The outbreak in Central Africa continues to spread. The latest figures of more than 160 deaths and 600 suspected cases almost certainly represent a significant undercount, and the trajectory remains deeply concerning. For those of us in the U.S., the personal risk remains low, but the toll on the region is severe.

Figure by Resolve to Save Lives

Ebola is often called the disease of compassion by experts like Dr. Craig Spencer. It spreads through direct contact with bodily fluids, which means it spreads when a family member tends to the sick, when a nurse stays at the bedside, or when a community gathers to bury their dead. In other words, it’s spread through acts of care.

But the phrase has been sitting differently lately because this outbreak is spreading not only through compassion but also through the global withdrawal of it. It’s impossible to ignore the quiet (or not-so-quiet) shift from “we” to “me” over the past several years (decades?), now contributing, to some extent, to a body count.

A dangerous myth: Self-interest and global good are opposites

Over the past several years (decades?), a tug-of-war battle has been taking place between individualism and collective responsibility, becoming one of the defining tensions in American identity.

It’s not too hard to understand why. When systems fail people, like through crushing health care costs, stagnant wages, lack of accountability, and governments captured by private interests, people stop trusting those systems. If no one is coming to save you, you learn to save yourself. Sprinkle in profit and power grabs amid the vulnerability of division and isolation, and… here we are.

This personal survival instinct became a governing philosophy, then policy. Fields like public health, which have been built on the basic assumption that society as a whole values a collective approach, have been intentionally targeted. This thinking became so dominant, in fact, that people cheered when a chainsaw was taken to USAID—an organization that built clinics, trained health workers, funded labs, and supported rapid response teams in the places where outbreaks begin. Ebola is one of the first outbreaks unfolding in the aftermath of cutting this global health funding.

Source: STAT news

The prevailing idea is that what happens on the other side of the world has nothing to do with us. But this idea is a myth, especially when it comes to diseases, for three main reasons:

1. Americans are impacted by this Ebola outbreak directly, as they are being flown to another country to seek care.
2. We live in an interconnected world bound together by supply chains, air travel corridors, and accelerating disease spillovers from animals to humans. No wall can stop a pathogen, and neither can a travel ban.
3. The stakes are also economic. For example, when the U.S. invests in global health research and development, it can yield a sixfold return, including new jobs and economic activity. The Covid-19 pandemic cost 500 times what it would have to invest in proposed preventive measures to reduce disease spillover. The price of prevention is remarkably low, at less than 1% of the federal budget.

This week, the State Department seemed to realize the mistake and announced it will fund up to 50 Ebola treatment clinics in the DRC and Uganda, touting it as an “ironclad” commitment. Sure, treatment centers matter a lot if this actually happens. (As you can see below, the countries don’t even know this is happening.) But what works even better, and is more cost-effective? Helping prevent this in the first place.

True self-interest, rightly understood, is investment in global health. It is a myth that they are at odds.

The ethic of “just because”

But reducing all of this to strategy, or ROI, or soft power is, itself, a shortcoming. Strategy isn’t necessarily why people like the doctors and nurses of Médecins Sans Frontières have spent decades running toward the fire. They put their lives on the line because they simply care.

There used to be a shared value of foreign aid and international cooperation, broadly based on the idea that help was needed. The ROI was compassionate care for others as neighbors, grounded in empathy and equity. The ROI was saving lives and serving. That is enough.

The World Health Organization was built on this. The entire postwar international order, as flawed and incomplete as it often was, rested on the idea that nations had obligations to one another that went beyond what they could extract. That a human life had value that did not depend on its proximity to power, or its usefulness to anyone’s GDP. The value of a life, of all lives, matters and should not depend on where you live.

The Marshall Plan, for example, was not philanthropy because it was strategic. It was simultaneously multiplicative, collective, and synergistic. The people who built it did not find that troubling.

We have lost the animating belief that strangers’ suffering is our concern. That the provision of care is not decided by power but by compassion and collective empathy.

The cost is always paid by the same people

The most heartbreaking thing about all of this is that radical individualism doesn’t distribute its consequences equally. It always funnels suffering downward to the poor, the rural, and the people whose names don’t appear in the articles until they are counted among the dead.

Ebola’s geography is not an accident. Sure, it’s where the fruit bats live, but the cost is high for a reason. The cost lives where the hospitals don’t, where the roads end in mud, and the power cuts out, where the cold chain for vaccines has never been reliable, where the nearest trained physician might be two days’ travel away. It thrives in the gaps left by decades of systematic disinvestment, war, poverty, and a warming climate, and structural adjustment programs that stripped health budgets to the bone. Sometimes international attention arrives, but like many things in public health, it comes in cycles of panic and neglect. Once the cameras leave, so does the money.

The pushback seems to center around power and money. The same countries that hold most of the world’s wealth continue to be the most advanced in terms of health care workers, the number of medical facilities, and their ability to care for infectious diseases like Ebola. There remains a misconception that trickle-down economics and capitalism are the only ways for countries and people to thrive. In an ironic twist, investing and caring for the poorest of the poor first actually benefits all of us more. No matter how you slice the data, collectivism beats out individualism every time.

Research from one of us (Emily Smith) shows that when we start with the poor first, in a trickle-up economy, we actually fare better globally. Within and between countries, starting with the most vulnerable, is advantageous to all of us, fiscally, more than trickle-down capitalistic, individualistic approaches. This is health and wealth. But it only happens when we center the poor first. When the poorest of us are taken care of, we all thrive.

Bottom line

Ebola is called the disease of compassion because it spreads through caring for one another. What we are watching now is what happens when that caring is systematically dismantled. I hope the pendulum finds its way back to a place where compassion and the communal good can, once again, simply exist.

Love, YLE and FNE (ES)

Dr. Emily Smith (ES) is a global health epidemiologist, professor, and scientific communicator. She is the author of the Substack Friendly Neighborhood Epidemiologist (FNE) and the book Science of the Good Samaritan.

Your Local Epidemiologist (YLE) is founded by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife. YLE comprises a team of experts, ranging from physicians to immunologists to epidemiologists to nutritionists, working together with one goal: to “Translate” ever-evolving public health science so that people are well-equipped to make evidence-based decisions. YLE reaches over 425,000 people across more than 132 countries. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below: