The
ongoing Ebola outbreak in West Africa is so
serious that the World Health Organization (WHO) has declared the situation a "Public
Health Emergency of International Concern" (PHEIC) (2). This is only the
third time that such a status has been activated. The main focus in the
mainstream media has been upon expensive potential pharmaceutical treatments,
such as ZMapp, or upon more desperate sounding convalescent serum treatments.
With drugs like ZMapp, even if they work on a large scale there is little
chance of the medications being mass produced in time to deal with the current
outbreak, even assuming that the African states or the people affected could
afford them - which they cannot (3). The alternative treatment using convalescent
serum -that is serum obtained from one who has recovered from an infectious
disease and considered to be especially rich in antibodies against the
infectious agent of the disease - was last tried in 1995 in an Ebola outbreak
in Kikwit in the Democratic Republic of the Congo
(4). However, the medical evidence pertaining to the success of this type of
treatment is contested between scientists.
Ebola
is a zoonotic disease. Exactly how the virus transferred to the human populace
is linked to bats being the vector (5). This long-established fact that has led
to some western-centric cultural critics deriding Africans for continuing to
eat fruits bats whilst ignoring the evidence that this is not the primary cause
for the viral spread (see, for example, The
Guardian - "Ebola risk unheeded
as Guinea's villagers keep on eating fruit bats" (6)).
Economic legacy
and weakened health systems
How
viral diseases evolve, whilst of interest, is not the subject here. What is
important for scientists to appreciate is how economic conditions can create
conditions that allow a virus like Ebola to spread and how prevailing
conditions affect the robustness of states to respond to such crises.
That
economic conditions have a causative role in the spread and response to the
current epidemic has been featured in two recent reports. The first report, from
Business Monitor, suggests that efforts to contain the outbreak have been
hampered by weak state capacity, lack of public funding and poor health
infrastructure (7). In essence, all affected countries do not possess the
requisite state resources and capacity to adequately manage the outbreak.
Although the report draws its arguments from a free-market perspective, the
analysis describes institutional weakness, widespread corruption and weak
government finances and capacity to act as factors that are constraining the
ability of governments and foreign aid agencies to respond effectively to the
situation. Moreover, a limited government ability to take command in rural
areas, where the majority of cases originate, is further impeding efforts to
slowdown the spread of the disease. An economic analysis may well identify similar
factors, although the prescription measures would be very different.
The
decades of under-investment in the health systems of West African states is
also covered in a report issued by the medical charity, The Wellcome Trust. The
Trust has announced that it is donating a multimillion pound sum to help
establish a non-governmental organization called "Enhancing Learning and Research for
Humanitarian Assistance" (ELRHA). The primary purpose of ELRHA is to build
a research community. The Trust argues that because of decades of under
investment in medical research the affected countries do not have a viable
scientific research community capable of developing home-grown potential drug
treatments to Ebola and other diseases (8).
The
poorly-conceived health systems and weak scientific culture are a consequence
of the colonial legacy and trajectory of post-colonial development. Intermixed
with some early flawed periods of state socialism; and followed by dictatorships,
political corruption and military coups; and ending with fragile capitalist democracies, the
post-colonial years have ended with West African nations seeing Western
governments and global monetary institutions impose an onerous debt regime.
This has forced these countries to pay more in interest on debts to the World
Bank and International Monetary Fund (IMF) than they spend on healthcare,
education, or infrastructure (9). Furthermore, much aid has been in the form of
Structural Adjustment Programmes (SAP), orientated towards projects that have
not often been for the good of the populations; and where projects, both good
or bad, have carried with them the price of debt servicing burdens and tie-ins
into regressive international trade.
The
effect of structural reforms on healthcare has led to a lack of primary care,
few healthcare campaigns aimed at health protection or health promotion,
systems that do not extend into the more economically deprived areas, and the
chilling hold of private corporations.
In
Guinea, for example, the Bamako Initiative of 1987 led to a shift towards a
fee-paying healthcare system leading to many treatments being beyond the reach
of ordinary citizens. The Bamako Initiative was drawn up in collaboration with
the World Bank and led to the decentralisation of healthcare across Benin,
Guinea and Nigeria (10). The decentralised system has arguably hindered the
ability to formulate an effective national plan against Ebola. In Sierra Leone
free healthcare only extends to pregnant and breast-feeding women and children
under five (11).
