Just after Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, called the ebola outbreak "completely out of control," the government of Sierra Leone ordered its citizens to stay indoors for three days.
By any measure, ebola has turned one of the world's poorest geographies into a veritable hot zone.
In Liberia, a poor nation of 4.5 million people, the epidemic is growing in an "essentially uncontrolled exponential manner."
Dr. Joanne Liu, international president of Médecins sans Frontières (MSF), now says "the world is losing the battle to contain it."
This nasty epidemic, which dispatches more than 50 per cent of its victims, should not be dismissed as some remote African horror story. The death toll is most recently about 2,300 and climbing.
It has highlighted key pest-fighting challenges for rich and poor alike, and offers some sobering insights on a number of other fronts, including globalization, bats, deforestation, unsustainable population growth and the limits to institutionalized global medicine.
The trouble with bigness
For starters, our technological society promises that only big organizations like the World Health Organization (WHO), a UN agency, can keep us safe from pandemics and other health tragedies.
But the poor of West Africa have learned differently. With dramatically slashed budgets and an epidemic unit employing just 52 people, the WHO has failed West Africa. Ebola just wasn't on their radar.
The outbreak began in 2013 in rural Guinea, but the WHO didn't declare an emergency until August 2014. At that point, the virus had already taken up residence in crowded urban slums where it could burn away for years like zebra mussels in the Great Lakes.
No real international response to the outbreak occurred until ebola starting infecting American aid workers. In Africa, it still takes a sick white man to alert people to the health realities of black men and women. When a Geneva-based global institution specifically designed to assist poor countries served by relatively few doctors can't do their job, then who can?
Large global institutions, from banks to corporations, tend to cultivate misery and inequality. Bigness doesn't care about local ecologies, let alone serving local needs. In many cases bigness just obliterates those realities and supports more bigness.
This is not to say that the world doesn't need top-notch scientific research and excellent public health agencies. It does. But these institutions should be nationally based, flexible, small and decentralized. They should be accountable to communities and not global economies.
Canada's modest but significant disease lab in Winnipeg, for example, contributed more initial expertise on the ebola outbreak than the WHO. But the Conservative government has cut the lab's budget to the bone.
Hospitals made it worse
The outbreak has also illustrated the folly of another centralized conceit: public health planning that puts hospitals at the centre of epidemic fighting.
In West Africa, hospitals were the first to be overwhelmed. Doctors and patients learned to fear them as sources and spreaders of infection. At one Sierra Leone hospital, 15 nurses bled outwith ebola. The hospitals were the first to run out of gloves, syringes and protective gear.
In the end, hospitals did what they have done for centuries: they dutifully amplified the epidemic.
The lesson here is clear. Prabhjot Singh, a professor of international and public affairs at Columbia University, has emphasized the importance of training of community health workers to help trace suspected patients along with the infected in West Africa.
Effective pandemic or epidemic planning must focus on mobilizing and training local citizens. History explains why: a potent influenza or hemorrhagic virus such as ebola will shut down centralized healthcare and kill most first responders.