In 1995, one year into my assignment in West and Central Africa for New York TimesI was pulled away from covering one of the ongoing conflicts in that part of the continent to report on another kind of crisis, one that was new and completely terrifying in the way it killed indiscriminately without using guns or violence: the Ebola virus.
Although it was by no means medically known, before that year’s outbreak in Kikwit, Zaire (now the Democratic Republic of the Congo), the cause of the disease was still largely unknown to the world. That changed dramatically within a week, when international scientists and journalists rushed to Bandundu, the west-central region of Zaire where the disease was spreading, spreading news of a staggering death rate and dire symptoms. Among others, these include bleeding from every orifice and vomiting.
In 1995, one year into my assignment in West and Central Africa for New York TimesI was pulled away from covering one of the ongoing conflicts in that part of the continent to report on another kind of crisis, one that was new and completely terrifying in the way it killed indiscriminately without using guns or violence: the Ebola virus.
Although it was by no means medically known, before that year’s outbreak in Kikwit, Zaire (now the Democratic Republic of the Congo), the cause of the disease was still largely unknown to the world. That changed dramatically within a week, when international scientists and journalists rushed to Bandundu, the west-central region of Zaire where the disease was spreading, spreading news of a staggering death rate and dire symptoms. Among others, these include bleeding from every orifice and vomiting.
When I arrived in Zaire’s capital, Kinshasa, that May, most of the news from the front lines had ended. Doctors and scientists were still working in Kikwit trying to control the epidemic and better understand the terrible virus, but when I landed there on a small chartered plane, almost all the reporters had left for fear of infection. Anyone else who could leave the city was hurrying to do so as well.
This was a time of great human ignorance about pathogens and epidemics. In those days, I never saw one of the N95 respirators that became common following the global spread of COVID-19; before leaving my base in Ivory Coast for Zaire, the best my local doctor could recommend was a simple cotton hat, along with surgical gloves and a paper bib to wear around Ebola patients.
Armed with the equipment, I interviewed relatives of people who were suffering from Ebola at Kikwit General Hospital and watched others bury their dead nearby. Later, I spent an afternoon walking around a village where the virus was still spreading, despite official reports from international health organizations that the Ebola outbreak was under control.
In my follow-up, I blamed rich nations for their role in the poor public health situation in Africa. This was not only a failure of recent investment, but also, to a large extent, an unacceptable legacy of underinvestment in public health and education, including medical schools, during the colonial period.
Ebola was not the tip of the iceberg. It had received such attention only because of the ease of infection and the alarming symptoms, which brought fear in the West that it would reach the rich world. At the same time, malaria, which did not give any information from the outside, was still killing millions of people in Africa, while diseases that have long been eliminated or placed elsewhere, from measles to yellow fever and meningitis, among others, destroyed many others.
Zaire’s 1995 Ebola outbreak had other major implications that I could not have predicted. Along with the last year’s genocide in Rwanda, it contributed to a major change in US policy towards Africa. Some of these had compelling facial logic, but many of their effects have unfortunately contributed to the continent’s present-day conflicts. The Clinton administration correctly understood that the genocide of the era and the Ebola outbreak were rooted in government failure, but from this it drew the wrong conclusion. The need to protect Western interests, whether against violent unrest and refugee flows or dangerous diseases, gave such conflicts a national security dimension, which paved the way for the Pentagon’s increasingly hawkish approach to the continent.
To deal with political instability in Africa, Washington emphasized democratic governance and prioritized relations with what it saw as authoritarian regimes in places like Ethiopia, Eritrea and post-genocide Rwanda. It also wished to continue in this direction in the region’s largest country, Zaire, by supporting the overthrow of its long-time client, Mobutu Sese Seko, in 1997 by a new Rwandan-backed dictator named Laurent-Désiré Kabila. Instead of bringing peace and stability, however, each of these countries experienced or became involved in disastrous wars.
Washington was at the same time pushing security-based approaches to the perceived threat to the world that Africa posed through infectious diseases. In June 1996, US Vice President Al Gore announced something called the Presidential Decision Directive on Infectious Diseases, which led the Pentagon to monitor disease outbreaks through border surveillance and military networks.
Despite this rationale from an early warning perspective, it did nothing to improve health care delivery in Africa or address the extreme poverty that favored disease transmission in the first place.
The fruits of this lack of vision were evident after repeated outbreaks of Ebola, including the largest outbreak, in West Africa between 2013 and 2016. Since the disease started again in Guinea, it quickly spread to neighboring countries such as Sierra Leone and Liberia and as far away as Nigeria’s largest city, Lagos. Before the shutdown, more than 11,000 people had died out of a total of more than 28,000 cases. The lesson was clear: The world needed more investment in African public health infrastructure, not less, and sustained engagement rather than crisis-driven attention. What followed under President Donald Trump has been the complete opposite.
Washington’s policy towards Africa in recent years under the leadership of Trump has been worse for public health on the continent than anything seen in modern times. In his two terms, Trump has downgraded Africa in terms of diplomatic relations and cooperation. He has also led the disbanding of the US government’s most important foreign aid arm, the United States Agency for International Development, to which much of its public health aid has been given. Many critics say he has severely undermined the US Centers for Disease Control and Prevention. And in January, he withdrew the United States from the World Health Organization (WHO), making it the first country to withdraw from this arm of the United Nations since its founding in 1948. This was more than a political statement. Washington was traditionally the WHO’s main source of funding.
Such measures have greatly accelerated Western commitments to public health and development in Africa. According to many health care experts, the short-term effects of this can be felt very much in the present The Ebola crisis in the Congo, which has slowly but steadily gained alarming momentum in recent weeks. Since Trump came to power last year, American laboratories that once did pioneering work to study the disease have been closed; appointed by Trump politically is reported he even dismissed Ebola as a “hoax.” US support for public health services in Africa, in general, has been reduced. And US contributions to the WHO’s emergency efforts to manage the crisis have dried up.
What makes the current outbreak worse is that it took too long for news to reach the outside world, favoring its spread by delaying any emergency response. The WHO announced the crisis on May 16, but scientists believe that by then it had already spread for days or weeks. Like previous problems, this one will end. The question is only a matter of time and taxation.
Crisis is opportunity, though, and what this teaches us is that if the Clinton administration got a lot of things wrong, it got one big thing right: It declared that infectious disease is a concern, global health is everyone’s problem. Thus, nations such as the United States, with their vast financial and scientific prowess, have moral and self-interested reasons to embrace accountability.
In today’s political climate, it seems highly unlikely that Washington could see things this way, even though selfishness would be sacrificed by working hard for the greater good. But if the United States is to return to a broader view of its role in the world, it should think about Africa from the bottom up. Supporting the provision of public goods—starting with health and education services—at the local level is the sure foundation for development. But it needs to create strong partnerships with governments that are democratically accountable to their people, and not just to Washington or to the interests of foreign donors.
