Opinion

The Great Debate

Remember the movie ‘Outbreak?’ Yeah, Ebola’s not really like that.

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The Ebola outbreak continues to spread in Guinea, Liberia and Sierra Leone, the countries hardest hit by the disease. More than 1,000 people have now died from the virus. The Centers for Disease Control and Prevention has issued its highest-level alert for a response to the Ebola crisis. The World Health Organization has declared the outbreak a Public Health Emergency of International Concern. The disease is intensifying in West Africa, but the epidemic poses minimal risk to Americans. So why are we so afraid?

Scientists think about the risk of Ebola in terms of how likely someone will get it and die. That probability of someone in this country dying from Ebola is miniscule. But how the average person thinks about risk is more complicated. Other factors — including fear of the exotic, dramatic and gruesome — heighten our anxieties and capture our imaginations.

The Zaire strain of Ebola out of control in West Africa is the most virulent form of the virus and comes from the “heart of darkness” itself. Many Americans still think of Africa as a failed continent plagued by disease, poverty and war — and we’re afraid of it. There’s a certain xenophobia to our fear of Ebola. Representatives Phil Gingrey (R-Ga.), Todd Rokita (R-Ind.) and Larry Buschon (R-Ind.) have gone so far as to voice concerns that the children from Central America crossing the U.S.-Mexico border might be carrying the Ebola virus. Gingrey is an obstetrician and Buschon a heart surgeon. But there is no Ebola in Central America.

We picture the disease liquefying organs and its victims spewing blood and other bodily fluids, eventually bleeding to death. But Ebola kills by lowering blood pressure and weakening the immune system. When vital organs don’t receive enough blood, they fail and die. When the immune system is impaired, the risk of other infections increases. Ebola can cause problems with blood clotting, but this typically causes oozing not massive bleeding.

We’re far more likely to die of heart disease, stroke or diabetes in this country, but these diseases are familiar and don’t terrify us like Ebola. It is, to some extent, normal to downplay the risks that we have to live with everyday. We continue to smoke, eat poorly and not exercise even though these behaviors put us at real risk. More than 50,000 Americans die of influenza and pneumonia each year, but we still don’t get our shots.

from Stories I’d like to see:

The price of a life and George W. Bush post-White House

A spectator smokes a cigarette as she waits for the start of the Dubai World Cup at Meydan Racecourse in Dubai

1. How government accountants value life:

Last week, the New York Times reported: “Buried deep in the federal government’s voluminous new tobacco regulations is a little-known cost-benefit calculation that public health experts see as potentially poisonous: the happiness quotient. It assumes that the benefits from reducing smoking -- fewer early deaths and diseases of the lungs and heart -- have to be discounted by 70 percent to offset the loss in pleasure that smokers suffer when they give up their habit.”

I hope editors at the New Yorker or Sixty Minutes noticed.

Did you know that a federal agency -- the Office of Management and Budget, which did the cost-benefit analysis described by the Times -- actually employs people who calculate how many lives will be saved by government regulations; then calculates the dollar value of the lives saved, and then weighs that value against the “cost” of the regulation?  Apparently in this case, part of the cost to be calculated was the cost of the lost pleasure from quitting smoking.

According to this report to Congress, OMB must make a cost-benefit analysis for every rule where the projected cost of compliance is more than $100 million. The agency with the most rules falling into that category has been the Environmental Protection Agency, and OMB has consistently found that the value of the lives saved exceeds the cost of compliance.

Liberia’s poverty, skepticism of experts makes treating Ebola harder

Medical staff working with Medecins sans Frontieres prepare to bring food to patients kept in an isolation area at the MSF Ebola treatment centre in Kailahun

The media is focused on the horrors of Ebola, a disease with no known cure that is jumping across borders in West Africa, leaving more than 900 dead in its wake. Fears of the disease’s spread even traveled to the United States, where two Ebola patients are being treated at Emory University hospital in Atlanta, Georgia.

The virus first appeared in West Africa in March, but suddenly gained momentum in the past few weeks, making it the worst outbreak ever. The vast majority of cases and deaths have been in Sierra Leone, Guinea and Liberia, but Nigeria now confirms the presence of the disease.

