"US Foreign Policy Regarding the Spread of Diseases in Nigeria"

West Africa’s Ebola Pandemic: Toward Effective Multilateral Responses

to Health Crises �

Obinna Franklin Ifediora and Kwesi Aning

The Ebola virus disease (EVD) outbreak in West Africa in 2014 became the re- gion’s most dangerous pandemic in history. Initially misdiagnosed by health authorities in Liberia, Guinea, and Sierra Leone, the epicenters of the crises, the wider health infrastructure of the international community similarly failed to grasp the enormity of the challenge posed by this pandemic to West Africa and its potential global ramifications. By the time recognition dawned about the immensity of the challenges that were posed by this pandemic, it took the introduction of extraordinary measures through the characteriza- tion of the disease as a threat to international peace and security pursuant to Chapter VII of the UN Charter to get the necessary institutional and bureau- cratic machineries to intervene. This article argues that EVD, disastrous in its outcome, exposed the weaknesses and failures of existing institutional frameworks at national, regional, and continental to global levels. Focusing primarily on multilateral responses (the UN, the African Union [AU], and the Economic Community of West African States [ECOWAS]) to the epidemic, this article argues for enhanced global-regional collaboration in the context of the UN Charter’s Chapter VIII for more effective future responses to health crises in West Africa. This article contributes to the ongoing debate on the re- form of global health governance by analyzing the existing health gover- nance strategies established by ECOWAS and implemented through the West African Health Organization. Keywords: ECOWAS, African Union, UN, pub- lic health, Ebola, Liberia, Sierra Leone, Guinea, West Africa.

THE WEST AFRICAN REGION FACES A SPECTRUM OF SECURITY AND DEVELOP- mental challenges ranging from political instability (often associated with bad governance) to transnational organized crime (which relates to porous borders and public corruption) to poverty, population growth, and natural disasters.1 The combined effects of these threats and vulnerabilities to peace, security, and stability in the region outpace the capacities and competences of individual states as well as the supranational body, the Economic Com- munity of West African States (ECOWAS), to effectively respond to several variations of their manifestations. Quite naturally, therefore, some forms of outside interventions are continuously needed to respond to emergent threats or their unintended consequences in the region. This is because some of these challenges often have implications for international peace and security. An example is the outbreak of Ebola virus disease (EVD) in several West

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African states, which is arguably a regional health pandemic with consider- able international dimensions.

One of the defining characteristics of twenty-first-century threats and challenges,2 especially to international peace and security, is the effect of globalization.3 Globalization enables speedier exchanges of ideas as well as challenges and vulnerabilities. There are increasing interconnectedness and interdependence among peoples and nations, which create opportunities for shared prosperity, challenges, and responsibilities.4 Moreover, transforma- tions in global interactions occur with intrinsic risks, including virulent dis- eases such as cholera,5 HIV/AIDS,6 and now EVD, and can no longer be contained within national borders. Such globalized challenges were aptly described by former UN Secretary-General Kofi Annan as “problems with- out passports” that require collective global response.7

International policymakers recognize that problems without borders present peculiarities and challenges that make the acknowledgment, accept- ance, and application of local knowledge imperative to effectively respond to and address such episodic pandemics. Accordingly, there is now a growing practice of utilizing regional capacities and resources as first responders, in most cases under the auspices of regional arrangements as envisioned in Chapter VIII of the UN Charter, in combating potential global threats and challenges. This practice is most visible in multidimensional peace support operations in Africa. For instance, Mali’s imminent collapse following the coup d’état in March 2012 led to an initial intervention by the African Union’s (AU)8 African-led International Support Mission in Mali (AFISMA)9 with considerable success before being rehatted in July 2013 as the UN Mul- tidimensional Integrated Stabilization Mission in Mali (MINUSMA).10

West Africa’s EVD outbreak led to the eventual international responses due to: (1) the threats posed to the affected states; (2) the prospects of wider destabilization to regional security; and (3) the threat to international peace and security. Such outbreaks of virulent diseases in West Africa are a peren- nial problem,11 often having significant impacts on public health systems; regional stability; economic,12 social, and political systems; and human secu- rity in the region. EVD was first reported in West Africa13 in Guinea on 23 March 2014,14 and eventually spread across the border into Sierra Leone and Liberia, then to Nigeria, Mali, and Senegal. By the time these affected West African states were declared Ebola-free in mid-2015, it had spread from the region to Spain, the United Kingdom, and the United States.

The crisis, therefore, presented ample opportunities for global and regional arrangements to deploy their conflict and emergency humanitar- ian response mechanisms toward containing the threat. However, both the AU’s and ECOWAS’s role in containing EVD transmission became a sub- ject of some controversy.15 The two organizations’ initial response to the crises in Guinea, Liberia, and Sierra Leone raises questions about regional

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institutional capacities in addressing health emergencies that pose consid- erable potential existential threats to communities and states and have seri- ous implications for international peace and security. Similarly, the World Health Organization (WHO) and the international community have been criticized for their initial apathetic responses.16 These critical assessments of the multilateral reactions to the EVD outbreak reveal a lack of adequate resources and preparedness for effective first responders measures to poten- tially dangerous emergencies.

In this article, we highlight the capacity gaps in health governance in the West African region by discussing the existing structure of ECOWAS’s West Africa Health Organization (WAHO)—the region’s pioneer health agency— and argue that global-regional health emergency response reforms, in relation to West Africa, will be more effective by operationalizing and leveraging existing WAHO assets rather than creating parallel technical organs. Further- more, we reiterate the centrality of global-regional collaboration, pursuant to Chapter VIII of the UN Charter, to regional capacity building and develop- ment toward effective crisis response and in fulfillment of regional institu- tions’ potential roles in maintaining international peace and security.

A key contribution of this article is that we pinpoint the types of regional capacities that should be developed in relation to public health emergency response in the future. Our propositions are based on the fact that global institutions are often beset by concurrent multiple emergencies that require equally substantial measures. This could have significant impact on response time, resource availability, mobilization, and allocation. Finally, we draw ECOWAS’s attention to its commitment to human security and call for the implementation of its policy shift toward an “ECOWAS of Peoples,” particularly following its responses to the EVD pandemic.

Consequently, in this article we assess the processes leading to the characterization of Ebola as a threat to international peace and security, cognizant that the EVD epidemic in West Africa is one of many reported cases in Africa. Thereafter, we examine and analyze initial global responses to the Ebola outbreak and the circumstances that contributed to the delays in the response. The focus of our analysis is on organizational responses— that is, UN/WHO, AU, and ECOWAS/WAHO. We conclude the article by presenting some proposals for consideration toward the ongoing rearticu- lation of global health governance.

