Packard begins and concludes his book with a discussion of the West Africa Ebola epidemic that began in Guinea in 2013. He argues that the international response to the Ebola epidemic reflected many of the challenges and conflicting visions that have marked the history of global health since its beginning (p.329).Discuss some of these challenges and conflicting visions. In what ways was the Ebola epidemic a product of global health’s history, i.e. the failure to address the underlying conditions that generated the epidemic? CONCLUSIONResponding to EbolaOPENED THIS BOOK with a discussion of the Ebola outbreak that began insistance. I will close by returning to West Africa to examine the internationalresponse to the epidemic-a response that reflected many of the challengesand conflicting visions that have marked the history of global health.The global response to the West African Ebola outbreak, which hadkilled over 8000 people by January 2015, unfolded slowly. A team of phy-sicians working for Doctors Without Borders/Médicins Sans Frontières(MSF) confirmed the presence of Ebola in Guinea in March 2014. By April,the disease was spreading beyond the country's borders, yet the WorldHealth Organization was reluctant to label it an epidemic. WHO spokes-person Gregory Hartl played down the importance of the outbreak at anApril news conference in Geneva, saying, “Ebola already causes enoughand we need to be very careful about how we characterize some-thing whichup until now an outbreak with sporadic cases."¹ WHODirector-General Margaret Chan was reluctant to the alarm aboutwhat was occurring in West Africa, in part because she had been criticizedfor her earlier warning about the threat of the H1N1 virus in 2009, and inpart because a number of earlier outbreaks of Ebola in East and CentralAfrica had been successfully contained.concern,MSF, which had sent teams to the region to open clinics and emergencyhospitals soon after Ebola was confirmed, strongly disagreed, warning,"We are facing an epidemic of a magnitude never before seen in terms ofthe distribution of cases in the country."2 MSF called for a much more ro-bust response from the world community. WHO, however, did not declarethat the outbreak was a global-health emergency until August 9, 2014, and329 not until October did significant additional aid begin reaching the threemost affected countries. There is no doubt that the delayed global responsecontributed to the spread and severity of the epidemic.With the discovery of the first case of Ebola in the United States in Sep-tember 2014, the Ebola outbreak suddenly became a global health emer-gency. This one case stimulated increased US commitments to fighting thedisease in West Africa, including the promise of several thousand US mili-tary troops to help with logistics. The US Congress was asked for US$4.6billion dollars, most of it to go to strengthening disease preparedness in theUnited States, global surveillance systems, and vaccine and drug develop-ment. Private foundations committed over US$100 million to supportcontrol efforts in West Africa. When aid began pouring in, it traveled alongwell-trodden colonial pathways, with the United States sending moneyand 2400 military troops to Liberia, the British sending resources primarilyto its former colony in Sierra Leone, and the French doing the same for itsformer colony in Guinea. Channeling aid in this way ignored the regionalnature of the epidemic and the need to coordinate relief activities acrossborders.In the meantime, dozens of international NGOs arrived, working as bestthey could to help stabilize the situation. There was very little coordinationamong these various groups, however, and no one was in charge. WHO,which should have played this role, lacked the resources to do so. Afterthe 2008 financial crisis, its overall budget had been cut to roughly US$2billion, or less than that of some major medical centers in the UnitedStates. Most outside contributions to WHO were directed to categoricalprograms, such as polio eradication. WHO's emergency-response office hadhad its budget cut by 51 percent. Again underplaying the need for regionalcoordination, Director-General Chan preferred to have the countries them-selves coordinate activities within their own borders. The three most affectedcountries, however, had a limited capacity to mobilize or coordinate the re-lief response.Lacking coordination, NGOs employed different protocols, duplicatedefforts, and, in some cases, overbuilt facilities, setting up beds that remainedempty. Early foreign assistance led to the creation of Ebola case-managementcenters but did not provide trained staff to run them.³ In Liberia, where mostof the US funding was directed, almost all of the support went to buildingfacilities in the capital, Monrovia, while rural areas, where many cases wereoccurring, received little attention. International actors, moreover, seemedunable to adapt quickly to a rapidly changing situation. Resources werebeing allocated to activities that were no longer appropriate. In Monrovia,330A HISTORY OF GLOBAL HEALTH

Packard begins and concludes his book with a discussion of the West Africa Ebola epidemic that began in Guinea in 2013. He argues that the international response to the Ebola epidemic reflected many of the challenges and conflicting visions that have marked the history of global health since its beginning (p.329). Discuss some of these challenges and conflicting visions. In what ways was the Ebola epidemic a product of global health’s history, i.e. the failure to address the underlying conditions that generated the epidemic?

Packard begins and concludes his book with a discussion of the West Africa Ebola epidemic that began in Guinea in 2013. He argues that the international response to the Ebola epidemic reflected many of the challenges and conflicting visions that have marked the history of global health since its beginning (p.329). Discuss some of these challenges and conflicting visions. In what ways was the Ebola epidemic a product of global health’s history, i.e. the failure to address the underlying conditions that generated the epidemic?