Liberian Army soldiers work on a new Ebola treatment center on Oct. 15, 2014 in Tubmanburg, Liberia. The center is the first of 17 Ebola treatment centers being built by Liberian forces under American supervision as part of Operation United Assistance to combat the Ebola epidemic. (John Moore/Getty Images)
Exasperated medical professionals seem to think that the challenge of Ebola is not a virulent and deadly pathogen. The problem is the failure of people to be perfect. Members of Medicins Sans Frontieres have blasted the World Health Organization for not being on the ground in West Africa. Many physicians and members of the public think that WHO has some sort of rapid-response force for infectious disease. According to Reuters:
“MSF International President Joanne Liu, who warned that her organization could not cope with the rising number of Ebola victims, has accused the WHO of failing its mandate to help member states cope with health emergencies.”
This statement is at odds with reality. The Centers of Disease Control and Prevention is probably the only organization with the capacity to act as such a force. However medical professionals aren’t trained to understand the politics of organizations. Social scientists, in contrast, expect that people will “fail” for political reasons. That “failure” is often what we study. And we can help medical professionals understand the social world so they can better address the local and global governance of “complex humanitarian emergencies.” As Jeremy Youde, a political scientist at the University of Minnesota-Duluth, points out, WHO “faces serious structural constraints that undermine its ability.” Who’s responsible for these constraints? Its members — the countries of the world.
First, social science can help explain why international organizations have such a hard time coping with crises, such as Ebola. It is politically difficult to get states to pay to solve collective problems, which means that international organizations are perennially under-resourced. WHO only controls about 20 percent of its overall budget (the remaining 80 percent is tied aid from countries, companies, and philanthropies, which can be used only for particular purposes). The WHO budget has seen sharp cuts during the global recession. It’s been cut by 12 percent in the last two years alone. Member states resist increases in their assessed dues. WHO lacks the capacity to manage the global response, even if that is its defined mission.
What about the United Nations? In an op-ed in The New York Times, Michael Osterholm, director of the University of Minnesota Center for Infectious Disease Research and Policy, argued the United Nations should take the lead on the current crisis. Only the United Nations “can direct the immense amount of medical, public health and humanitarian aid that must come from many different countries and nongovernmental groups to smother this epidemic.” He argues that a Security Council resolution would bridge the divide between operational control and respect for national sovereignty, and the United Nations could secure aircraft, provide beds, and recruit and train the necessary medical personnel.
A basic understanding of political science and history would suggest that this disease policy argument is wrong. The U.N. process isn’t a magic bullet for solving global problems — it, too, is a creature of disagreements between states. Even if one ignores the U.N.’s own budgetary problems (like the WHO, its general budgetary funds are dwarfed by special projects) and its need to convince donors to provide the necessary personnel and supplies, the UN has difficulties responding to ongoing crises. Recent history, from the Rwandan genocide to the African HIV crisis, illustrate the U.N.’s sclerotic response.
The Security Council is only effective when big states agree that a problem needs to be solved, and agree on how to solve it. But such agreement is much rarer than op-ed writers fondly imagine. Powerful nations, especially the United States, have been unwilling to submit to global governance in humanitarian crises. Whether the United Nations should be effective in these matters is a different matter than whether it can do anything now.
Second, social science can also help craft better responses, albeit at a much smaller scale. Some have argued that the “problem” of Ebola in West Africa is a lack of medical knowledge and cultural practices that involve, for example, preparing and touching bodies at burial. Barry Hewlett, an anthropologist at Washington State University, has studied ongoing medical Ebola responses. Hewlett and his co-authors have identified steps that would not hinder medical or epidemiological operations, but that would work with — not against — local cultures and potentially be more acceptable to members of highly affected populations like those in West Africa, without hindering medical or epidemiological operations. Medical teams can establish isolation units that do not block views of those being treated, so families can see their loved ones. Some burial rituals could be carried out in protective gear. Personal effects can be burned in the presence of the family.
These are the sorts of insights that social scientists can offer to help aim medical interventions in the direction they will be most effective. Ebola shows how global public health is too important to leave solely to medical experts and politicians. Medical professionals will still be on the frontlines of addressing the crisis, whether in West Africa or the developed world.
This is not to say that Ebola responders have completely ignored social scientific insights. In a recent conversation with high-ranking military personnel familiar with U.S.’s work in Liberia, I learned that the military devotes some of its planning resources to examining how we social scientists suggest epidemic response be best carried out. That said, the primary role of the U.S. Army in western Africa has been logistical, so the impact of social scientific expertise is quite limited.
Social scientists do not have the answers to the Ebola crisis. However, we can explain why calls for powerful and effective international organizations are often driven by wishful thinking, and point out changes around the margins that could help make medical disaster intervention more effective.