It is no accident that the Ebola epidemic has affected three of the poorest countries in the world, write David Sanders, Amit Sengupta and Vera Scott.
This year, the global community has watched in horror as the largest Ebola epidemic ever known has spread from Guinea in West Africa to neighbouring Liberia, Sierra Leone and beyond. The total number of deaths thus far is more than 40 times that of the previous highest death toll recorded (425 deaths in Uganda in 2000).
The cumulative number of cases and deaths in the three countries at the epicentre stood at 15 901 cases and 5 674 deaths at the end of last month, though official figures are likely to be a major underestimation.
Most media coverage has focused on the high mortality rates, the threat and fear of spread, the danger faced by healthworkers and the failing health systems. In this analysis, we dig deeper into the root causes of Ebola virus disease (EVD) as we explore the global and local political and economic factors that underlie the current outbreak. In doing so, we point the way to active prevention of future outbreaks.
Human beings are not the primary targets of the Ebola virus. It is thought now that a few species of fruit bats act as the reservoir. Ebola affects humans who come into close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines. Since the natural habitat of fruit bats lies in Central Africa (the site of all earlier major outbreaks), hundreds of kilometres away from the epicentre of the present epidemic in West Africa, it is hypothesised that there might have been a major shift in the habitat of fruit bats, or that the infection was been imported into the region by a human contact.
Human-to-human transmission can take place through direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people and indirect contact with environments contaminated with such fluids. Traditional burial practices may also be a source of infection. Healthworkers are particularly at risk when they work in unhygienic and unprotected conditions. Once infected, a person is capable of infecting others for up to seven weeks after recovery from illness.
While Ebola has a very high fatality rate, it has a relatively low level of infectivity, being transmitted only through direct contact of the bodily secretions of an infected person with broken skin or mucous membrane (the linings of eyes, mouth and others). People become infectious only when they have symptoms, and these symptoms are severe and relatively easy to identify. The above three characteristics do not make the Ebola virus an ideal candidate for a major epidemic. (This is in contrast to diseases such as Avian influenza, which is highly infectious and transmitted via airborne droplets. It is infectious before symptoms develop, which can be mild and go unnoticed.)
Why then this large and uncontrolled epidemic in West Africa? The answer lies not in the pathology of the disease, but in the pathology of our society and the global political and economic architecture. It is no accident that the present epidemic has affected three of the poorest countries in the world. Liberia, Guinea and Sierra Leone number 175, 179 and 183 respectively out of 187 countries on the UN’s Human Development Index. Their health systems are ineffective and almost non-existent in many regions. The present epidemic is one brought about by poverty and ruthless exploitation of the region’s natural resources.
The “Zaire” strain of Ebola has never been detected in humans in the countries currently affected. How did it travel thousands of kilometres from its known habitat in Central Africa? A plausible explanation is that it was introduced by fruit bats whose natural distribution has been altered by massive deforestation and consequent dry spells. A review of earlier epidemics suggests an additional two factors: invariably Ebola and similar pathogens have affected regions whose economies and public health systems have been disrupted. In the three countries currently affected, chronic food shortages and extreme poverty drive people deeper into the forests to look for food and fuel, where they may come into contact with animals harbouring the virus.
The affected area in Guinea has recently attracted agribusiness. In 2010, the British-backed Farm Land of Guinea Limited bought huge tracts of land for maize and soybean cultivation. The Italian energy company Nuove Iniziative Industriali has bought more than 700 000 hectares for biofuel crops. In neighbouring Liberia, its transition to a cash-crop export economy, controlled by foreign transnational companies (TNCs), began in 1925 with the Firestone Rubber Company, which acquired 404 686 hectares for 99 years at six cents an acre.
Today, Liberia has the highest ratio of foreign direct investment to GDP in the world. In less than a decade, Liberia has signed concession agreements in the iron ore and palm oil industries with numerous TNCs, including BHP Billiton, ArcelorMittal, Golden Veroleum (US) and Sime Darby (Malaysia). The rapid expansion of Sierra Leone’s nascent iron ore mining industry fuelled economic growth of 20 percent last year, among the highest in the world, according to IMF data, but prices also surged in the impoverished West African nation.