Other
health statistics indicate why the West African states have struggled to
contain the Ebola. Guinea spends only $62 per person on health each year,
compared with $3,364 in the U.K. Guinea has the lowest number of hospital beds
per capita in the world. Sierra Leone has just two doctors per 100,000 people,
compared with 245 in the U.S. Nigeria too has experienced a lack of medical
personnel. It is estimated that as many Nigerian doctors are practising in the U.S.
alone as there are working in the whole Nigerian public service (12).
Furthermore,
post-colonial economic management by West African governments in thrall of
western capital has led to decentralised health systems and collaborations with
private multinationals. These reforms have further hindered the ability of the
governments to respond effectively to the crisis. Moreover, the countries
contain internal divisions and competing power blocks; without intending to
oversimplify, the separations of language, religion, and ethnic groups have
been exacerbated by post-colonial policies that have widened economic
inequality and orientated healthcare towards the cities and away from the
countryside. It is in the poorest regions, outside of the cities, where Ebola
is most concentrated.
There
is also a legacy of mistrust against health workers from the West. When much of
the continent was under colonial rule, colonial powers used African outposts as
their laboratories, and Africans as their test subjects. This accounts for a
level of fear and suspicion, and an appreciation of this is important for the
voluntary workers engaged in the affected countries. The extent that the
populations feel helped or exploited at the end of the crisis will help modify
whether this suspicion of the outsider is enhanced or attenuated.
The myth of
international aid
It
could be taken from some reported news
stories that money is flooding into West Africa as a result of the Ebola
epidemic. While some funding has been sent through, the level of support and
aid going into the west African nations is not as great as the global media
implies. With the WHO, for example, the United Nations body's budget for
outbreaks and crises has declined by 35% since 2010. In July 2014, WHO estimated
that $103 million was needed to continue the fight against Ebola. Nevertheless,
the Agency only has a fifth of that available and it faces a gap of $79
million. Moreover, a decline in aid and support in the years leading up to the
current Ebola epidemic have arguably laid down some of the foundations for
sluggish ability of the African governments to respond.
Whilst
a number of aid agencies have sent out health workers and charities have
transferred donations, the levels of money provided by the governments of the
West and the major global institutions fall far short of what is needed. Again
the veneer of rhetoric needs to be stripped away. The World Bank has stated
that it will devote up to $200 million to fight Ebola; however, most of this
will be drawn from funds already allocated to the affected countries. It also
stands that this aid comes with a string of policies that must be applied
(continuing with the SAP initiatives, as discussed above).
Economic impact
and the continuing hold of the multinational
The
economic impact of Ebola on the affected states is considerable. With the
internal economy, a combination of cases of infection and a fear of the
virus appear to have had an equivalent
impact to that of an environmental disaster. Crops rot in the fields, mines are
abandoned and goods cannot get to market. In quarantined zones in Sierra Leone
and Liberia, key cash crops such as cocoa and coffee have been left rotting in
the fields as farmers fear to stray far from home. Agricultural issues are not
only confined to exports. In township markets, supplies of staple commodities
such as rice are already dwindling, with only the bravest traders willing to
venture far afield to buy stocks.
Rather
than address the fall-out, several of the actions of the African governments
have been directed to appeasing international capital management. This is the
basis of a charge made by Amadou Soumah, a trade union official in Guinea. It
was only during mid-August that Guinea declared Ebola to be a national emergency.
This is despite the country being at the epicentre of the outbreak, with the
first cases reported in March 2014. Soumah argues that the government played down
the crisis "to stop investors fleeing" (13).
Despite
of the attempts by some African government to micro-manage the crisis, the
economic response from the multinational firms has been to protect their
interests. Several multinational companies
have suspended operations. For example, Steel giant ArcelorMittal,
headquartered in Luxembourg, has halted work at its iron ore works in Liberia
and has withdrawn its executives. Having exploited the region for decades, the
company seems to have no inclination to offer economic support. To take a
different example, several international airlines have halted their flights to West
Africa. These reactions are likely to have a long-lasting impact on the
national economies, a point noted recently by the president of the African
Development Bank, Donald Kaberuka (14).