Conceptualizing Global-Regional Collaboration in Responding to Evolving Threats to International Peace and Security The peaceful resolution of the Cold War ushered in fresh thinking in rela- tion to security and the balance of power in the study of international rela-

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tions (IR). Although, there is an agreement among the theoretical divides in IR on the structure of international society, which has been described as anarchical17—that is, the absence of a governance system18—contempo- rary debate relates to the context of cooperation among sovereign states.19 However, for realist thinkers, the establishments of global institutions, such as the UN, have had little impact on attenuating the effects of the anarchical nature of the international system and state behavior.20 Instead, order is promoted in the international arena through distribution of power.21 The Cold War order built around the US-Soviet bipolarity meant that the collective security system established after World War II and enshrined in Chapter VII of the UN Charter was ineffective. The crowning effect of this power relation crystalized in the genocide in Rwanda in 1994 and the Security Council’s failure to respond. This failing, among others, by the UN can be accounted for by the distinctive character of threats to international peace and security that emerged after the Cold War, which include human vulnerabilities22 such as virulent diseases and human rights.

Nevertheless, for those from the Global South, this inadequacy in global security governance became an issue of taking more prominent action in the management of these new challenges.23 Chapter VIII of the UN Charter provides the legal framework for enhanced regional action in the management of international peace and security.24 Essentially, this meant that while the UN Security Council retains the primary responsibil- ity of maintaining international peace and security, which also involves the power of designating a situation as a threat to international peace and security, under Chapter VII, it recognizes that global challenges need to be addressed by making greater use of Chapter VIII mechanisms.25 In this context, the Security Council utilizes regional organizations as first responders to conflicts that, if not contained, could threaten international peace and security.26

The idea behind this new paradigm was that “cooperation between regional organizations and the United Nations would not only lighten the burden of the Council but would also contribute to deeper participation of regional actors in international affairs.”27 This partnership, as envisioned, should be based on complementarity and comparative advantages of regional organizations.28 The imperative of this practice has been effec- tively conceptualized in various thematic UN documents, notably: the UN “Millennium Declaration,”29 “In Larger Freedom,”30 “A More Secured World,”31 the “World Summit Outcome,”32 and the “Regional-Global Security Partnership.”33 One of the key outputs of these efforts was the establishment of a Ten-Year Capacity Building Programme in 2006 for the AU, to capacitate the organization to take more direct and prominent action in addressing local disputes with international security ramifica-

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tions. Although this program is mainly focused on peacekeeping and peacebuilding activities in Africa, it has incorporated health-related risks following the classification of HIV/AIDS as a threat to the international peace and security by the Security Council in 2000.34 Consequently, the AU has followed in this step,35 thus improving collaboration in address- ing global risks36 including HIV/AIDS. Accordingly, it is within this purview of regional-global security governance in relation to health mat- ters that we review the multilateral response to the Ebola pandemic in West Africa in this article while noting the impact of globalization and the free-border regime in West Africa.37

The Role of Regional Institutions: WAHO ECOWAS implements its policies and strategies through its specialized institutions when responding to security or developmental challenges in the region. Accordingly, in response to tackling EVD, it is critical to examine WAHO’s objectives as the pioneer regional health organization in West Africa.

Establishment, Mission, and Objective In November 1984, the ECOWAS Council of Ministers created WAHO and in July 1987, the Heads of State and Government of the ECOWAS Commission adopted a protocol38 in Abuja formally inaugurating WAHO. WAHO became operational in March 2000. WAHO’s mission is to attain the highest possible standard and protection of health of West African peo- ples through the harmonization of the policies of member states, pooling of resources, and cooperation with one another and with other states for a collective and strategic response to health problems in the region.39 ECOWAS’s Strategic Plan describes WAHO as:

A Specialized Institution for health, namely the West African Health Orga- nization (WAHO). This Institution is responsible for the implementation of the regional policy through regional health programmes. It is the NEPAD Focal Point on Health and MDGs for ECOWAS. Besides states, the private sector (ECOWAS pharmaceutical industries), civil society and basic com- munities constitute essential partners of WAHO.40

Apparently, ECOWAS’s intentions for WAHO are highly ambitious. Quite apart from being a proactive tool for facilitating regional health inte- gration, WAHO also corresponds to ECOWAS’s grand strategic vision— that is, an ECOWAS of Peoples by the year 2020.41 In line with this con- ceptualization, WAHO has developed a strategic document that would guide its operations as well as identifying potential challenges in carrying out its work (i.e., WAHO’s Strategic Plan).

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WAHO Strategic Plan, 2009−2013 The document states that the organization’s vision is to crystalize as the pri- mary force for regional health integration that enables high-impact and cost- effective interventions and programs.42 Its goals are to substantially improve the quality of health system management and health care for the peoples of the region by developing and supporting integrated health policies and pro- grams. The Strategic Plan identifies WAHO’s areas of interest of all prior- ity programs and this includes: (1) emergency preparedness and response; (2) control of epidemics; (3) behavior change communication; (4) human resources; and (5) medicines, vaccines, and medical consumables.43 Inter- estingly, the Strategic Orientation of the organization is directed at imple- menting relevant programs on health information that involve “detection of cases, launching of strategies to prevent transmission or reduce morbidity and mortality.”44 In furtherance of this Orientation, the Strategic Plan under- scores the imperative of regional health surveillance, especially due to the consequences of transmission of diseases beyond national borders.45

In relation to the EVD outbreak in West Africa, WAHO’s Strategic Plan and its Orientation on health governance in the region are prescient. The assessment is strikingly correct (“the imperative of regional health surveil- lance”), and the prediction manifested in the form of Ebola epidemic (“con- sequences of transmission of disease beyond national borders”).46 With such an excellent framework and plan already in place in the region, the question then is: Why did the EVD remain unidentified for three months? When the disease was identified, why was transmission beyond national borders not controlled or stopped early enough?

The developers of WAHO’s Strategic Plan had anticipated such regional health crises and had this explanation: “Inadequacy of a sub- regional database hampers cooperation and collaboration in the effective prevention and control of diseases. Thus, the objective is to strengthen development of health management information systems for disease pre- vention and control in the ECOWAS sub-region.”47

Within this purview, priority is given to control of epidemics and information management and facilitation of health research and develop- ment.48 Nevertheless, the organization faces unprecedented challenges, including civil conflicts and political instability, poor coordination and integration of donor-funded programs, corruption, and high population.49 In the light of the EVD outbreak and its devastating consequences in the region, and with the ECOWAS/WAHO response to the health crisis, there is no gainsaying that the Strategic Plan’s direction and implementation are yet to be fully realized.50 In other words, much-needed capacity build- ing should focus on strategies and programs that will substantially improve WAHO’s ability to implement the provisions of its Strategic Plan and Orientation.

