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Ebola Virus Outbreak

The Next Ebola Zone: Report Finds 28 High-Risk Countries

Image: Medical staff carry James Dorbor, 8, suspected of having Ebola, into a treatment facility

Medical staff carry James Dorbor, 8, suspected of having Ebola, into a treatment facility in Monrovia, Liberia. Daniel Berehulak

Where else could an epidemic of Ebola or some other disease come? Try Somalia, Chad, Nigeria, Afghanistan, Haiti, Ethiopia, Central Africa Republic, Guinea, Niger, and then Mali. They all have weaker health care systems than Sierra Leone, Save the Children warns.

The group, which has been fighting the epidemic ravaging Sierra Leone, Guinea and Liberia, says 28 countries have near-nonexistent health systems.

Public health experts agree that poor health systems helped Ebola turn from a series of outbreaks into a full-fledged epidemic. It’s infected nearly 24,000 people and killed around 10,000 by official count. People carried the virus to the U.S., to Europe and to neighboring countries.

“A robust health system could have helped get Ebola under control much sooner, saving thousands of children’s lives and billions of dollars,” Save the Children says.

“A robust health system could have helped get Ebola under control much sooner."

And many other countries are just as vulnerable, if not more so.

The group devised an index of the public health systems of the world's poorest countries based on the number of health workers, government spending on health and mortality rates.

Somalia ranked worst, with the index finding there is one health worker for every 6,711 people compared to one health worker for every 88 people in Britain. Chad has one health worker for every 4,444 people and Niger one per 6,410 people.

In Afghanistan, which was fourth-lowest, public spending on health is $10.71 per person a year compared to more than $3,000 in Britain and $4,000 in the United States. In Guinea, it’s $9 a person.

“Without trained health workers and a functioning health system in place, it’s more likely that an epidemic could spread across international borders with catastrophic effects,” said Carolyn Miles, president and CEO of Save the Children USA.

“The world woke up to Ebola but now people need to wake up to the scandal of weak health systems, which not only risk new diseases spreading, but also contribute to the deaths of 17,000 children each day from preventable causes like pneumonia and malaria.”

Ebola Survivor Heads Back to Liberia 1:54

Building better public health systems would be cheaper than fighting epidemics, the report argues. It says the cost of dealing with this Ebola outbreak has been nearly three times the annual cost of investing in building a universal health service in all three affected countries.

The World Bank projected that fighting this Ebola epidemic could cost $30 billion.

The U.S. spent $1 million to treat just two of its 10 Ebola patients.

Countries and other donors have promised $4.3 billion to fight Ebola in Sierra Leone, Guinea and Liberia. “This is 15 times the annual national health budgets of the three countries combined,” the report says.

But this cash has flowed only slowly. The world is poorly equipped to move quickly against a crisis like a fast-moving epidemic—another argument for building health systems that can prevent epidemics in the first place.

“The world woke up to Ebola but now people need to wake up to the scandal of weak health systems."

“There is broad agreement that the Ebola crisis was not quickly contained, reversed or mitigated because national health systems in these countries were dangerously under-resourced, under-staffed and poorly equipped,” said Dr. Peter Piot, director of the London School of Hygiene and Tropical Medicine, who helped identify the Ebola virus.

“It is a wake-up call that the world can no longer allow any country to continue with dangerously inadequate health services.”

Separately, the Rand corporation released its own analysis predicting future hot zones. Burkina Faso, the Central African Republic, Chad, Côte d’Ivoire, Ethiopia and Mali are all at risk for Ebola epidemics, it found.

Rand’s analytical tool uses government effectiveness, availability of communications, and the status of a nation’s health care infrastructure and workforce to predict vulnerability.

Afghanistan was rated as a high risk of an epidemic in South Asia, while no nations were ranked as high risk among the handful examined in either the Middle East or in Southeast Asia.