As you know, BRICS’ economic engagement with African nations has been substantial in recent years, including in the region badly hit by Ebola. With many BRICS workers in the Ebola affected regions, BRICS countries quickly understood the risk of the virus for their own countries, in light of the increased migration and with booming economies. BRICS thus responded positively—but unfortunately also largely separately, not as a joint BRICS effort —to the Ebola outbreak in West Africa, even if some of the former colonial powers from the West took the lead in the global response (albeit belatedly). BRICS countries contributed bilaterally, via regional channels but also through multilateral institutions, especially UNMEER, the UN Mission for Ebola Emergency Response, and WHO.

Of the BRICS countries, China’s contribution has no doubt been the most significant, even if the epidemic also revealed certain problems in Sino-African relations, according to Ian Taylor.  China delivered four rounds of emergency funding up to 129 million dollars, building treatment centers, increasing the number of Chinese medical and military medical staff and building mobile laboratories. The Ebola situation was the first time that China extended humanitarian aid to countries facing a public health emergency.  China has donated approximately 13.9  million USD to  multi-lateral agencies like the World Food Program (WFP), WHO and the UN Multi-Partner trust Fund (MPTF) under UNMEER, and nearly 30.7 million USD in the form of in kind aid for laboratories, food, disease prevention materials, and medical response teams in Liberia, Guinea and Sierra Leone. The latter funds have also contributed to containment efforts in ten neighboring countries and within the African Union.

The South African Cabinet committed close to $3 million to support the containment of the virus through mobile laboratory services and training healthcare personnel. Till now, South Africa has donated almost 325,000 USD to the WHO for Ebola relief efforts. The country also sent some health professionals to deal with the epidemic. The  Ebola Response Fund, a joint initiative of the South African government and the private sector also raised 1 million USD in cash and resources.

Although their bilateral links to West Africa are less strong, other BRICS countries also provided direct support to Ebola affected countries. For example, Brazil’s Health Ministry donated a number of medical kits to affected countries, and donated   nearly 7.3 million USD in bilateral aid and contributions to the WFP, WHO and the MPTF under UNMEER, to affected countries. India gave 2 million dollars for the purchase of protective gear for health workers in the affected regions,  10 million USD to MPTF/UNMEER, and nearly 0.6 million USD to support WHO efforts to prevent the spread of the Ebola virus. The Russian Federation has provided nearly 0.5 million USD to the WFP and 20 million USD in bilateral aid to the governments of affected countries. Russia has also pledged nearly 8 million USD to various other UN agencies. BRICS countries also help develop affordable Ebola drugs and vaccines, with the Chinese increasingly playing  an important role in this respect.

In addition to providing direct financial support to other UN agencies than UNMEER & WHO (see for example quite a substantial contribution from China to the World Food Program activities in affected areas), BRICS  also sent peace-keeping task forces. In addition to the national governments, several BRICS companies operating in West Africa also contributed to the Ebola response. For instance, China Kingho Group, a leading exploration and mining company in Sierra Leone, donated about $90,000 to the government and people of Sierra Leone. The Russian mining company Rusal  constructed and opened a treatment and research center in the city of Kindia in Guinea at a cost of $10 million.

An assessment

As we already mentioned, information on BRICS’ aid to West Africa (not just Ebola related assistance) is fragmented. Although development assistance for health from BRICS countries is increasing, their support has not often been recorded in the OECD-DAC report. Figures in different Ebola response resource trackers do not always correspond, and there’s also sometimes a difference between amounts pledged and money actually delivered (like for other countries). Nevertheless, let us try to come up with some key messages anyway, even if based on patchy data and a ‘quick & dirty’ search.

Despite widespread criticism of WHO’s handling of the Ebola response at the early stages, BRICS countries have firmly supported the UN and WHO in coordinating efforts to contain Ebola throughout the epidemic. The 4^th BRICS health ministers’ meeting in Brasilia, December 5 2014,  supported the efforts taken at all levels and confirmed support for the strategic objectives of UNMEER to contain the outbreak, treat the infected, ensure essential services, and preserve stability.

