“You have to love its simplicity. It’s one-billionth our size and it’s beating us.” – Sam Daniels (Dustin Hoffman), Outbreak.
There are no borders for a pandemic. It increases, exponentially, so much so as that even thousand miles away one starts asking himself “Am I really safe?” In 1976, the Ebola Virus Disease (EVD) or Ebola Hemorrhagic Fever (EHF), or simply nicknamed Ebola, made its first appearance with two back to back outbreaks. First in Nzara, Sudan and second, in Yambuku, a village near the Ebola River in Congo, from which it essentially derives its name. According to WHO reports, signs and symptoms of the disease typically start between two days and three weeks after being infected, which include fever, sore throat, muscular pain, and headaches, followed by vomiting, diarrhoea and rash, along with decreased functioning of the liver and kidneys. At this time the victims start bleeding, both internally and externally. Death follows within six to sixteen days after symptoms appear, often due to low blood pressure from fluid loss. However, this is not yet the worst picture of this disease. One skips a heartbeat once they are told ‘Ebola is highly communicable.’ Ebola spreads through direct contact, with the blood, secretions, organs or other bodily fluids of infected people and with surfaces and materials contaminated with these fluids. Although a range of blood, immunological and drug therapies are said to be under development yet, the absence of any licensed treatment is what leaves one surprised. “There are currently no licensed Ebola vaccines but two potential candidates are undergoing evaluation”, read a factsheet by World Health Organization.
Ebola, as a global concern has evolved as the largest and most complex outbreak after a case notified on March 2014, in Africa. It is true that the recent outbreak has topped all others combined, in terms of both casualties and fatalities, but the idea that Ebola is a ‘new’ concern fails to appeal. Ever since 1976, Ebola has had a capricious character. It sometimes went ‘underground’ and then emerged again, causing continuous havoc especially to the people of Africa. The following graph proves the point.
Taking the data into consideration, what any rational mind would ask is: Why did the WHO Director-General take as long as August 8, 2014 to declare this outbreak a Public Health Emergency of International Concern, when major countries of the African continent were already facing the perils for nearly the last four decades? Why has no vaccines been developed yet? Why has the development in health failed to combat such an outbreak at the root and why is it a growing concern worldwide, now when it is no more limited to the African continent? Why this no-resistance to Ebola virus?
Quoting Leigh Phillips, “Ebola is a problem that will not be solved, because it isn’t profitable to do so.” To the major pharmaceutical and drug companies the stakes of combating Ebola against the stakes for developing the required treatment is very low. Moreover, as Phillips puts it, the profit earners are barely inspired to focus on some disease that infect few and kill far fewer (if treated properly). They would rather produce a vaccine which fought malaria or tuberculosis which not only have a world-wide appeal but also kill upto numbers like 300,000 and 600,000 respectively ever since the dawn of this never-heard, less-appealing disease called ‘Ebola’. Naturally, the global tigers in the market never took up the assignment. Whatever little advancement that has been made in the last decade stayed limited to the low funded public enterprise or to very small biotech companies with insufficient funding. A variety of treatment options were developed ranging from nucleic-acid-based products to antibody therapies, and a number of candidate vaccines. Yes, the general know-how has always been there, but massive outbreaks were too rare to incentivise the major enterprises and provoke them to develop a vaccine that had a very little consumer demand in the global market, and that too from amongst the low-income earners. Moreover, the tigers saw whatever therapies or drugs they bring to the market the consumers would only have limited utility. Therefore after a point the demand shall go down and down further. Therefore they were in the right senses when they thought of investing on chronic diseases like cancer and diabetes, where the demand for the prescribed drugs never falls but rises with time. John Ashton, president of the UK Faculty of Public Health, called this “the moral bankruptcy of capitalism acting in the absence of an ethical and social framework.”
