As noted in an earlier post, British PM David Cameron has called for a "rapid response team" to deal with serious outbreaks like Ebola. It's an attractive idea, but it's also a diversion.
It's culturally attractive in "developed" countries that use highly trained military forces to resolve awkward problems: US Navy SEALs, British commandoes, Russian spetznaz. Even modest Canada has its Joint Task Force 2, and every North American police force aspires to armoured personnel carriers to deter black teenagers from robbing convenience stores. Like Alexander, we prefer to untie the Gordian knot by hacking it apart.
Ebola even taught us to try the military response. No one less than Peter Piot called for it, and US soldiers flew into West Africa to start building treatment centres. They got results.
It's a truism that outbreak response depends on good epidemic intelligence, which in turn depends on good surveillance. Health agencies around the world devote a lot of time and energy to just keeping track of reports from all over the world, including places of zero political or economic interest to the world powers.
But knowing something and acting on it are two very different conditions. WHO, CDC, ECDC, and the West African nations themselves knew early on that something bad was happening in Guinea last spring. For such agencies and governments, a health problem is ipso facto a political problem: Who will be embarrassed by this unfortunate turn of events?
Finding the answer to that question took precious time and the lives of many poor black West Africans. And it wasn't the agencies and governments who found it—it was our de facto Epi-Commando Force, MSF, which was already on the ground and running low on ammo. MSF International's formidable Dr. Joanne Liu deliberately embarrassed the Security Council itself.
It was overdue shock therapy, and it goaded the Council (like so many overweight CEOs given bad news by their GPs about their odds of seeing next year) into a semblance of cleaning up their act.
Whatever Ebola revealed about the failings of West Africa's healthcare systems, it revealed about our own. Not only was WHO financially and politically restrained from a rapid response, but even the American elephant was terrified by a few mice infected with Ebola.
Richard Horton, editor of The Lancet, has offered some realistic ideas for overhauling WHO, which is now structurally limited from imposing health decisions on its member states. But turning WHO into a global doctor making house calls is out of the question. Given their budget constraints in the last few years, they embarked on a campaign to strengthen individual countries' healthcare systems, giving them the resilience to cope with outbreaks.
That has clearly not been enough, but at least it's pointed in the right direction. Poor countries, where people live literally unwashed hand to malnourished mouth, are precisely the countries that need robust healthcare systems. They will never get them until they rid themselves of corrupt rulers and exploitative deals with foreign countries and corporations.
Until they achieve those goals, an Epi-Commando Force would be just another colourful Band-Aid, a good story about superheroes who sally forth to smite our foes and return with the status quo intact. As an expression of wishful thinking, it's attractive. As medical ethics and a serious global-health policy, it's an abomination.