Despite several large scale efforts of health cooperation among BRICs countries in recent years, it is fair to say that the BRICS responses related to Ebola control in West Africa have been relatively fragmented. BRICS countries prioritized global health strategies mainly through (their own) bilateral cooperation with West-African countries, and by contributing to the global multilateral response. Although the BRICS share many common health interests, different foreign policy interests may have prevented them from developing common positions or a coordinated response in this particular international public health emergency.  That is definitely not a first, BRICS countries are, like other countries, quite flexible in seeking coalitions in other (for example development) agendas.

In comparison to former colonial powerhouses such as the US and the UK, BRICS countries have  played a constructive but secondary role in responding to Ebola emergency. Among the BRICS countries, China seems to have made the most significant contribution, which is easy to understand as China, among the BRICS countries, has the longest history of supporting health and economic development in Africa. It is likely that China will also play a key role in the recovery stage of countries (and their health systems) in the post-Ebola stage, in line with its new aid focus on UHC in Africa.

Finally, BRICS countries will no doubt have their say in the – likely – thorough revamp of the global health architecture in the coming months and years, after this rather nasty surprise. Global health security is also a key concern for them, not just for wealthy nations in the North. No doubt that will already become clear at next week’s World Health Assembly in Geneva.

Correspondence to: Guanyang Zou (zgy1021@hotmail.com)

My name is Guanyang Zou. I’m currently working as a China Program Manager for the DFID-funded COMDIS Health Services Delivery Research Consortium, University of Leeds, and also doing a PhD (part-time) at the Institute for International Health and Development, Queen Margaret University, Edinburgh UK(1).

I am lucky enough to be selected for the 2014 Emerging Voices for Global Health Program, having the privilege to access state-of-art training in health research, including attending the 3^rd Global Symposium in Cape Town, South Africa. If you vote for me, I will represent the Emerging Voices and other young voices, especially those from the Asian Pacific Region, in the Health Systems Global Board.

It is precisely the dynamic, stimulating and excellent Emerging Voices groupthat has motivated me to stand for this election, to represent and serve diverse and emerging needs of these and other young researchers. As emerging researchers, we understand how important it is to have young representatives to advocate for the interests and development of young researchers in the Board and beyond. Young researchers are active, energetic and have clear views. They are in the best position (and stage of career) to conduct research, and what they are doing now will influence their lifelong research.

However, publication-based, impact-factor orientated research assessment may dampen our enthusiasm, especially for qualitative health systems research. Indeed research does not mean publication only, but also involves contributing to policy and practice. We are often puzzled about the value of research because of the poor utilization of research evidence in the health policy, especially in bureaucratic systems. We may not have adequate access to research grants which tend to go to more experienced and senior researchers. But we need more opportunity and ownership and we are well placed to have these. We also lack mechanisms where our voices can be adequately heard, especially in the field of health systems research.

Therefore, we need better incentives, ownership and mentorship to pursue lifelong and high quality health systems research. I believe addressing young researchers’ needs will help to advance the mission of the Society- in terms of knowledge generation, knowledge translation and implementation research.

If selected, I would bring on board my six years of operational research experience with DFID-funded programs, which aim to influence policy and practice in disease control in China and other developing countries. This experience, together with my first employment as an aid officer for Africa (2000-08), has shaped my particular interest in the global and health systems debate, especially on South-South collaboration in health systems strengthening through knowledge translation(2,3).

