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The West Africa Ebola outbreak is now a “public health emergency of international concern”, according to the WHO.
In among some alarmist reportage of the outbreak it is not too hard to find expert and balanced comment from the WHO, medical and development specialists. [1,2]
The media reports are consistent on the basic facts. This is the deadliest and longest-lasting outbreak of Ebola recorded. There is no known cure for the disease. Once one is infected with the Ebola virus, survival rates are low and death from it is horrific. However, most poor people, even in those countries most affected by the outbreak — Guinea, Liberia, Nigeria and Sierra Leone — are still much more likely to die of something else.
But why West Africa, and why now? In spite of all the articles on fruit bats, the natural host of the virus, and the potential role that disruption of their forest habitat may play in increasing transmission, I have not seen an explanation that convincingly answers those questions. Perhaps no one could have foreseen or prevented the outbreak.
“The primary tragedy is that Ebola has overwhelmed healthcare systems that were already failing the poor.”
Yet people in rich countries should ask why we are suddenly so bothered about Ebola, but not the Africans who will die today of diarrhoea-related causes, malaria, Lassa fever, sleeping sickness or many other illnesses.
Presidential involvement in the response to the crisis (whether from the West Wing or West Africa), global coverage on outlets such as the BBC and CNN, and declarations of “states of emergency” with troops round airports all push the issue up the news agenda.
But does this help an effective public health response? Where were the big politicians when Ebola was seen as an issue affecting rural Africans? It has, after all, been known about since the 1970s. And, as early as June, Médecins Sans Frontières/Doctors Without Borders was saying that it had reached the limits of what it could do about emerging cases. 
The primary tragedy is that Ebola has overwhelmed healthcare systems that were already failing the poor. The people of Guinea, Liberia and Sierra Leone needed adequate healthcare services before this outbreak happened. Of course, a healthcare system that cannot cope with more prevalent diseases cannot cope with an extraordinary outbreak like this, either. Progress in developing countries on the health-related Millennium Development Goals shows that improving health systems is affordable and achievable.
Surely the twenty-first century response to the diseases of the poor should, as well as addressing the immediate Ebola crisis, be to strengthen health systems in the poorest countries.
Roger Williamson is an independent consultant and visiting fellow at the Institute of Development Studies at the University of Sussex, United Kingdom. Previous positions include organising nearly 80 international policy conferences for the UK Foreign Office and being head of policy and campaigns at Christian Aid.
 Andrew Green WHO and partners launch Ebola response plan (The Lancet, 9 August 2014)
 Dispelling the myths of Ebola (Institute of Development Studies, 22 July 2014)
 Alexandra Sifferlin Ebola outbreak beyond our control, Doctors Without Borders says (Time, 23 June 2014)