Interest in its largely untapped mineral resources has sparked a flood of investment in Sierra Leone a decade after the end of the devastating 1991-2002 civil war. In 2010, the country’s mining industry contributed almost 60 percent of exports, but only 8 percent of government revenue.
In 2011, only one of the major mining firms in the country was paying corporate income tax, while none of the top five was reporting profits despite the boom in mineral exports. Gross ecological changes have been wrought by the takeover of agricultural land by agribusiness and these are likely to be altering the natural distribution of fruit bats. In addition, agriculture and extractive industries have forged new roads into previously remote forest areas enabling access by humans driven deeper into the forest areas for sustenance.
Years of civil strife, largely fuelled by competition over the control of valuable natural resources, led to enormous displacements of the local population and consequently increased the pressure on forest land, and also accelerated migration out of areas harbouring forest animals. The civil wars in Liberia and Sierra Leone have involved powerful local interests that work at the behest of foreign transnational corporations. Diamond mining was one of the major causes of the civil war in 1991 in Sierra Leone.
The Ebola epidemic is compounded by the inability of a public health system to respond effectively. Indeed, the health system becomes a site of transmission, and patients and healthworkers alike carry the infection to the general population. However, it is not just Ebola that is killing people. In Sierra Leone, in the first four months of the outbreak, 365 people died of Ebola. Yet every four months Sierra Leone sees about 650 deaths from meningitis, 670 from tuberculosis, 790 from HIV/Aids, 845 from diarrhoeal diseases and more than 3 000 from malaria. Such deaths have been occurring for decades in all three countries, but have not attracted the attention of the global community.
Nationally, there has been a chronic underinvestment in health systems after these countries’ colonial occupation (brief, in Liberia’s case) and exploitation left them poor. Structural adjustment programmes instituted by the World Bank and the IMF then prescribed public spending on welfare and public services. These countries also subsidise the health systems of rich countries (more doctors born in Liberia and Sierra Leone work in OECD countries than in their home countries). Corruption has aggravated weak systems, for example, Sierra Leone’s public sector has been wracked by financial scandal. Last year seven medical practitioners and 22 others working in the public service were convicted of misappropriation of donor finances, having “misused” GAVI (the Global Alliance for Vaccines and Immunisation) funds.
Although the Ebola virus has been known for 40 years, no vaccine or cure has been developed. There is no incentive for pharmaceutical companies to develop drugs that affect the poor who cannot afford to pay blockbuster prices for blockbuster drugs.
The epidemic has overwhelmed the already fragile health system. In Liberia’s capital, Monrovia, at one point all five of the main hospitals were closed. Some have since reopened but are barely functioning. Healthworkers, understandably scared for their safety, have fled, given that gloves, gowns and even safe water are in short supply. There is a stark irony to the reality of lack of gloves in Liberia as the country houses the “largest single natural rubber operation in the world” – Firestone Natural Rubber Company. Although Liberian rubber is mainly used in Bridgestone car tires, the company also supplies rubber to companies manufacturing “vital medical components” such as the latex gloves desperately needed in health facilities in the region. But latex products are not manufactured in Liberia, the rubber is harvested only in Liberia, then shipped elsewhere for production – a typical scenario of natural resource extraction in Africa.
In the short term, at a minimum, the response from the global community, and particularly the rich countries, has to be greatly accelerated and much more generous. Large numbers of personnel, quantities of equipment and supportive medicines must be provided. The expediting of candidate drugs is urgent. In the medium term, there is an urgent need to strengthen health systems in the region. Initially, this will require greatly increased donor assistance. A sustainable solution, however, requires fundamental changes to economic and power relations between these countries and the capitalist economies and enterprises that continue to bleed them dry, often with the collusion of local officials and elites.
The epidemic, in all probability, will run its course and die down after leaving a trail of death and destruction. Not because we as a global community would have done very much right, but because of the nature of the virus itself. The moot question is: will we have learnt anything? Or will it be back to (big) business as usual?
* Sanders, Sengupta and Scott are medical doctors. Sanders and Sengupta are members of the People’s Health Movement.
** The views expressed here are not necessarily those of Independent Media.
Cape Times