If selected, I will contribute to the Board by:

• Shedding light on the broad experiences, perspectives and knowledge of young voices and engaging young researchers for cross-country learning of health systems, e.g.,  through on-line forums.
• Suggesting research agenda items for the Society, notably regarding young researchers’ development and mentorship, e.g., establishing a coaching scheme through matching of senior and young members, and a mutual development scheme between young members, in any issues regarding career development, grant application, writing publications, ….
• Facilitating more small-scale health systems research grants and travel grants for young researchers.
• Improving networking opportunities for youth, e.g., by ensuring a youth lens in all thematic groups.
• Facilitating the establishment of a youth committee, to coordinate with the current Emerging Voices Program and other youth affairs, and attract more young members.
• Assisting with financial management and contributing to the research agenda.

To vote, please go to http://www.votebyinternet.com/hsrs2014  You have to login first. The on-line election is open until next Tuesday (16 Sep). My name (Guanyang Zou) appears as the last of the – alphabetical – candidates’ list.

References:

(1)   http://www.qmu.ac.uk/iihd/profiles/research_student_profile_Zou_Guanyang.htm

(2)   http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60713-3/fulltext;

(3) http://www.internationalhealthpolicies.org/china-helps-to-combat-ebola-in-west-africa/

In recent months Ebola has become a public health emergency of international concern. In response, China, a country with over 50 years’ history of providing medical aid in Africa, has sent small teams of public health emergency experts to three Ebola-affected West African nations — Guinea, Liberia and Sierra Leone. This is the first time that China has dispatched expert taskforces to foreign countries in response to a public health emergency.

The emergency response teams, which include public health and intensive care experts, work closely with the Chinese Medical Teams already present in these countries to strengthen  the prevention and control of Ebola, for a limited period of time. Chinese Medical Teams are rotating every 2 years and based in 49 developing countries – 42 of the countries to which teams are dispatched are in Africa (as of 2013). Each team consists of a number of medical and auxiliary staff who provide medical services and train local medical workers.

The dispatched teams also get generous emergency relief support from China, and do not only contribute to the containment and control of Ebola, e.g. via personal protection and hospital infection control, but also assist with the medical treatment of Ebola. In addition, they carry responsibility for the prevention and control of Ebola among the Chinese population in these countries.

However, given the long history of Chinese medical aid in Africa, and the country’s rich domestic experience in responding to public health emergencies such as SARS and H7N9, China could play an even bigger role in supporting West Africa to combat Ebola.

Firstly, improved sharing of the successful experiences in controlling SARS, H7N9 and other emerging infectious diseases with Ebola affected nations in West Africa is a must. It was not until the SARS outbreak in 2003 that China’s public health system was greatly strengthened –  with improved funding, infrastructure and human resources. Hopefully, the affected nations will also benefit from the response to the Ebola outbreak to improve their health systems. As a priority, China can share with them its successful experiences in improving emergency response systems, including, for instance, improved public health and medical responses and effective collaboration between both responses, strengthened health infrastructure and disease surveillance as well as information sharing, multi-sector and international collaboration. No doubt the dispatched teams will talk about these domestic experiences during their work in the affected nations. However, more financial and technical and even longer term support could be provided to affected nations to improve their public health systems. Having said this,  China will no doubt also learn from its participation in the Ebola response.

Secondly, Chinese Medical Teams, which tend to have a good reputation among local patients, should help to improve public awareness of the disease, and regain people’s trust and confidence in the health care response and staff, which is perceived as the biggest challenge in the battle to contain Ebola.

Thirdly, strengthening international collaboration will be crucial to reduce aid duplication and  stop the international spread of Ebola. The dispatched teams need to overcome language and cultural barriers in the wider collaboration with international and local experts in a foreign environment.

Providing public health and system support to African partners is relatively new for China.   The Ebola outbreak further suggests the importance of investing in public health and research initiatives in Africa. The current medical teams need to be reshaped, with enhanced public health training and the inclusion of public health experts to better contribute to health systems strengthening in Africa.

Correspondence toGuanyang Zou, Room 403 No.1032 Dongmen Bei Rd, Shenzhen, China, PC 518000, Tel(fax): +86 755 22250390; Email:zgy1021@hotmail.com;Gzou@qmu.ac.uk