When Global Governance Doesn’t Work

The ambulance pulled up to the deserted hospital entrance.  Its rear doors opened, and a figure swathed in a white hazmat suit slowly stepped down.  It was met by another similarly clad figure from inside the hospital, which offered an arm to lean on, and together they shuffled carefully inside.  Thus did Ebola first appear in the United States at Emory University Hospital.

Infectious disease is a scary thing; but a hemorrhagic fever like Ebola can be especially horrifying because patients often vomit blood, which is terrifying to both patient and caregivers.  Diseases like this are why the world has tried to cooperate in the matter of public health, tracking, treating, and containing them before they spread.  Despite the huge network of international organizations, government agencies, healthcare providers, and nongovernmental aid groups, the world’s way of making and enforcing rules of behavior — global governance — leaves a lot to be desired.  Infectious disease is just one example of this dearth of control.

Dr. Kent Brantly, the American physician who had contracted Ebola as an aid worker with Samaritan’s Purse in Monrovia, Liberia, survived.  Emory specializes in the care of acutely ill adults, and their specialized isolation facility exists for just such an event.

Unfortunately, the global response to the epidemic in West Africa was not as efficient.  As cases continued to grow, the disease sapped the health care systems of Liberia, Sierra Leone, and Guinea-Bissau.  The three original countries of the outbreak were all attempting to recover from utterly ruinous civil wars, which meant that much of the actual health care available was provided by the aid groups Médicins sans Frontières (MSF) and Samaritan’s Purse.  These groups were sharply critical of the delay of the World Health Organization (WHO) response.  In August 2014, WHO requested only $100 million to help contain the outbreak; by the middle of September that amount looked ludicrously small, as the disease had spread to Nigeria and the number of people killed had grown to 2,630.  WHO increased its request exponentially to $1 billion, and the rest of the world started to take Ebola seriously, sending aid and medical personnel.

Furthermore, images of Dr. Brantly had been transmitted globally, fueling hysteria.  But not a month later, a man named Thomas Eric Duncan went to an Emergency Room in Dallas, Texas, with the following symptoms: severe headache, muscle pain, fatigue, diarrhea, vomiting, and stomach pain.  He also told them he had recently traveled from Liberia.  He was sent home with painkillers and antibiotics.  If his relatives hadn’t taken it upon themselves to contact the Centers for Disease Control (CDC), the first man to be diagnosed with Ebola in the U.S. would have died at home, infecting his family and friends in a major metropolitan area.  As it was, dozens of people had to be monitored for signs of the disease.  And Mr. Duncan later died.

This demonstrates a key problem with global governance in particular and with networks in general: as any utility will tell you, it’s connecting the last 100 feet between house and street that is the hard part.  Convincing U.S. health care providers to alter their procedures is in some ways every bit as difficult as providing health care in nations recovering from years of civil war.

The example of Ebola serves to show that “global governance” is not necessarily positive or effective.  What it is, and what it could or should be, are very different animals.  This is partly because the task of governing does not always fall to governments, especially in the case of global problems.  And even when it does, those governments — or other actors in the network — may not have the capacity or the will.

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