WHO director Margaret Chan stated “The Ebola outbreak spotlights the dangers of the world’s growing social and economic inequalities”. Sharp economic disparity and an inefficient healthcare, quadrupled by a tragic colonial history, superpower geopolitics and developmental neo-liberalism, collectively magnified the spread of Ebola. The economy is so weak that even the funding coming in is not allocated properly. Money needs to be spent fast and there is staunch institutional inadequacy at district level for its proper distribution. Africa carries the burden of a scary 24 percent of the world’s most infectious diseases but have only 3 percent of the world’s health professionals on board. The availability of efficient health staff including technicians and administrators is also miserably low. The countries of Sierra Leone, Guinea and Liberia combined, makes an annual expenditure on health of only US$900 million, which is nothing but a mere US$45 per head. The local health-care infrastructure is another part of the misery. Given its weak foundations the entire system is in a state of chaos and struck with the continuous shocks waves of the pandemic it has all but collapsed. Added to that, the most crucial determinant that led to the evolvement of the virus in the very first place was the lack of urban employment opportunities. A significant section of the population plunges into the rainforests as a part of livelihood, everyday, only to come out with zoonotic pathogens like Ebola.
Surprisingly, racism, as an ideology is still very much under practise in the developed world. An Ebola vaccine developed during an on-going experiment in Canada was provided on an emergency use basis to a German researcher in 2009 after he had fallen victim to an unfortunate lab accident. Jeremy Farrar, who is an infectious disease specialist and runs one of the largest medical research charities in the world, Welcome Trust, confirmed, “We moved heaven and earth to help a German lab technician. Why is it different, because this is West Africa?” In 2014, US recorded 4 incidents of Ebola infectants, all of whom were healthcare workers. All had survived, but one. On the contrary, according to WHO records, West Africa, until April 12, 2015 recorded, 14,864 laboratory-confirmed cases, out of which Ebola proved fatal to 10,626. This leads us to the obvious question: If not racism, what is it?
Besides these, the political scenario acted as a cherry on the top. While the economic elements fired the outbreak, the political factors, added fuel to the flame. Africa as a whole, from a long time has been a cave of ethnic conflicts. Mistrust against the government is a common show. So, when the outbreak occurred, initially it wasn’t just the Ebola they were fighting, the groups played blame-game. People developed a common perception that the government has used Ebola as a weapon for bio terrorism to kill a section of the population and that the injections provided by the health staff was doing less to cure them and more to spread the virus further. A second unfortunate perception which created unrest at the initial stage was when Médecins Sans Frontières (MSF) had planned to leave the country on December’13. At first their dislike towards MSF was backed by their suspicion that the aforementioned group was entirely responsible for the outbreak, and once the pandemic broke out they saw it as an excuse to stay back and draw blood from the local people which they are likely to sell and used in France. Moreover, when the first-phase of patients, who were being treated in closed tents by the MSF died, their assumptions were strongly fuelled leading to immense social disorder.
The other political element that wrecked further havoc in the crisis is when the government enforced its control measures by installing 1150 Community Watch Committees (CWC). The prime duty of the CWC was to do early warning & surveillance tasks and facilitate communication with the people on how to quell the epidemic. Every village had five committee members who were to be elected bottom up by the community itself. However, it was seen, no such elections were held, rather fixations to the post was done by the government. Moreover, the CWCs were not only heavily funded by the UNICEF and the World Bank, they were also paid a monthly remuneration of US$50 which is a considerable amount by Guinean standards. And all this was done without paying much heed to the efficiency projected by the members. The local health authorities instantly revolted against the government for demolishing the existing health structures and governance mechanisms by creating a parallel structure.
However, structural forces cannot be accused solely for the havoc brought down to the victims and their families. Culture too played bad. The ignorance and backwardness of the people hinders enlightened epidemic control efforts. They believe in spirits and witchcrafts and some are even the under the impression that Ebola is the result of some occult activities. Consequently, they diligently reject biomedicines. These beliefs also motivate their cultural behaviours like the cultural tradition of Bushmeat consumption, which is considered one of the prime reasons for the outbreak. Then the strong family feeling among the population prevents the bliss of quarantine. The victims prefer to die together as a family than survive in isolation.
While culture and economics stood at the gate waiting for the disease to evolve as a pandemic, politics and culture (again) aided in maintaining the prolonged tenure of the outbreak. While domestic groups and governments fought amongst themselves, the big brothers mishandled the situation, pretending not to see the future parameters of the trauma. It was not a four-year-phenomenon; it was both ignorance and intelligent-selfishness feeding the devil for four constant decades, to emerge in a shape like now. All one can do now is simply hope that the joint effort on the part of local and international bodies, pharmaceutical companies, and public health experts, end the current outbreak soon.
By: Senjuty Bhowmik