As of Oct. 1, there have been 3,330 deaths from Ebola in Guinea, Liberia and Sierra Leone, according to the World Health Organization (WHO). The WHO has also warned of 20,000 more cases in these three countries by November and, in the worst-case scenario, 1.4 million cases in the new year. Doctors Without Borders’ head Joanne Lui warns that the promised money, beds and equipment have yet to arrive and are simply trickling into these places.
This week, Ebola arrived on US shores as the Centers for Disease Control and Prevention announced that Thomas Eric Duncan, a middle-aged man from Monrovia recently working as a driver in the Liberian capital, had fallen ill with the disease in Dallas. The first response of many I know has been, as exhibited on my Facebook wall and in emails and text messages:
Am I safe?
I’m no expert on Ebola but have worked in global health for a long time. I don’t blame my friends or family for asking me. Nor do I blame them for the obvious question.
And yet, therein lies the problem.
This year, it’s Ebola. A few years ago it was extensively drug resistant tuberculosis or XDR-TB. For those that can remember the early 1980s, then it was HIV. Exotic infections for Americans, often from far away places, often Africa, strike fear into their hearts, but only once the pathogens have cleared customs. The death toll on the other side of oceans has little meaning for us.
We need to remember that all these epidemics didn’t need to happen. Early action could have prevented their spread, investing in health systems could have stymied their emergence in the first place. We like to call them diseases of the poor, but this is a strange construction.
Poverty doesn’t cause Ebola, XDR-TB or HIV/AIDS. These are diseases visited on the poor, biblical plagues inflicted upon them. In the Old Testament of course, it was the powerful that felt God’s wrath, the Pharoah’s people who watched their loved ones die. In the great book of the modern world, it’s the powerless that perish at the hands of men.
The Americans, the Canadians, the Europeans, the Australians, the Japanese all largely ignored what we now call global health before the advent of the AIDS epidemic. In fact, the so-called developed world waited 20 years to do anything about that scourge, even after millions and millions of deaths. Now of course there are billions of dollars sloshing around for global health, but there simply isn’t enough to go around.
Foreign aid for global health, for all the good it has done—and it’s made a significant, though probably temporary dent in the AIDS epidemic, for instance—usually comes along with caveats and riders that end up making things worse. A case in point: the US is the largest donor for HIV/AIDS globally, but Democrats and Republican administrations have relentlessly tried to cripple generic production of AIDS drugs through trade agreements, intensive lobbying or outright threats directed at countries that have tried to do the right thing.
Even as Indian prime minister Narendra Modi was at the White House this week, in a visit more pomp than circumstance, getting some movement on trade was a priority for the US and a new working group on trade and intellectual property was established. Reigning in the Indian generic industry will likely be part of our country’s goals in this new collaboration: what we give with one hand, we take away with the other.
The theologian Reinhold Niebuhr once remarked that that “philanthropy combines genuine pity with the display of power and that the latter element explains why the powerful are more inclined to be generous than to grant social justice.” The generosity of rich countries over the past 15 years on HIV/AIDS, their re-discovery of the health of poorer nations, the current response to Ebola, have much to do with pity, charity, and perhaps fear that new infections may come knocking at home one day.
Some epidemics are unavoidable, but many are a result of crumbling health systems, economic inequality, local kleptocracies and global power dynamics, which perpetuate an ongoing cycle of fresh outbreaks, of new and old diseases. Until we address the issues of social injustice, we’ll not be doing enough to make a real difference over the long term. We’ll treat the symptoms, but not the cause of what ails people.
This isn’t simply to put the fate of poorer nations in the hands of the richer ones. These countries have leaders who make bad choices too, but as Cambridge economist Ha-Joon Chang has described in detail, political leaders in the global North in the modern era of free trade and globalization have pressed for policies that most of them didn’t utilize in their own economic and social ascent.
World Bank president Jim Yong Kim and longtime colleague Paul Farmer have been tasked to help coordinate the response to Ebola in West Africa. They both know that people are dying for growth; they’ve both written on the effects of globalization and free-market fundamentalism on people’s health, on what Farmer calls pathologies of power. It wouldn’t be a surprise for them to say that there is a political economy of Ebola and other diseases, which generates these epidemics.
The cure for Ebola then isn’t ZMAPP, the investigational new drug that people were clamoring for only a few weeks ago. The cure is political and depends on economic and social justice for the people of Guinea, Liberia, Sierra Leone—for the global South as a whole. But no one is clamoring for that.
I admire my friends and colleagues working on the ground in Liberia and elsewhere tending to the sick, setting up hospitals, trying to get the epidemic under control. But watch what happens in six months, in a year. Ebola will recede from the headlines, just as XDR-TB, just as HIV did before it.
We really never learn. As long as we’re spared, as long as we escape the flood, we’re inclined to go back to the way things were. We see the rainbow and think the storm is over.
Am I safe? We really never have been.
If we’re not inclined to value the suffering of our global neighbors in Guinea, Liberia and Sierra Leone, perhaps we should reconsider our shortsightedness. We share this ever-shrinking world together. We can finally address the social and economic inequalities that drive sickness and death or we can marvel in our good fortune, our luck.
As horrific as the current Ebola outbreak is, it can get a whole lot worse.
As the old African-American spiritual says: God gave Noah the rainbow sign; no more water, fire the next time.