In
other cases, the multinationals are staying put. There are no signs that the
epidemic has affected the economically vital oil industry, mainly because the
African governments and multinationals are working hard together to ensure
continuity. Taking Nigeria, where the multinational oil companies have for many
years collaborated with the government to exploit a region in southern Niger
Delta that lies about 600 miles from Lagos. In this region, there have been as
many cases of Ebola as they have been in areas where agricultural commodities
predominate. However, with these oil rich areas the Nigerian government has
provided support, in terms of supplies, resources, and it has erected barriers
to create a quarantine zone, protecting the oil drilling activities of Royal
Dutch Shell and Chevron Corporation from the main parts of the country. West
Africa sits atop 15 percent of the world’s oil (15) and this is far too
profitable an operation to be interrupted by illnesses afflicting the local
populace.
The
crisis also carries with it the risk of further liberalisation of the economies
of the affected countries and thus more opportunities for multinationals to
move in once the crisis is over. The African Development Bank, which is locked
into the global financial system, has provided loans and is proposing a greater
injection of capital to West Africa. The problem is that these are tied loans
in a similar way to money advanced by the World Bank. Here capital is
orientated towards particular projects aimed at diversifying the economy and
cementing damaging public-private partnerships.
On
the political front the crisis presents opportunities for governments to
strengthen authoritarianism. For example, in the worst affected country
Liberia, President Ellen Johnson Sirleaf, of the right-wing Unity Party, has ordered
night time curfews and quarantine zones in the most economically deprived areas
in the country, including Monrovia's West Point slum and Dolo Town, to the east
of the capital.
Another
fall-out from the crisis that could have longer-lasting repercussions is the
effect on pan-African unity for some underlying historical fractures have been
re-opened. Several West African nations have sealed their borders with their
neighbours in attempts avoid cross-infection. This could lead to countries
leaning more towards the international capital rather than engaging in
cross-national trading, getting further indebted in the process. An alternative
would be to build a pan-African union based on greater self-sufficiency and
less dependence upon the invasive multinationals.
The way forwards
There
are no immediate solutions to the Ebola crisis other than supporting the work
of aid agencies and health care workers. Once the epidemic has declined, and
hopefully the risk of pandemic does not rise, then what matters is helping the
West African nations to build effective healthcare systems on a central model
and free from interference from global finance. These healthcare systems need
to be properly staffed, with well-supplied clinics, and free at the
point-of-use. Behind this a scientific foundation is needed so that African
nations can develop appropriate medicines and become less reliant upon global
pharmaceutical companies. For instance the only reason why there is any
treatment at all in the pipeline, Tekmira’s TKM trial drug, is that the US
Department of Defense funded the work. There is little profit for big
pharmaceutical corporations in a drug to treat intermittent virus outbreaks,
especially in the world’s poorest countries. There is a lot more money in
drugs, like Simvastatins, that people will take for decades for less serious
conditions in the richer countries of the world. Even New Scientist was moved
to comment on ‘market failure’. Home grown science and infrastructure would help
these countries handle not just outbreaks of Ebola, but more common diseases
such as malaria, cholera and HIV. To do so requires governments willing to
consider central solutions and to steer economies in alternative directions
from capitalism.
Summary
This
article has attempted to place the Ebola crisis into a historical and economic
context. Part of the reason for the deficiencies in containing the spread of
the disease is a consequence of a failure during the post-colonial years to
have built up a strong socialised health care system, and where the elements of
it existed, to dismantle it; a secondary reason is the bias of major programmes
to attract investors rather than developing the infrastructure necessary to
build up the affected countries .
Scientists need to analyse the events of the past and examine the internal and external
influencing factors on post-colonial
development; and then to use this inquiry as a means to help develop an
alternate socio-economic trajectory. The very real risk is, with a crisis still
unfolding and the death toll rising, that governments will extend their hands
further out to the multinationals and international capital will increase its
hold on West African states even more tightly than before.
In
the short term we should insist that the resources necessary to contain
Ebola are found. Instead of voting for $225 million to fund the Israeli state’s
‘Iron Dome’, the US Congress should have sent that money to West Africa . The
health workers of West Africa must be honoured and supported not feared and
taken for granted. The UK health unions must find a way to get money to their
west African colleagues to ensure they are looked after and have full trade
union rights
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Posted by Tim Sandle
The
contents are:
Posted by Tim Sandle
Posted by Tim Sandle