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Internationalizing the Ebola Threat: From Regional to Global Responses The emergence of EVD became an existential threat to human security in West Africa as it constituted an “extraordinary event and a matter of pub- lic health risk to other states.”51 Moreover, considering the “unprecedented extent” of the outbreak, it also constituted a threat to international peace and security for a few reasons.52 For example, Margaret Chan posits,

This has been West Africa’s first encounter with Ebola virus disease. No cli- nician had ever managed a patient; no laboratory had ever handled a diag- nostic specimen; no government had the experience to understand what a disease like Ebola could do to a country’s future. . . . The [affected countries] are among the poorest in the world, borders are porous and population mo- bility is high as people move. Public health infrastructures in all three coun- tries were damaged or destroyed during years of civil war and unrest.53

Furthermore, a report prepared for the African Development Bank (AfDB) Group argues that “all three Mano River Union (MRU) countries at the center of the epidemic have a history of fragility, civil conflict, weak state-society relations and governance deficit, ongoing insecurity and weak institutional capacity at national and regional levels.”54 More- over, other factors that elevated the EVD outbreak to global attention included the “unprecedented scale and pace of transmission.”55 Addition- ally, President Barack Obama’s characterization of the situation as demanding “national security priority” and “a growing threat to regional and global security”56 was borne by the infection-to-death ratio, which is approximately more than half.57 These are incredible statistics for a little known disease in the region. As a result, EVD “preyed on the fear of the unfamiliar. . . . [T]he disease also preyed on a deep-seated cultural tradi- tion: compassion [and a desire to give the dead a befitting and intimate send-off]. That is, compassionate care for the ill and ceremonial care of their bodies if they die.”58 Contrasting the outbreak of Ebola in West Africa with previous knowledge of the disease from experiences in the Democratic Republic of Congo (DRC), for instance, the AfDB report noted that:

This outbreak of Ebola in West Africa is the largest and deadliest Ebola epi- demic historically recorded. It exhibits a different pattern from the epidemic observed in Central Africa (DRC). As a consequence, health authorities are experiencing difficulties in both monitoring and forecasting the epidemic. The epidemic has recently expanded beyond the typical risk groups in rural remote areas inhabited by populations in contact with wild life, to new groups living in densely populated urban areas, including individuals work- ing for governments, who were contaminated by human-to-human contact.59

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At the regional level, similar assessments were made. The AU Peace and Security Council (AU PSC) regarded the epidemic as a humanitarian emergency requiring operationalization of Article 6(f) of its protocol that deals with humanitarian action and disaster management, as well as the insertion of the African Standby Force (ASF).60 ECOWAS, meanwhile, took a broader analytical approach to the situation and rather stressed fac- tors that aggravated the outbreak. This includes weaknesses in governance, economic growth, population control, poverty, resource crisis (such as lack of human resources), security challenges, political instability, food insecu- rity, and climate change. Even so, it highlighted the reoccurrence of cholera, measles, meningitis, and Lassa fever epidemics as contributory factors undermining the region’s fragile health systems.61

Because of such evaluations, the EVD outbreak was viewed as the gravest humanitarian crisis to erupt in the region. As Chan pointed out in August 2014, “If we do not do more to stop transmission, this health crisis can rapidly become a humanitarian crisis.”62 According to UN Secretary- General Ban Ki-moon, “The gravity and scale of the situation now require a level of international action unprecedented for an emergency.”63 From the foregoing statements it is evident that the nature and scope of the Ebola outbreak goaded global institutions to utilize “securitizing speech acts”64 to mobilize international political support for Ebola response. The language used by these authorities elevated the Ebola virus from the realm of politi- cal and health discourse to the realm of international collective security and defense.65

From Inertia to Action: From a Humanitarian-Development to a Securitized Response to the EVD Threat The initial global response to the EVD outbreak has been criticized as “too slow,”66 and as lacking in “solidarity”67 in relation to regional arrangements, particularly the AU. In many ways, this initial inertia could be attributed to wrong assessments of the situation by the WHO’s advance medical team.68 In addition, there were multiple and concurrent Grade 369 emergencies across the globe at the time of the outbreak.70 Another reason could be because Ebola was not reported until three months after patient zero was identified.71

WHO: A Humanitarian Response On 23 March 2014, WHO officially put the world on notice concerning the outbreak of Ebola in Guinea and, by 25 March, medical teams under the aus- pices of its Global Outbreak Alert and Response Network (GOARN) arrived in Guinea. Although the WHO response was early, it proved ineffective.72 It

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was not until 24 July that WHO’s West Africa intervention took a decisive turn. Then, its director-general upgraded the Ebola virus outbreak from Grade 2 to Grade 3,73 the highest level based on the WHO’s Emergency Response Framework (ERF).74 Subsequently, on 8 August 2014, the out- break was declared a Public Health Emergency of International Concern,75 thus further recognizing the dangers posed by the pandemic. What this meant in practical terms was that WHO and its agencies and external part- ners were required to commit substantial resources to provide support.76 Identifying some lapses, WHO had announced a series of reviews of its health emergency response model, and it pointed out some structural defi- ciencies stemming from lack of implementation of the International Health Regulations (IHR) 2005 in national health systems that urgently needed addressing. According to Chan, “The International Health Regulations pro- vide the mechanism for collective defense against this universal threat, and shared responsibility for this defense. Only 64 of WHO’s 194 Member States have the essential surveillance, laboratory, response, and other capac- ities in place to fulfil their obligations under the IHR.”77

However, as we argue in this article, while global health reform initia- tives have occurred (though yet to be implemented), they will have greater strategic impact if channeled through collective security arrangements led by regional organizations rather than state entities.78 More so, it is pertinent to underscore that collective security systems depend on effective multilateral institutions capable of undertaking collective action and meeting shared responsibilities. The WHO Executive Board for the Ebola Emergency high- lighted the importance of regional structures, especially their advantages in tailoring the implementation of global strategies and guidelines to local cul- tures and conditions, in shaping the response of neighboring countries to shared interests, and in helping countries to build and certify the core capac- ities set out in the IHR to be better prepared for the next emergency.79 Fur- thermore, Chan contemplated the future of emergency response operations and argued that solutions to Africa’s problems must be uniquely African solutions. She noted that in the past Africa had followed the priorities and strategies defined by global health initiatives, and she concluded that Africa must now lead.80 Moreover, regarding changes to WHO’s emergency sys- tems necessary to meet the challenges of future health crises, Chan pointed to three main areas: rebuilding national and international emergency pre- paredness and response, strengthening national and international emergency preparedness and response,81 and emphasizing the modalities for collective defense against infectious diseases. Thus, achieving these changes will involve:

1. Investing in building resilient communities and well-performing health systems that integrate public health and primary health care

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2. Developing systems, capacities, and financing mechanisms needed to build surge capacity for responding to outbreaks and humanitarian emergencies

3. Creating incentive for research and development (R&D) for new medical products for diseases that primarily affect the poor.82

But as we argue, before the above can be achieved (particularly in rela- tion to national health systems), capacities and coordination of multilateral organizations and their agencies should be strengthened to respond speed- ily and effectively to common security threats brought about by virulent diseases such as EVD.

