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Ebola shows global health governance weak

By Xu Tongwu | 2015-10-30 | Hits:
(Chinese Social Sciences Today)

A man walks past an Ebola awareness mural in Monrovia, capital of Liberia.


The world has witnessed a variety of major disasters and public security crises since 2014. The most terrible and unforgettable is the ongoing global public health emergency triggered by the outbreak of the Ebola virus last year.

The virus is named after the Ebola River in the Central Africa, where the virus was first observed 40 years ago.

Spreading epidemic
The Ebola outbreak that began in West Africa in early 2014 was the worst seen since virus was first identified in 1976. The outbreak showed several distinctive characteristics.


First, the scope of the epidemic is unprecedented and it has lasted for a prolonged period of time, posing a great danger to the world. As of April 19, 2015, the cumulative worldwide death toll has reached 10,823 out of a total of 26,079 cases of infection, far exceeding the cumulative total deaths reported in 36 years from 1976 to 2012.

Second, the transmission and the severity of the virus have exceeded expectations. So far, nine countries in Africa, Europe and North America have reported Ebola cases—Guinea, Liberia, Sierra Leone, Mali, Nigeria, Senegal, Spain, the UK and the US. Guinea, Sierra Leone and Liberia were most affected by the outbreak.

Third, due to the ripple effect, it has resulted in a nonparallel economic and social dilemma. According to the World Bank, the economies of the three most-affected countries in West Africa have plummeted, with a total gross domestic product loss of some $2 billion from 2014 to 2015.

Tough control measures, crumbling economies, strains on public finance and reductions in public services have inevitably led to poverty and unemployment. Furthermore, the crisis has impacted fertility rates, human relationships, traditional culture and democracy to the point that new social contradictions, political conflicts and regional security crises might emerge.

International response
The international community’s response to the most recent Ebola outbreak was slow for the first six months. The intervention of international organizations and unaffected countries began in March 2014.
The World Health Organization (WHO), the World Food Programme, the United Nations Children’s Fund, the European Union, the African Union and other relevant international organizations, as well as China, Japan, the US and Cuba took the lead in providing emergency public health and humanitarian assistance to the Ebola-affected countries in West Africa.

In September 2014, the UN Security Council unanimously adopted a resolution calling the Ebola outbreak in West Africa “a threat to international peace and security,” and a global state of emergency was declared. Resolution 2177 (2014) was approved by an unprecedented 134 states.

Afterward, the UN General Assembly and Security Council approved resolutions creating the UN Mission for Ebola Emergency Response, marking the first time in history that the UN has created a mission for a public health emergency. The mission aims to bring together the vast resources of the UN agencies, funds and programs, to reinforce the WHO’s technical expertise and experience in disease outbreaks.

On Sept. 22, 2014, the UN established the Ebola Response Multi-Partner Trust Fund to ensure a coherent contribution to the efforts to combat the spreading disease.

With all these efforts, the international community launched an all-round war against the Ebola virus, containing the epidemic to a great extent within seven months.

Three-dimensional challenges
The Ebola epidemic is not just a public health crisis. It poses severe challenges to mankind in at least three dimensions—science, public psychology, and global health governance.


The fields of medicine and science still have not determined the exact reservoir hosts of the Ebola virus, and there is no specific treatment or vaccine at the moment.

In addition, public mental health is at risk. According to The Economist, fear and suspicion tend to spread faster than the virus during an Ebola outbreak. The penetrating fear, rumors and various conspiracy theories cast a mysterious color on the disease, making prevention and containment much harder.

Finally, the epidemic exposes the weaknesses of current global health governance. The existing governance system is mostly based on the international political and economic order established after World War II. It centers on a series of UN agencies, such as the WHO, and is supported by regional international organizations, social agencies and local health departments in countries and regions. In an era of globalization, such a complex system has many internal problems, hindering the revolutionary transformation of global health governance.

Lessons for China
Learning from the recent Ebola outbreak in West Africa is imperative for China if we are to stand any chance of preventing or at least managing  future epidemics.


To start with, biological defense is a strategic issue concerning the national health security while it is of vital significance to sustainable development and overall national security. As the world’s largest developing country, China faces the most severe challenges in prevention and control of infectious diseases.

China has a total population of 1.37 billion, with a majority living east of the Hu Huanyong Population Line. Population mobility is higher than any other country in the world. Each year, nearly half the population travels during the Spring Festival rush. China’s annual outbound tourists total around 100 million, and there are more than 1.5 million China-African bilateral people exchanges annually. The ecological system is vulnerable, and environmental pollution is serious. The public’s scientific literacy is at least 20 years behind populations of developed countries. Public health infrastructure is far from sufficient. AIDS, dengue fever and malaria are raging in neighboring countries on China’s southern borders. All these pose tremendous public health risks to China.

What’s worse, China faces the threats of biological terrorism and potential biological warfare. The ongoing Ebola outbreak reminds China that in light of biological risks and threats, China must enhance chemical and biological defense capabilities in order to safeguard public health and national security.

Second, public health diplomacy should play an important role in China’s new diplomatic strategy. In contemporary international politics, cross-border public health issues, such as communicable disease prevention and control, are closely associated with the global goal of sustainable development, the protection of national security and diplomatic strategy. Thus, public health diplomacy is an effective tool to ensure national interest, improve international image and enhance international influence. It is becoming more and more important in the overall national security strategy and diplomacy. In essence, public health diplomacy aims to safeguard national interest through medical and health assistance overseas. For China, it is urgent to develop a customized global health strategy.

Last, the government should encourage and develop China’s international nongovernmental organizations. One of the outstanding features of the Ebola outbreak in 2014 lies in the active engagement of numerous nongovernmental organizations worldwide. Their contributions are indispensable and widely praised. Their involvement has enhanced the flexibility of international aid and the nation’s soft power. Through the work of thousands of volunteers and massive donations, nongovernmental organizations are able to display a nation’s governing and diplomatic concept, further promoting the national image.

Since the reform and opening up, China has gained a considerable amount of wealth while nongovernmental organizations have also continued to grow in fits and starts. However, during the Ebola outbreak, the China Foundation for Poverty Alleviation was the only nongovernmental organization to launch massive fundraising activities for the affected areas in West Africa. Though it achieved some results, it failed to attract sigificant attention from the general public.

Therefore, China needs to encourage a batch of comprehensively capable nongovernmental organizations that enjoy public support. Their engagement in public diplomacy and international affairs is not only essential to China’s extended national interests but also a manifestation of Chinese core values and an effective way to enhance people-to-people exchanges and promote national image.

The fight against Ebola is now in its third phase, with new cases gradually approaching zero, but the future task is still very arduous and perplexing. At present, no one can guarantee that this war will come to an outright victory by the end of 2015. What would be expected, though, is that due to global warming, terrorism proliferation, frequent international exchanges and contradictions in global governance, as well as the Western logic of hegemony, biological threats, including infectious disease, will be more serious while the enormous challenges that global public health governance faces will be prolonged and complicated. The international community must be on alert at any time.

Xu Tongwu is from the Institute of International and Strategic Studies at Peking University.