Europe's 'Moral Obligation' Is To Repair West Africa's Health Care System

It's not just about Ebola.

That's the message from EU Health Commissioner Tonio Borg. He was in Washington last week to talk about Europe's response to the crisis at a meeting of the Global Health Security Agenda. The European Union is a key player in the global effort to stop the epidemic.

Goats and Soda sat down with Borg and learned that his focus is twofold: Stop the epidemic and repair the devastated healthcare systems of West Africa.

"I always speak of this weakest link even when I speak about health within the European Union," So if one member state has different standards than another, he notes, "We are now a union where there are no controls. We are only as strong as our weakest link." And a weak link can expose an entire continent — or world — to risks.

"We need global initiatives on antimicrobial resistance, global initiatives on epidemics, as if a virus would take heed of any frontiers or boundaries," Borg says. "So I think this is the new challenge for all health ministers around the globe."

Most of the EU's Ebola assistance — a pledge of 180 million Euros or about $226 million — is earmarked for improving the public health care systems in West Africa, Borg says. The money from the EU is separate from funding that's coming directly from EU member states, he says. France, for instance, is sending aid directly to Guinea, and Britain is setting up Ebola treatment units in Sierra Leone.

But Borg says what's needed in the longer term is investment in weak local health care systems "because this epidemic will come again, perhaps in another form. Our aim is not just to dish out the cash now but to provide a long-term partnership in this regard."

Borg, who is from Malta, says strengthening public health systems in the world's poorest countries benefits everyone: "We have a moral obligation towards developing countries — whether in Europe or United States — but, of course, my responsibility is also to protect our own citizens. But the two are not separate, watertight compartments. By containing the disease in these countries, we are also protecting ourselves. Self-interest should not be the prime mover of what we do. The prime mover should be health as a value in itself; we have this moral obligation towards developing countries. But this indirectly also helps our own situation and the health situation of our own citizens."

One dire need right now is for more health care workers to combat the Ebola outbreak in West Africa. Borg says the EU is trying to organize deployment of more doctors, nurses and other medical personnel.

A significant barrier is the lack of a medical evacuation plan for Europeans who get infected with the virus. Evacuees would need to be medevaced back to Europe in a specially equipped aircraft. Borg says the EU is trying to come up with a protocol that would allow all EU member countries to use the same plane.

"Until now, we have coped," Borg says. "Until now, most member states are prepared to evacuate their own. But we need to work harder so that they would be able to evacuate also others. Take my own country. I come from Malta, the smallest member state. We don't have any military aircraft. So in the situation of a Maltese social worker or health worker having a problem, first it would be important to send him to a facility [in West Africa] which is safe, which is run according to European standards of health, and then evacuate him through an aircraft of another country. I think that the EU member states would rise to the occasion, particularly if the emergency continues.

"But we need to form a network of laboratories and isolation hospitals and units within the European Union."

Finally, Borg stresses the need to look beyond the outbreak to West Africa's overall health care crisis. "We need to plan ahead. [Ebola] has an actual lifespan, but whether it will be long or short depends on us.

"Now let's think about the post-Ebola [situation] as well. What we can do in these countries that will not be just a medicine for an immediate problem but more of a long-term solution?" From a global health perspective, he says, fixing the health care system in Liberia will make people safer in Washington, London ... and Malta.

Note: Quotes have been edited for length and clarity.