The Security Council and General Assembly: Providing a Securitized Response On 18 September 2014, the Security Council determined that “the unprece- dented extent of the Ebola outbreak in West Africa constituted a threat to international peace and security.”83 On 19 September, the General Assembly declared its “strong commitment” to responding to EVD in a timely, effec- tive, and coordinated manner.84 These resolutions gave birth to the UN Mis- sion for the Ebola Emergency Response (UNMEER),85 whose objectives were to stop the outbreak, treat the infected, ensure essential services, pre- serve stability, and prevent further outbreaks. The mission’s operational guid- ing principles included adopting a regional approach, centrality of national ownership, which is a UN strategy that is specific to the needs of each coun- try and a singular UN systemwide approach in responding to Ebola.86

The Peace and Security Council of the African Union: Toward a Securitized Humanitarian Response Similarly, the AU’s response to its critics over its initial “nonintervention” to the EVD outbreak in West Africa came on 19 August 2014. The AU PSC, referring to its mandate to authorize humanitarian action and disaster man- agement and to operationalize the African Standby Force in emergency sit- uations, approved the deployment of an AU-led military and civilian mis- sion to what it described as an “emergency situation caused by the Ebola outbreak.”87 Furthermore, on 8 September, at the sixteenth Extraordinary Session of the Executive Council of the AU held in Addis Ababa, a decision was adopted to establish an African Centre for Disease Control and Pre- vention. Finally, on 29 October the AU PSC, in a communiqué, authorized the deployment of an AU support mission for the fight against the Ebola outbreak in West Africa (ASEOWA). Between August and September 2014, $1.1 million was requisitioned from the AU’s Special Emergency Assis- tance Fund for Drought and Famine and Special Fund Contributions.88 Fur-

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thermore, ASEOWA’s Concept of Operations (CONOPS) deployed up to 1,000 health workers to the Ebola-affected countries between December 2014 and May 2015. By 10 January 2015, 835 health workers were deployed under ASEOWA.89 On 8 November 2014 at an AU-organized Africa Business Roundtable on Ebola, involving the private sector and the AfDB in Addis Ababa, $32 million had been raised to support ASEOWA efforts in stemming the tide of Ebola in West Africa.90

ECOWAS’s Curious Response: A Developmental Approach To appreciate ECOWAS’s response to the EVD outbreak, it is critical to rec- ognize the value of ECOWAS’s own assessment of the health crisis. ECOWAS initially took a developmental approach to the crisis,91 and this inaccurate assessment hampered mobilization of appropriate resources and responses. Indeed, this faulty diagnosis of the Ebola epidemic defined the scope of ECOWAS’s requests for support from the international community. Accordingly, when the Heads of State and Government of ECOWAS mem- ber states met at a summit in Yamoussoukro, Côte d’Ivoire, on 28 and 29 March 2014, they made their first appeal for international aid to support its Ebola efforts.92 The AfDB responded to ECOWAS’s appeal in May by offer- ing 2 million Units of Account (equivalent to $3 million).93 On 11 and 12 April, WAHO had made a presentation of the status of the epidemic at the fifteenth Ordinary Meeting of the Assembly of Health Ministers in Mon- rovia, Liberia, where it highlighted the response measures to be taken by the region and member states.94 In this instance, the commission’s response to EVD was undertaken by WAHO. In its response, WAHO’s focus was to sup- port the affected countries, especially in the areas of capacity building, sur- veillance, preventive measures, and strengthening collaboration among health ministries and departments for a multisectoral response.95 In line with these objectives, the commission, through WAHO, disbursed $4.5 million to the affected countries.96 WAHO also assisted in training health workers for deployment to Ebola-affected countries. Accordingly, on 24 November, WAHO announced a plan to train 150 health workers from six ECOWAS member states at the Kofi Annan International Peacekeeping Training Cen- tre (KAIPTC), Accra, Ghana.97 This training program was supported by the AfDB.

Civil Society: A Humanitarian Response Although the role of civil society in the framework of collective security system is not specifically stated in the UN Charter, the contributions of civil society organizations to the management of international peace and security, through humanitarian responses, have become prominent and often pivotal in addressing the impacts of catastrophic events on civilian populations. In relation to the EVD pandemic in West Africa, Médecins

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Sans Frontières (Doctors Without Borders) particularly took the initial lead in reacting to the threat posed by Ebola by sending medical personnel to the region, and it subsequently raised the alarm over the scale of the devasta- tion and pointed out the inadequacy of deployed capacity by the interna- tional community, especially WHO.

Outcomes of the Global Response to the EVD Outbreak in West Africa In several respects, the international community’s eventual overwhelming response to the EVD outbreak in West Africa contributed remarkably in rolling back the spread of the disease in the region. According to WHO, as of 24 May 2015 there were 27,013 reported confirmed, probable, and sus- pected cases, with 11,134 deaths in the affected West African countries.98 These figures are significantly impressive because Ebola was previously known for the incredible record of over 50 percent average death rates among infected populations.99 On 9 May 2015, WHO had declared Liberia free of Ebola virus transmission, noting that forty-four days had passed since the last patient with a laboratory-confirmed case was buried on 28 March, describing this development as a “monumental achievement” because Liberia reported the highest number of deaths in the “largest, longest, and most complex outbreak since Ebola first emerged in 1976.” It was further observed that at the peak of the transmission, between August and September 2014, Liberia was reporting 300 to 400 cases every week.100

From the foregoing analysis of the global response to the EVD epi- demic in West Africa, a number of deductions can be made: (1) multilater- alism works when policies are properly sequenced during an international crisis; (2) global responses to emergencies are most effective when the con- ditions that gave rise to the situation are properly analyzed and the right policies implemented by relevant stakeholders; (3) early warning is critical to timely and effective response to potential threats to peace and security; (4) regional arrangements can play vital roles in early warning and timely response to emergencies with likely global dimensions only if they possess the requisite capacity; (5) collaborating with local sources of authority, power, and knowledge at the community level is critical to building strate- gic alliances and passing on important messages; and (6) garnering interna- tional consensus to respond to crises is more effective through securitiza- tion of the risk or threat involved.

