute. Liberia, Sierra Leone, and Guinea desperately need more trained personnel, more facilities, and more beds – and are being starved of such resources by the transport shutdown, he says.
Solidarity in air links
Ethiopia is insistent that continuing flights poses no additional threat. Addis Tamire Woldemariam, director general of the office of the Ethiopian minister of health, says that unless the WHO and the International Civil Aviation Organization urge an end to air traffic, Ethiopian Airlines will continue flying.
“This is a time we have to show solidarity,” Dr. Addis says. “We are citizens of Africa. We believe we have to continue flying.”
“There may be some [public] pressure [to halt flights], but also we have to think of the people dying there… because they don’t have enough supplies,” he adds.
Similarly, Nigeria, a key hub for West Africa, has kept its borders open while stepping up screening. Nigeria, which does not share a border with the three hardest hit countries, has had 19 confirmed cases of Ebola.
Nigeria's more open response is the right one says Dr. Clement Adebamowo, a Nigerian public health specialist and chairman of the National Health Research Ethics Committee of Nigeria.
"Many countries, including countries that have next to no risk at all – at least as best one can see – are freaking out about the risk of Ebola to their population. People are not taking decisions based on objective facts," he says.
'Capital of Africa' takes precautions
Populous Ethiopia has been preparing for the possible arrival of Ebola since July. There is now a quarantine center in the Bole International Airport and at all land border crossings, as well as isolation centers on the outskirts of the capital, with additional centers under construction in its provinces.
Anyone from the affected countries transiting through Bole airport is monitored while on the ground, and everyone who exits into Ethiopia proper is visited daily by health workers for the entirety of their stay – including high-level officials attending African Union meetings.
“The fact that Ethiopia is 100 percent prepared does not mean that it won’t have any risk. We’ve got to be prepared as a region,” Addis says.
The US response announced today also includes a joint forces command center in Monrovia, the capital of Liberia. There are provisions for at least six months of training for healthcare workers, and $58 million for speeding up production of the drug ZMapp and other vaccine candidates.
Ebola will not remain only an African problem if the world does not pitch in further, Dr. Adebamowo warned last week, before the US announcement.
"It's not going to end there. It's going to have implications afield. I should have thought the world would have learned this lesson by now," he says. "If we treat them like it's not our problem, eventually it becomes our problem."