Imagine two cities. In City A, town leaders notice that every few weeks a house catches fire. So they create a fire department – a group of professionals with prepositioned firefighting equipment and special expertise. In City B, town leaders don’t create a fire department. When there’s a fire they hurriedly cobble together some people and equipment to fight it.
We are City B. We are particularly slow to build institutions to combat long-running problems. The most obvious example is the fight against jihadism. We've been facing Islamist terror for several decades, now, but every time it erupts – in Lebanon, Nigeria, Sudan, Syria and beyond – leaders start from scratch and build some new ad hoc coalition to fight it.
The most egregious example is global health emergencies. Every few years, some significant epidemic strikes, and somebody suggests that we form a medical expeditionary corps, a specialised organisation that would help co-ordinate and execute the global response.
The result, right now, is unnecessary deaths from the Ebola virus in Africa. Ebola is a recurring problem, yet the world seems unprepared. The response has been slow and unco-ordinated.
The virus's spread, once linear, is now exponential. The normal countermeasures – isolation, contact tracing – are rendered increasingly irrelevant by the rate of increase. Treatment centres open and are immediately filled to twice capacity as people die on the streets outside. An Oxford University forecast warns as many as 15 more countries are vulnerable to outbreaks. The president of Liberia, Ellen Johnson Sirleaf, warned: "At this rate we will never break the transmission chain and the virus will overwhelm us."
The catastrophe extends beyond the disease. Economies are rocked as flights are cancelled and outsiders flee.
, a philanthropist and United Nations special envoy focused on global health, points out the impact on health more broadly. For example, people in the early stages of malaria show similar symptoms to Ebola and other diseases. Many hesitate to seek treatment fearing they’ll get sent to an isolation centre. So death rates from malaria, pneumonia and other common diseases could rise, as further Ebola cases fail to be diagnosed.
The World Health Organisation has recently come out with an action plan but lacks logistical capabilities. US president Barack Obama asked for a strategy, but that was two months ago and the government is only now coming up with a strong comprehensive plan. Up until now, aid has been scattershot. The Pentagon opened a 25-bed field hospital in Liberia. The US donated five ambulances to Sierra Leone. Co-ordination has just not been there.
At root, this is a governance failure. The disease spreads fastest in places where the healthcare infrastructure is lacking or nonexistent. Liberia, for example, is being overrun while Ivory Coast has put in a series of policies to prevent an outbreak. The few doctors and nurses in the affected places have trouble acquiring the safety basics: gloves and body bags. More than 100, so far, have died fighting the outbreak. But it's not just a failure of governance in Africa. It's a failure of governance around the world. I wonder if we are looking at the results of a cultural shift.
A few generations ago people grew up in and were comfortable with big organisations – the army, corporations and agencies. They organised huge construction projects in the 1930s, gigantic industrial mobilisation during the second World War, motorway construction and corporate growth during the 1950s. Institutional stewardship, the care and reform of big organisations, was more prestigious.
Now nobody wants to be an organisation man. We like start-ups, disrupters and rebels. Creativity is honoured more than the administrative execution. Post-internet, many people assume that big problems can be solved by swarms of small, loosely networked nonprofits and social entrepreneurs. Big hierarchical organisations are dinosaurs.
The Ebola crisis is another example that shows that this is misguided. The big, stolid agencies – health ministries, infrastructure builders, procurement agencies – are the bulwarks of the civil and global order. Public and nonprofit management, the stuff that gets derided as “overhead”, matters. It’s as important to attract talent to health ministries as it is to spend money on specific medicines.
As recent books by Francis Fukuyama and Philip Howard have detailed, this is an era of general institutional decay. New, mobile institutions languish on the drawing broad, while old ones are not reformed and tended. Executives at public agencies are robbed of discretionary power. Their hands are bound by court judgments and regulations.
When the boring tasks of governance are not performed, infrastructures don’t get built. Then, when epidemics strike, people die. – (New York Times 2014)