Indeed, the failure of ECOWAS to employ the services of its special- ized institution, WAHO, to correctly diagnose Ebola in December 2013 and the inability of the ECOWAS Mediation and Security Council to properly assess EVD as a serious threat to regional security and stability and its implications to international peace and security demonstrate lack of requi-

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site capacity. Moreover, for an institution that prides itself for its forward- looking conceptualization of security, exemplified by its shift from an ECOWAS of States to an ECOWAS of Peoples, an expression that trans- lates to embrace the concept of human security, its policy on the EVD epi- demic was at best obfuscating. However, recognizing that ECOWAS still has a central if not pivotal role to play in any future epidemic response in the West African region, the international community, in keeping with the doctrine of regional-global partnerships in peace and security in accordance with Chapters VII and VIII of the UN Charter, may have to consider assist- ing the organization in developing the capacity and capability of WAHO in order to be able to operationalize and deploy its Strategic Plan and Orien- tation in the future.

Conclusion In summation, the international community faces tremendous challenges as globalization enhances mobility of risks across international borders, thereby making us all vulnerable. To galvanize political will and resources, such risks become characterized as a threat to international peace and secu- rity, which requires utilizing regional arrangements as first responders to such problems. But as we have shown in this article, internationalization of risks and threats will have little effect if regional arrangements lack ade- quate capacity to fulfill their roles within the global collective security architecture. To help in thinking how best to close the capacity gap identi- fied in this article, and as a way of preparing for future emergencies, we have outlined some policy measures below.

In accordance with the 2000 Abuja Declaration of Heads of State and Government on scaling up health budgets by 15 percent of annual budgets to reach a 65 percent response rate to malaria symptoms within eight hours anywhere in the region, the ECOWAS Authority should demand immedi- ate compliance by member states. This will go a long way in providing much-needed financing for developing health management systems in the region. The proposed African Centres for Disease Control and Prevention (CDCP) with headquarters in Abuja, Nigeria, should be integrated into WAHO’s Directorate of Epidemic and Disease Control (DEDC) and aligned to WAHO’s Strategic Plan and Orientation. This will avoid duplication of roles and the waste of scarce resources. Building on existing assets is a strategic opportunism.101 Furthermore, ECOWAS should inaugurate a Regional Integrated Security Bureau under the ECOWAS Early Warning and Response Network (ECOWARN) to monitor and assess threats from all sectors to regional security and stability, which would report directly to the Mediation and Security Council. WAHO’s Focal Points, which are spread across the capitals of the fifteen member states of ECOWAS, should be

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properly staffed and mobilized with critical resources. Obviously, these Focal Points will be the bedrock of multilateral responses to health emer- gencies in the future.

The African Union should maintain the Crisis Fund and the Solidarity Fund that it set up in November 2014. The funds should be available for emergency mobilization response in the continent that will provide initial financial facility for deployment of its missions in emergencies. The pro- posed establishment of the CDCP is welcome and should be expedited.102 The center, when fully operational, should be linked to existing Centers for Disease Control and Prevention within the regional economic communities (RECs) in the continent, such as ECOWAS’s DEDC. The AU should encourage RECs without such centers to establish them as a matter of urgent regional security and provide necessary support in that regard.

In line with the WHO reform proposals, especially in relation to capac- ity building, while this initiative is welcome, WHO should consider focus- ing on regional organizations or agencies, such as WAHO, rather than state units.103 This is because regional arrangements have wider reach104 and can therefore deliver health care, support national authorities by extending training received from WHO. Regional organizations are better placed to survey, collect, and centralize data on diseases, using fewer resources; they can also provide more effective support to the establishment and smooth running of the proposed CDCP in West Africa by helping provide local capabilities and training staff.

Considering that regional arrangements play a vital role in responding to threats to international peace and security, the UN and donor partners should empower them by assisting in building and developing their capac- ity for crisis and emergency response. Accordingly, necessary steps should be taken to provide funding for the establishment of the CDCP proposed by the AU and ECOWAS. �

Notes Obinna Franklin Ifediora is a doctoral candidate at the Asia Pacific Centre for the Responsibility to Protect (AP R2P), School of Political Science and International Studies, University of Queensland, Australia. Kwesi Aning is the director of the fac- ulty of Academic Affairs & Research at the Kofi Annan International Peacekeeping Training Centre in Accra, Ghana.

1. See Adekeye Adebajo, Building Peace in West Africa: Liberia, Sierra Leone, and Guinea-Bissau (Boulder: Lynne Rienner, 2002).

2. UN, A More Secured World: Our Shared Responsibility, Report of the High Level Panel on Threat, Challenges and Change (New York: UN, 2 December 2004).

3. See Jan Aart Scholte, Globalization: A Critical Introduction (New York: Palgrave Macmillan, 2005); David Held and Anthony McGrew, eds., Governing Globalization: Power, Authority and Global Governance (Malden, MA: Polity Press, 2002).

238 West Africa’s Ebola Pandemic

4. On these issues, see, especially, Scholte, Globalization; Held and McGrew, Governing Globalization.

5. See Kelley Lee and Richard Dodgson, “Globalization and Cholera: Impli- cations for Global Governance,” Global Governance 6, no. 2 (2000): 213−236.

6. See Stefan Elbe, Strategic Implications of HIV/AIDS (Oxford: Oxford Uni- versity Press, 2003).

7. Kofi Annan, “Problems Without Passports,” Foreign Policy, 9 November 2009, http://foreignpolicy.com/2009/11/09/problems-without-passports, accessed 26 February 2017.

8. See, for example, African Union, “AFISMA Transfers Its Authority to MINUSMA,” July 2013, www.peaceau.org/en/article/afisma-transfers-its-authority -to-minusma, accessed 14 June 2015.

9. UN Security Council, Res. S/RES/2085 (20 December 2012). 10. UN Security Council, Res. S/RES/2100 (25 April 2013). See, for example,

UN, Uniting Our Strategies for Peace: Politics, Partnerships and People, Report of the High-Level Independent Panel on UN Peace Operations (New York: UN, 16 June 2015).

11. See West African Health Organization (WAHO), “Strategic Plan, 2009− 2013,” March 2008, p. 17.

12. For detailed assessment of the economic impact of Ebola on the economies of the affected countries, see World Bank Group, The Economic Impact of Ebola on Sub-Saharan Africa (Washington, DC: World Bank Group, 2015).

