Ebola: The View from 3° 30’ South

I moved to Burundi in February. I work for a small company providing training and micro credit to 30,000 subsistence farmers.

Recently, I spoke with several Burundian friends about the Ebola epidemic in West Africa. I asked them if they thought it would eventually arrive in Burundi. Their answers surprised me.

They said Ebola would not get to Burundi. I disagreed noting that if it can get to Texas and Madrid it can get anywhere. I was wrong, they said, because no one comes to Burundi. Grinning, I said suppose there was an outbreak in Congo (just across Lake Tanganyika) and people wanted to escape the disease. They told me those people would go to Tanzania and once in Tanzania, why would they want to come to Burundi? There is an odd logic there.

The wishful naivety of these answers, however, reminded me of the response to AIDS when I lived in Dakar in 1986. The government avowed that a good Muslim country (90%) would not have problems with those kinds of diseases. Then USAID did some blood tests around town and found that Senegal already had a big problem. To their credit and the enduring benefit of the population, the government of Senegal launched a very aggressive education campaign that rapidly slowed the spread of the disease.

In other countries, truck drivers spread the disease down the main highways and into the large towns. The ebb and flow of the populace  brought it to even the most isolated villages. The health systems had no capacity to deal with this progression. Effective education and essential treatment were beyond the reach of already cash poor governments.

The economic impact was devastating. In a decade the most economically productive age cohort (20 – 45 years old) was decimated. Life expectancy dropped to the low 40s. Entire towns were reduced to groups of orphans and their grandparents. It was out of control until the “religious right” in the U.S. convinced President George W. Bush to take action pointing out that, as a Christian, it was a moral imperative. When Bush increased aid to the continent from $1.4 billion to $15 billion, the tide of infections and deaths began to recede.

It is relatively easy to avoid getting AIDs. Ebola is a different matter. Despite the fact that infected people die in a few weeks limiting interactions with others, the disease can spread rapidly because it is very contagious – on par with measles according to some epidemiologists. This is one reason why the forecasts of 1.4 million cases by January are believable.

The second reason is that there is no ability to match the growth of cases with appropriate treatment facilities. The WHO recently published a profile of a treatment center and the resources needed to operate it. In addition to 600 staffers for 125 patients, you need 6,600 gallons of water, 2,500 gallons of bleach, 1,050 rubber gloves and 350 body suits per day. Soon there will be 10,000 new cases per week. The arithmetic is daunting.

The cost of treatment is only the tip of the economic iceberg. Closing borders will restrict trade. Out of fear, people will stop traveling. Essential imports (food and petroleum) will be more difficult to obtain. Suppliers will charge a premium to operate in Ebola areas. Trust levels, already low in these formerly war-torn nations, will decline further. The cost of all economic exchanges will increase.

So what will happen in West Africa? Guinea, Sierra Leone and Liberia will be emptied out. Here is why.

Suppose you hear that your neighborhood is going to be quarantined, cordoned off so no one enters or exits. Isn’t that pretty much a death sentence for you and your family? What would you do – wait around for the disease to hit so you can die alone in a plastic tent?

The Ebola refugee migration has already begun. There are incredible stories of West Africans showing up on the border in Kenya having traveled overland by bus and truck to take their families to safety. Liberia is 5,000 miles from Kenya. This migration of Ebola refugees will spread the disease just like the truck drivers spread AIDS.

Meanwhile, the Obama administration sees mostly a political problem rather than a public health problem – hence, the appointment of long time Democratic Party functionary, Ron Klain, as the “Ebola Czar”. The key, according to the President, is to calm people down. So the citizens are subjected to a series of “not to worry” public statements from the White House often replete with scientific inaccuracies. Imagine Bush announcing on the eve of Katrina, “A little rain never hurt anyone…”

The administration is wringing its hands over the idea of a travel ban for people from afflicted countries. In Africa, most governments put that travel ban in place weeks ago. They are not willing to risk their citizens or their economies for some miss-guided notion of openness and fairness.

If we get 500,000 deaths in West Africa, cultures and social structures may change as they did in 1348 with the Black Death in Europe. By 1350, the depopulation of Europe had produced an immediate economic decline. Goods were in surplus and prices collapsed. Labor was in short supply and landlords started paying wages to attract workers for their fields ultimately bringing to an end the feudal system of land tenancy. The elaborate structure of English inheritance rights was developed after the plague had reduced aristocratic families to the point where it was hard to find any living heirs at all.

Economically, for West Africa, Ebola is already a Nassim Taleb, “Black Swan”. The only question that remains: will it become a Black Swan for the rest of us?