Kristof: Anatomy of a global Ebola fiasco

The Ebola epidemic in West Africa is a tragedy. But, more than that, the response to it has been a gross failure.

It’s a classic case where early action could have saved lives and money. Yet the world dithered, and with Ebola cases in Liberia now doubling every two to three weeks, the latest worst-case estimate from the Centers for Disease Control and Prevention is that there could be 1.4 million cases in Liberia and Sierra Leone by late January.

We would never tolerate such shortsightedness in private behavior. If a roof leaks, we fix it before a home is ruined. If we buy a car, we add oil to keep the engine going. Yet in public policy - from education to global health - we routinely refuse to invest at the front end and have to pay far more at the back end.

We know how to confront the Ebola virus. In Uganda, an excellent U.S.-backed prevention initiative trained local health workers to recognize the virus and stop it from spreading, so, in 2011, an Ebola outbreak there stopped after just a single case.

We also know from our catastrophic mishandling of AIDS a generation ago - or the mishandling of cholera in Haiti more recently - that it’s imperative to stop infectious diseases early. Yet the reaction to the Ebola outbreak after it began in December in Guinea was a global shrug: It was mishandled by local countries and by the rest of the world, so, instead of a tiny cost in money and lives, we will now all pay hugely.

If the worst-case scenario comes to pass in West Africa, it may become endemic in the region and reach the West. Ebola is quite lethal but not particularly contagious, so it presumably wouldn’t cause an epidemic in countries with modern health systems. This entire tragedy is a failure of humanity.

As donor countries scramble to respond (which may cost $1 billion in the next six months, according to the United Nations, although nobody really knows), the risk is that they will raid pots of money intended for other vital purposes to assist the world’s needy. Jamie Drummond of the One campaign says he worries that governments may try to finance Ebola countermeasures with money that otherwise would buy childhood vaccines or ease emerging famines in Somalia and South Sudan.

Vaccines are a bargain. Since 1990, vaccines and other simple interventions (such as treatments for diarrhea) have saved nearly 100 million children’s lives, according to UNICEF. Gavi, the Vaccine Alliance, is now in the middle of trying to raise an additional $7.5 billion to subsidize vaccinations of 300 million additional children around the world. On top of the $2 billion it has, Gavi says this would save 5 million to 6 million lives and produce economic benefits of $80 billion to $100 billion.

Such an investment should be a no-brainer. In the 21st century, we have the resources to fight more than one fire at a time.

“I am worried,” said Seth Berkley, the chief executive of Gavi. “You wouldn’t want to reduce immunizing children around the world to deal with an emergency even as severe as Ebola.”

We invest vast sums to address national security risks that have a military dimension, hence President Barack Obama’s decision to renovate the U.S. nuclear arsenal at a cost that could reach $1 trillion over three decades. So let’s remember that infectious diseases can also constitute a national security threat.

Our shortsightedness afflicts so many areas of public policy. We spend billions of dollars fighting extremists today but don’t invest tiny sums educating children or empowering women, even though that’s the strategy with a solid record of success at reducing extremism in the medium term - and even though we can finance at least 20 schools for the cost of deploying one soldier abroad for one year.

At home, we don’t invest adequately in family-planning programs even though pregnancy prevention initiatives for at-risk teenagers pay for themselves many times over.

We don’t invest in early education programs that have a robust record in reducing later criminal behavior, preferring instead to pay for prisons.

Indeed, this is such a market failure that new financial instruments - social impact bonds -- address it. The bonds pay for job training or early education programs and then earn a financial return for investors when the government saves money.

Yet the worst consequence of our myopia isn’t financial waste. It’s that people are dying unnecessarily of Ebola. It’s that some children in the United States grow up semiliterate.

And it’s the risk that the cost of leaders’ mismanagement of Ebola will be borne by children going without vaccines.

Nicholas Kristof is a columnist for the New York Times.