13. EVD was associated with poor remote African countries, often reported in central Africa. See WHO, “Ebola in West Africa: Heading for Catastrophe?” Series on Ebola at 6 Months, http://www.who.int/csr/disease/ebola/ebola-6-months/west -africa/en/, accessed 25 February 2017.

14. WHO officially published Ebola notification at its website. However, there are reports that trace the outbreak back to December 2013. See WHO, “Statement of the 1st Meeting of the International Health Regulations (IHR) Emergency Commit- tee on the 2014 Ebola Outbreak in West Africa,” 8 August 2014, http://www .who.int/mediacentre/news/statements/2014/ebola-20140808/en/, accessed 25 Feb- ruary 2017.

15. See for instance, Michael R. Snyder, “After Ebola, Can Africa Take Lead in Responding to Health Emergencies?” Global Observatory, 14 May 2015, https://the globalobservatory.org/2015/05/ebola-african-union-health, accessed 25 February 2017.

16. See, especially, Suerie Moon, Devi Sridhar, Muhammad Pate, Ashish Jha, Chelsea Clinton, Sophie Delaunay, Valnora Edwin, et al., “Will Ebola Change the Game? Ten Essential Reforms Before the Next Pandemic. The Report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola,” The Lancet 386, no. 10009 (2015): 2204–2221. See also Médecins Sans Frontières (MSF), “Ebola: The Failures of the International Outbreak Response,” 29 August 2015, www.msf.org/article/ebola-failures-international-outbreak-response, accessed 25 February 2017; Laurie Garret, “The Ebola Review, Part I,” Foreign Policy, 6 June 2015, http://foreignpolicy.com/2015/06/06/ebola-review-world-health-organization -g-7-merkel, accessed 25 February 2017; Laurie Garret, “Ebola’s Lessons: How the WHO Mishandled the Crisis,” Foreign Affairs 94, no. 5 (2015): 80–107.

17. Hedley Bull, The Anarchical Society: A Study of Order in World Politics (New York: Macmillan, 1977); Robert Keohane, After Hegemony: Cooperation and Discord in the World Political Economy (Princeton: Princeton University Press, 1984); Robert Gilpin, War and Change in World Politics (Cambridge: Cambridge University Press, 1981).

Obinna Franklin Ifediora and Kwesi Aning 239

18. Kenneth A. Oye, ed., Cooperation Under Anarchy (Princeton: Princeton University Press, 1986); Kenneth N. Waltz, Theory of International Politics (Read- ing, MA: Addison-Wesley, 1979).

19. David A. Baldwin, ed., Neorealism and Neoliberalism: The Contemporary Debate (New York: Columbia University Press, 1993); see, for example, Thomas G. Weiss and Rorden Wilkinson, “Global Governance to the Rescue: Saving Interna- tional Relations?” Global Governance 20, no. 1 (2014): 19−36.

20. Joseph M. Grieco, “Anarchy and the Limits of Cooperation: A Realist Cri- tique of the Newest Neoliberal Institutionalism,” International Organization 42, no. 3 (1988): 485−507.

21. Robert W. Tucker, The Inequality of Nations (New York: Basic Books, 1977).

22. See the report of the UN Development Programme (UNDP), Human Devel- opment Report, 1994 (Oxford: Oxford University Press, 1994).

23. See Obijiofor Aginam, “Turbulent Marriage or Peaceful Divorce? Forecast- ing the Future Relationship of the PSC and the United Nations Security Council,” in Tim Murithi and Hallelujah Lulie, eds., The African Union Peace and Security Council: A Five-year Appraisal, Monograph No. 187 (Addis Ababa: ISS, 2012), pp. 215–228.

24. Paul-Henri Bischoff, Kwesi Aning, and Amitav Acharya, eds., Africa in Global International Relations—Emerging Approaches to Theory and Practice (London: Routledge, 2015).

25. Boutros Boutros-Ghali, An Agenda for Peace: Preventive Diplomacy, Peace- making and Peace-keeping, Report of the United Nations Secretary-General, UN doc. A/47/277- S/24111, 18 December 1992.

26. See the following Council resolutions on global-regional collaboration in the areas of peace and security: UN Security Council, Res. S/RES/1625/2005 (14 Septem- ber 2015); UN Security Council, Res. S/RES/1631/2005 (17 October 2005); UN Secu- rity Council, Res. S/RES/2033/2012 (12 January 2012). See also AU Peace and Secu- rity Council (AU PSC) communiqué, AU doc. PSC/PR/2. (CCCVII) (9 January 2012); AU PSC communiqué, AU doc. PSC/PR/COMM.(CLXXVIII) (13 March 2009).

27. Boutros-Ghali, An Agenda for Peace, par. 64. 28. See UN Security Council, “Statement by the President of the Security Coun-

cil,” UN doc. S/PRST/2004/27 (20 July 2004). 29. UN General Assembly, Res. 55/2 (18 September 2000). 30. “In Larger Freedom: Towards Development, Security, and Human Rights for

All,” Report of the Secretary-General (A/59/2005/Add.3, 26 May 2005). 31. “A More Secured World: Our Shared Responsibility,” Report of the High-

Level Panel on Threats, Challenges and Change (A/59/565/ 2 December 2004). 32. UN General Assembly, Res. 60/1 (24 October 2005). 33. “A Regional-Global Security Partnership: Challenges and Opportunities,”

Report of the Secretary-General (A/61/204–S/2006/590, 28 July 2006). 34. See the Security Council on the impact of HIV/AIDS in Africa UN doc.

S/PV.4087 (10 January 2000); UN Security Council, Res. S/RES/1308 (17 July 2000); UN Security Council, Res. S/RES/1983 (7 June 2011). See also Elbe, Strate- gic Implications of HIV/AIDS.

35. See the Special Summit of the African Union on HIV/AIDS, Tuberculosis, and Malaria (ATM) in Abuja, Nigeria, on the theme, “Universal Access to HIV/AIDS, Tuberculosis and Malaria Services by 2020—An African Position for the UN General Assembly Special Session (UNGASS) on AIDS, New York, June 2006” (SP/Assembly/ATM/3 (I), 2–4 May 2006).

240 West Africa’s Ebola Pandemic

36. See, for example, Paul D. Williams and Solomon A. Dersso, Saving Strangers and Neighbors: Advancing UN-AU Cooperation on Peace Operations (New York: International Peace Institute, 2015).

37. On these issues, see John J. Kirton, Andrew Cooper, Franklin Lisk, and Hany Besada, eds., Moving Health Sovereignty in Africa: Disease, Governance, Cli- mate Change (Surrey: Ashgate, 2014); Obijiofor Aginam, Global Health Gover- nance: International Law and Public Health in a Divided World (Toronto, ON: Uni- versity of Toronto Press, 2005).

