Stewart started with a job at the media --- isn't the outbreak of ebola over now that no Americans have been affected in the last few weeks? Of course, Delaunay responded the way any international observer of global health specialist would "I wish that were the case." The interview not only highlights the ongoing crisis, but Delaunay also provides excellent explanations for why the support has been inefficient. Not only has aid been slow to arrive, by the time it arrives, needs have changed.
I recently participated in a panel about Ebola arranged by the MPA students. They wanted me to talk about the role of federalism in responding to Ebola in the US. I spoke a little bit about the role of federalism and how the CDC fits into the broader health system. But I then launched into a discussion about the need for international response --- arguing that the best way to protect US citizens and health care workers was to be proactive in dealing with health threats around the world. Delaunay makes the point equally well. Viruses do not respect borders.
One of the primary difficulties in responding to Ebola has been the availablity of funds. Many observers, individuals and states alike, have argued that the funds for responding to the crisis should come from existing budgets --- hospital budgets, WHO budgets, and other agency budgets. The problem is that these budgets are planned in advance and are generally fully allocated to specific programs, leaving few funds available for unanticipated crises. Moreover, much of the budgeting and allocation process leaves little flexibility for responding to rapidly changing circumstances. For example, the minutes from an International Incident Management System meeting in Liberia illustrated an ongoing disagreement between Liberian officials and donors. Two European and one Asian donor had allocated funds to build medical units in Monrovia. Yet Liberian leaders argued that such units should be built in rural areas because the need in Monrovia had declined. In fact, hospitals in Monrovia had free beds, whereas in rural areas people were still being turned away due to limited capacity. The donors were reluctant to change their plans because they had promised their domestic populations that the funds would build units in Monrovia.
The politics of where and how resources get allocated are an essential part of the success of international responses and play a role in who lives and who dies. Where the political calculations outweigh the calls from folks like Delaunay, consequences are grave.