The virus is spread through bodily fluids and has a relatively long incubation period of up to 21 days. At this point, roughly 40 percent to 90 percent who become infected eventually die.

Violence or vaccines: Which path for U.S. in Africa?

A U.S. Special Forces trainer conducts a military assault drill for a unit within the Sudan People's Liberation Army (SPLA) during an exercise in Nzara on the outskirts of Yambio

Africa is the new frontier for the U.S. Defense Department. The Pentagon has applied counterterrorism tactics throughout the Middle East and, to a lesser extent, Central and South Asia. Now it is monitoring the African continent for counterterrorism initiatives. It staged more than 546 military exercises on the continent last year, a 217 percent increase since 2008, and is now involved in nearly 50 African countries.

  RELATED COLUMNS Michael Elliott: Africa’s about more than Ebola, it’s about optimism, too

U.S. military and police aid to all Africa this year totaled nearly $1.8 billion, with additional arms sales surpassing $800 million. In terms of ensuring Africa’s safety and security, however, the return on this investment is questionable.

To match feature LEONE-MALARIA/What if, for example, that money was instead spent eradicating pervasive viruses that are undermining Africa’s future? Yellow fever vaccination doses cost less than $1.00 and Hepatitis B vaccination doses cost 25 cents or less. These viruses, and their deadly bedfellows like Ebola, are the real threats terrorizing African communities — and more deserving of U.S. defense dollars.

Africa’s about more than Ebola, it’s about optimism, too

The seat of the representative from Guinea remains empty at the U.S.-Africa Leaders Summit in Washington

The conversations at the U.S-Africa Leaders Summit in Washington this week, Secretary of State John Kerry said on the first day, are very different from discussions about Africa 15, or even 10, years ago.

He’s right — and he should know.

In the early 2000s, then-Senator Kerry (D-Mass.) was one of the leaders in the bipartisan effort to scale up U.S. funding for the HIV/AIDS pandemic through the President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria — just as both programs were gaining their footing in Africa. As recently as 2000, The Economist had featured a notorious cover story calling Africa “the hopeless continent,” and debating its future of war, disease and endless poverty.

Kerry takes his seat with Kikwete and Mahama as they arrive for a civil society forum during the U.S.-Africa Leaders Summit in WashingtonThe representatives from some 50 African nations who arrived in Washington this weekend, by contrast, brought with them a ringing sense of optimism and hope — to say nothing of style and flair.  In this miserable political year, the city could do with all those attributes.

Tracking the Nigerian kidnappers

nigeria -- candlelight vigil

Abubakar Shekau, the purported leader of Boko Haram, ignited international outrage when he announced that he would sell more than 200 of the kidnapped Nigerian schoolgirls “in the market.” Nations around the globe offered help to Nigeria.

Getting back the more than 200 Nigerian girls who were kidnapped from school a month ago will require a deep understanding of the environment the extremist group that took them operates in.

Thanks to some new tools, and the spread of some older technologies, crucial data can be gleaned to show where the kidnappers, Boko Haram, may be holed up. Everything from cell phone usage to weapons acoustics to satellite imagery can help build a more complete picture of the group and its activities.  Possibly even a map.

Post Rwanda: Invest in atrocity prevention

In the 20 years since the horrific 1994 genocide in Rwanda and its terrible spillover into the Congo, it has been clear that the global community remains ill-equipped to address such human-made catastrophic tragedies.

While many have worked to heal Rwanda, crises of unfathomable mass violence have continued to unfold in places like Sierra Leone, the former Yugoslavia, Sri Lanka, Sudan, South Sudan, Central African Republic and Syria. In each case, the international community has failed to live up to a global commitment to prevention, protection and accountability for mass crimes.

War and mass violence not only halts development, it reverses it — scarring the lives and memories of new generations.  This creates traumatized societies — one of the biggest factors contributing to conflict.

A ‘Marshall Plan’ for Africa’s employment challenge

To Africa’s many challenges, add one more: unemployment.