38. See ECOWAS Protocol A/P2/7/87 on the Establishment of the West African Health Organization (WAHO), 9 July 1987. This protocol effectively merged the two existing health institutions in the region: the Francophone Organization de Coordination et de Cooperation pour la Lutte Contre les Grandes Endemies (OCCGE) and the Anglophone West African Health Community (WAHC). The rationale for the merger is to improve health systems’ and programs’ integration and synchronization of efforts for greater health delivery impact in the region.

39. Ibid., Article III (1). 40. ECOWAS, “2007−2010 Strategic Plan” (May 2007), p. 31. 41. WAHO, “Strategic Plan, 2009−2013,” p. 5. See also WAHO, “Strategic Plan,

2016–2020” (September 2015). 42. WAHO, “Strategic Plan, 2009−2013,” p. 25. 43. Ibid., pp. 8, 22. 44. Ibid., p. 30 45. Ibid. 46. Ibid. 47. Ibid., p. 31. 48. Ibid., p. 33. 49. Ibid., p. 20. 50. However, with the policy changes announced by the AU, WHO, and

ECOWAS relating to improving health management systems in the region, it is anticipated that the WAHO Strategic Plan will be reviewed, revived, and imple- mented.

51. See WHO, “International Health Regulations (IHR) Emergency Committee Statement” (2014), http://www.who.int/mediacentre/news/statements/2014/ebola -20140808/en, accessed 25 February 2017.

52. See UN Security Council, Res. 2177 (18 September 2014). 53. See Margaret Chan, “Keynote Address at the Special Meeting of the Eco-

nomic and Social Council on ‘Ebola: A Threat to Economic and Social Progress,’” New York, 5 December 2014, http://www.who.int/dg/speeches/2014/ecosoc-ebola -meeting/en/, accessed 26 February 2017.

54. African Development Bank Group (AfDB), “Report and Recommendation on a Proposal to Award a Grant of UA 40,000,000 ($60,000,000.00) Million to Strengthen West Africa’s Public Health Systems Response to the Ebola Crisis,” August 2014, p. 13. For more on civil conflicts and fragility in the three affected countries, see Adebajo, Building Peace in West Africa.

55. Margaret Chan, “Briefing to the UN on the Ebola Outbreak and Response in Guinea, Liberia, Nigeria and Sierra Leone” (Geneva: UN, 12 August 2014), http:// www.who.int/dg/speeches/2014/ebola-briefing/en/, accessed 26 February 2017.

56. Barack Obama, “Remarks at the U.N. Meeting on Ebola,” UN, New York, 15 September 2014, www.whitehouse.gov/the-press-office/2014/09/25/remarks -president-obama-un-meeting-ebola, accessed 5 June 2015.

57. See WHO, “IHR Emergency Committee Statement.”

Obinna Franklin Ifediora and Kwesi Aning 241

58. Margaret Chan, “Report by the Director-General to the Special Session of the Executive Board on Ebola,” Geneva, 25 January 2015, http://www.who.int/dg /speeches/2015/executive-board-ebola/en, accessed 26 February 2017.

59. AfDB Report, 2014, p. 39. 60. AU PSC communiqué, AU doc. PSC/PR/COMM (CDL) (19 August 2014).

See also Article 13(3)(f) of the Protocol Relating to the Establishment of the Peace and Security Council of the Africa Union, 2004, in relation to humanitarian assis- tance to alleviate the suffering of civilian populations in conflict areas and support efforts to address major natural disasters. The AU Constitutive Act identifies the need for a common policy relating to common threats and Article 4(d) provides for the “establishment of a common defense policy for the African continent.” Subse- quently, an AU document, the Common African Defense and Security Policy, iden- tified “grave humanitarian situations, as well as other circumstances and other fac- tors that engender insecurity [such as] pandemic diseases such as HIV/AIDS, tuberculosis, and malaria.” See AU, Common African Defense and Security Policy, 2004, sec. 2(iv).

61. See ECOWAS, “The Ebola: The Fight Against Epidemic of the Ebola Virus Disease Within ECOWAS,” 28 December 2014, www.ecowas.int/ebola/, accessed 25 February 2017.

62. Chan, “Briefing to the UN on the Ebola Outbreak and Response in Guinea, Liberia, Nigeria and Sierra Leone.”

63. See “Secretary-General Opens Meeting with Briefings from United Nations Coordinator for Ebola, World Health Organization, Médecins Sans Frontières,” Statement by the UN Secretary-General at the Security Council meeting, UN doc. SC/11566 (18 September 2014).

64. Ole Wæver, “Securitization and Desecuritization,” in Ronnie Lipschute, ed., On Security (New York: Columbia University Press, 1995), pp. 46–86.

65. See Gian L. Burci and Jakob Quirin, “Ebola, WHO, and the UN: Conver- gence of Global Public Health and International Peace and Security,” American Society of International Law 18, no. 25 (2014), www.asil.org/insights/volume/18 /issue/25/ebola-who-and-united-nations-convergence-global-public-health-and, accessed 25 February 2017. On securitization of public health, see, especially, Andrew T. Price-Smith, The Health of Nations: Infectious Disease, Environmental Change, and Their Effects on National Security and Development (London: MIT Press, 2002).

66. Joseph A. Lewnard, Martial L. Ndeffo Mbah, Jorge A. Alfaro-Murillo, Fred- erick L. Altice, Luke Bawo, Tolbert Nyenswah, and Alison Galvani, “Dynamics and Control of Ebola Virus Transmission in Montserrado, Liberia: A Mathematical Mod- elling Analysis,” The Lancet Infectious Diseases 14, no. 12 (2014): 1189–1195. See also MSF press release, “Ebola: International Response Slow and Uneven,” 2 December 2014.

67. See Karim Lebhour and Frankie Taggart, “Ebola Reveals Shortcoming of African Solidarity,” AFP Dakar, 1 February 2015, uk.news.yahoo.com/ebola-reveals -shortcomings-african-solidarity-155031418.html, accessed 25 February 2017.

68. See Garret, “The Ebola Review, Part I.” 69. According to the WHO Emergency Response Framework (ERF), Grade 3

emergency means a single or multiple country event with substantial public health consequences that requires a substantial WHO Country Office (WCO) response or the external support required by the WCO is substantial; WHO, Emergency Response Framework (Geneva: WHO, 2013), p. 19, http://www.who.int/hac/about /erf_.pdf, accessed 25 February 2017.

