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Submitted by Olga on

What you say about prevention and preparedness, and how public health systems are needed, is very true. Not to be too cynical, it's also what people say during every crisis. Everyone sees the huge damage to people, communities and economies when a crisis is ongoing. So there is a blip of awareness that preparedness pays.

It's clear to all now that the crisis was caused by poor public health systems. The crisis did not have to happen. The crisis was preventable. This is all true.

It's also true that this is the case for this infectious disease outbreak crisis, as well as for the previous one, and the one before that. All of them could have been prevented by early detection and rapid containment of the outbreak. It's also known that governments chronically underinvest in public health, in capacities that detect disease outbreaks early and control them promptly. Nearly all World Bank public expenditure reports in the past 3 decades find that there is gross underspending on prevention. So this is not new knowledge, unfortunately for the poor who suffer the most from the setbacks of these crises. Unfortunately, nothing much happens as a result of this knowledge. "It's nobody's fault."

We know about the consequences of lack of preparedness and prevention, and we have known that before. Still, investments in public health (prevention of disease) are not on donors' lists of things to fund and promote. They are not on the government's list. So the investments are not made. This is a chronic situation.

I hope a bold journalist can interview the Ministers of Health who were in office 15, 10 and 5 years ago. Or perhaps a parliamentary commission can look into their records of spending on prevention and ask them why they did not prioritize public health, by financing functions where very small investments yield huge returns when an outbreak of Ebola or cholera or other such diseases starts and is promptly contained. Why did they not do much more to protect the population?

These are not unexpected events, they happen again and again. It's not plausible that the Health Ministers did not know. They did know that there is no accountability and perhaps also that the health ministry will get more money from donors during crises, certainly more than donors ever give for preparedness and prevention.

The first task of a health minister is to protect the public from contagion because only a government can do that. The economic rates of return on such investments are far, far higher than those on any other health ministry spending. The investments save lives, prevent misery of disease, protect communities and economies.

Without accountability and without vigorous advocacy for preparedness and prevention by partners who should know better, health ministers will continue to think too little about tomorrow, and the poor will continue to bear tragic and costly consequences of recurrent infectious disease crises.

While diseases are a natural hazard, crises are man-made.