Unemployment, independent of any other factor, threatens to derail the economic promise that Africa deserves. It’s a time bomb with no geographical boundaries: Economists expect Africa to create 54 million new jobs by 2020, but 122 million Africans will enter the labor force during that time frame. Adding to this shortfall are tens of millions currently unemployed or underemployed, making the human and economic consequences nearly too large to imagine.

Thus, even with the strong economic growth we have seen over the past decade, job creation in Africa remains much too slow. Africa needs a comprehensive, coordinated approach akin to America’s “Marshall Plan” in Europe after World War Two. That effort focused on building infrastructure, modernizing the business sector, and improving trade. By the end of the four-year program, Europe surpassed its pre-war economic output.

We can, and must, do the same for Africa. Entrepreneurs, politicians, philanthropic foundations, and development organizations — such as the World Bank, International Finance Corporation and USAID — must all work together to solve the unemployment crisis and make Africa an engine of growth. If we are outrun by the employment challenge, Africa will be a drag on global growth and resources for generations to come.

Internet access is a vital healthcare tool

When Mark Zuckerberg announced a new private sector initiative last month to make affordable Internet access available to people in developing countries, he breathed new life into a long-simmering debate within the global development community — what is the value of technology in societies suffering from urgent social, economic and humanitarian challenges? Familiar voices of criticism have been heard, pointing out that in communities lacking food, clean water and medicine, getting people online is hardly a priority.

Some of these critics are trusted friends and colleagues within the healthcare and humanitarian sector. But as someone with over thirty years of field experience in developing countries, I humbly disagree with them. Achieving greater Internet access in developing countries can save lives, transform communities and revolutionize the quality and provision of healthcare for hundreds of millions of people today. Not only should connectivity be part of the global development agenda, it must be recognized as a vital enabler of the entire agenda.

There are several important reasons for this.

First, better tools for diagnosis and communications can lead to differences in health outcomes. One group of students at Stanford, through our Liberation Technology course, recently produced a mobile app to improve clean water delivery in a large slum in Kenya, allowing users of the app to locate the cheapest prices for water in their community, comment on quality and identify sources of water that make people ill. Another app for community workers targets cholera treatment in areas without any physicians. While many of us in the developed world use our mobile phones for triviality, in developing countries they can be the first line of defense in a public health emergency. This isn’t about cat pictures or Angry Birds — mobile phones can be the difference between life and death.

An agenda to boost Africa’s economy

A lot can happen in a year. This time last year, U.S. businesses and NGOs bemoaned the Obama administration’s perceived indifference to Africa. Now, they’re trying to find out how to catch the wave of interest. Major new initiatives, including Power Africa and Trade Africa, unveiled during President Obama’s first true trip to Africa this summer, as well as a reinvigorated push to renew the African Growth and Opportunity Act fully two years before it’s due to expire, have given U.S.-Africa watchers a lot to consider. But what — and when — is enough for U.S. policy in Africa? What more can be done in the year ahead? How do things really shake out for investors, civil society and Africans? Here are three additional areas the Administration should consider as it deepens its commitment to the continent:

1. Invest in Africa’s equity and commodity markets. ­Despite all the interest in Africa’s economic growth and investment potential, it’s still very hard to invest on the continent. Of its less than 30 stock markets, only a few exchanges really offer modern processes and back-end technology to facilitate daily transactions. As Todd Moss from the Center for Global Development notes in a recent paper, some African exchanges trade less in a whole year than New York does before “their first coffee break.” As a result, for institutional investors who need to take large positions or who have fiduciary requirements for daily liquidity, Africa remains almost entirely off-limits. In an era of algorithmic and high-speed trading, Africa’s antique market infrastructure is a major barrier to entry for much needed foreign direct investment.

Innovation is perhaps most evident in commodity exchanges. A number of projects in East Africa are taking off — including the East Africa Exchange (EAX), a private initiative founded by Heirs Holdings, Berggruen Holdings and 50 Ventures, which was launched in January this year. The eponymous Eleni LLC, a consultancy focused on developing private exchanges, builds off the rapid success of Ethiopia’s commodity exchange and the work of Eleni Gabre-Madhin, its founder. Both efforts build the critical architecture necessary for productivity growth in economies that still remain predominantly agrarian.

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