242 West Africa’s Ebola Pandemic

70. See Jenny L. Revelo, “The Other Grade 3 Emergencies Apart from Ebola,” Devex, 21 May 2015, https://www.devex.com/news/the-other-grade-3-emergencies -apart-from-ebola-86200, accessed 25 February 2017.

71. See WHO, “Statement of the 1st Meeting of the IHR Emergency Committee on Ebola Outbreak in West Africa.”

72. See Chan, “Briefing to the UN on the Ebola Outbreak and Response in Guinea, Liberia, Nigeria and Sierra Leone.”

73. WHO, “Emergency Response Framework,” p. 19. 74. Ibid., pp. 18−22. 75. See Article 12, IHR (2005). 76. WHO, “Emergency Response Framework,” p. 18. 77. Margaret Chan, “Preventing the Spread: Promoting Prevention and Improv-

ing Preparedness,” paper prepared for the “Ebola Conference: From Emergency to Recovery,” Brussels, March 2015, http://www.who.int/dg/speeches/2015/ebola -conference-brussels/en/, accessed 25 February 2017.

78. Margaret Chan seems to prefer state action and posited that “for prepared- ness, WHO identified 14 priority countries in the region. . . . The resulting national preparedness plans give development partners guidance on where support is likely to have the greatest impact.” Ibid.

79. The Executive Board, Special Session, “IHR and Ebola: Special Session of the Executive Board on the Ebola Emergency” (Geneva: WHO, 25 January 2015).

80. Margaret Chan, “Address by Dr Margaret Chan, WHO Director-General, at the Opening Ceremony of the Sixty-Fourth Session of the WHO Regional Commit- tee for Africa,” Cotonou, Republic of Benin, 3 November 2014.

81. Ibid. 82. Margaret Chan, “From Crisis to Sustainable Development: Lessons from

Ebola Outbreak,” Women in Science Lecture Series No. 10, London School of Hygiene and Tropical Medicine, 2015.

83. UN Security Council, Res. 2177 (18 September 2014). Note that the resolu- tion recognized the intervention of the UN Mission in Liberia (UNMIL) to provide support in combating Ebola virus.

84. UN General Assembly, Res. 69/1 (19 September 2014). 85. UNMEER is arguably the world’s largest multilateral response to health

emergency. It comprises some of the following partners: UN Population Fund, UN Development Programme, UN Children’s Fund, UN Office for the Coordination of Humanitarian Affairs, European Union (EU), African Union, MSF, US Centers for Disease Control (CDC), US Agency for International Development (USAID), World Bank Group, UN World Food Programme, Red Cross and Red Crescent Societies, and Logistics Cluster.

86. See “UN Mission for Ebola Emergency Response,” https://ebolaresponse .un.org/un-mission-ebola-emergency-response-unmeer, accessed 30 May 2015.

87. AU Peace and Security Council Decision on Ebola, AU doc. PSC/PR/ COMM.(CDL), 19 August 2014, pp. 4, 6.

88. ASEOWA Factsheet, “African Union Response to the Ebola Epidemic in West Africa, as of 1/26/2015,” 26 January 2015, p. 1, https://www.au.int/web/sites /default/files/documents/30999-doc-fact_sheet_as_of_26_jan_2015.pdf, accessed 25 February 2017.

89. Ibid., p. 2. 90. Ibid. 91. See ECOWAS, “The Ebola: The Fight Against Epidemic of the Ebola Virus

Disease Within ECOWAS,” 28 December 2017, http://www.ecowas.int/ebola/#,

Obinna Franklin Ifediora and Kwesi Aning 243

accessed 25 February 2017. See also, ECOWAS, “Final Communiqué,” Forty-seventh Ordinary Session of the Authority of ECOWAS Heads of State and Government, 19 May 2015, pp. 5–7, www.ecowas.int/wp-content/uploads/2015/05/Final-Communiqu %C3%A9_47th-Summit_Accra_19-May-15_Eng.pdf, accessed 25 February 2017.

92. Note that the summit’s original agenda, which was to discuss “regional security and financial issues,” had been set and published at the ECOWAS website on 20 March 2014. Thus, the Ebola outbreak was not on the agenda since the epi- demic was reported a day after. See AfDB, “Report and Recommendation,” p. 18.

93. Ibid., p. 18. 94. It is important to note that the ECOWAS Commission works through spe-

cialized institutions in emergency situations in the region. 95. ECOWAS press release, “ECOWAS Strengthens Fight Against Ebola,” 26

November 2014, http://www.ecowas.int/ecowas-strengthens-fight-against-ebola-2/, accessed 25 February 2017.

96. ECOWAS press release, “ECOWAS Defense Chiefs Mobilize Against Ebola,” 11 December 2014, http://www.ecowas.int/ecowas-defence-chiefs-mobilize -against-ebola/, accessed 25 February 2017.

97. This included Benin, Niger, Côte d’Ivoire, Ghana, Nigeria, and Mali. 98. WHO, “Ebola Situation Report—27 May 2015,” p. 2, http://apps.who.int

/iris/bitstream/10665/172637/1/roadmapsitrep_27May15_eng.pdf, accessed 25 Feb- ruary 2017.

99. WHO, “Ebola Virus Disease: Fact Sheet,” updated January 2016, http:// www.who.int/mediacentre/factsheets/fs103/en/, accessed 25 February 2017.

100. WHO Statement, “The Ebola Outbreak in Liberia Is Over,” 9 May 2015, http://www.who.int/mediacentre/news/statements/2015/liberia-ends-ebola/en/, accessed 25 February 2017. Moreover, these figures are far less than the predictions of the US CDC, although it warned that if something drastic was not done, the infection rate could top well over 1 million by January 2015. Unfortunately, reports have emerged that indicate reoccurrence of EVD in Liberia. See WHO, Ebola Situ- ation Report, 1 July 2015, http://apps.who.int/ebola/current-situation/ebola-situation -report-1-july-2015, accessed 7 July 2015.

101. See UNDP, “Recovering from the Ebola Crisis,” 2015, p. 14, http:// www.undp.org/content/dam/undp/library/crisis%20prevention/Recovering%20from %20the%20Ebola%20Crisis-Full-Report-Final_Eng-web-version.pdf, accessed 25 February 2017.

102. Although the center became operational in 2016, it is yet to be fully inte- grated into the existing RECs’ capacities, such as the ECOWAS DECD.

103. Chan’s strategy for global health security is anchored on developing country-based capacity. See Chan, “Special Session of the Executive Board on Ebola.”

104. WAHO has focal points across the capitals of the fifteen member states of ECOWAS.

244 West Africa’s Ebola Pandemic

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