Opinionista Mark Heywood 20 October 2014

Ebola’s rapid death march: It’s time we learnt

In its youth, Ebola had to play a slow game of chess. It kept on being blocked by rapid responses by heroic health teams in remote jungle areas of central Africa. Now that it has found its way at last into teeming slums and broken health systems, it can run like Usain Bolt. It was always bound to get there.

Where have all the people gone, long time passing??
Where have all the people gone, long time ago??
Where have all the people gone??
Gone to graveyards, everyone.?
Oh, when will they ever learn?
Oh, when will they ever learn?

Pete Seeger

In our brave new world, preventable disease kills 20 million people a year – many more people than wars – so the late, great Pete Seeger will forgive me my slight adaptation of his iconic anti-war song ‘Where have all the Flowers Gone’.

Ebola is the latest proof of this. It comes just after 30 years since the Human Immuno Deficiency Virus (HIV) made its appearance on the scene, causing the deaths of over 36 million people since then.

Ebola and HIV are not direct virological relations. Ebola is an extremely contagious hemorrhagic virus whose incubation period is very rapid and which, once in the bloodstream, quickly infects many cell types, leading to multi-organ failure and shock. In its rampage in West Africa, it appears to cause death in up to 70% of those infected. In a short period of time it has killed up to 5,000 people and is predicted to kill many more in the months ahead.

HIV is a retrovirus, meaning that it targets and replicates itself in a particular host cell. Today people are infected with HIV primarily through unprotected sex and ‘vertical transmission’ from pregnant mother to child. In some parts of the world, sharing needles amongst drug users is a major cause of transmission.

HIV targets only particular cells and takes a long time to wear down our immune systems. It’s now treatable – even if incurable – but it still quietly kills over a million people a year, including between 300 and 400 people a day in South Africa.

However, they are closely related in their social pathogenesis. The horrific and bloody rampage of Ebola through three states in West Africa, and HIV’s continued silent march across our world, are not unrelated. The rapidity of their transmission between humans has a social pathology: it is directly related to appalling governance of public heath systems and social inequality.

In its youth, Ebola had to play a slow game of chess. It kept on being blocked by rapid responses by heroic health teams in remote jungle areas of central Africa. Now that it has found its way at last into teeming slums and broken health systems, it can run like Usain Bolt. It was always bound to get there.

The grossly high paid bureaucrats at the World Health Organisation (WHO) who have great legal power and resources entrusted in them, and who now wring their hands in despair below the mists of Geneva, have known about Ebola for many years. Ebola may seem new, but the slums of Monrovia and Freetown are not. Neither is the acute shortage of health workers in the Guinea, Liberia and Sierra Leone.

In fact, Ebola is not such a new virus. Its discovery predates HIV. It has been known about since being ‘discovered’ by Peter Piot in 1976. But since then it has been portrayed as an exotic virus. Sensationalist reporting misrepresented it as incurable and 99% fatal, thereby permitting a premature surrender into further medical investigation. Yet a report in the British Sunday Times (12/10/14), cited a Cambridge University zoologist as saying that “it is quite possible to design a vaccine against this disease” but reported that applications to conduct further research on Ebola were rebuffed because “nobody has been willing to spend the twenty million pounds or so needed to get vaccines through trial and production”.

Why? For the world powers that be, the fact that it was largely confined to the jungles of central Africa kept it out of harm’s way. The heroic and taken for granted efforts of the few medics who did venture to treat and contain it allowed a further level of complacency.

Now that complacency is shattered. The US government is moving, the EU is moving, the WHO is moving. But the growing alarm over Ebola seems less to do with sympathy with affected and dying people, the destruction of already ravaged economies, but much more to do with Western countries fears of it making inroads into their own populations and economies.

This is why AIDS and Ebola have something else in common. Ultimately their control and treatment boils down to issues of democracy, equality and good governance.

HIV, when it was first discovered in the early 1980s, also elicited the level of fear, panic and stigma now being witnessed in relation to Ebola.

The ingredient that changed that was the rise of activists from affected communities and their demand that human rights principles drive the response to HIV. In two decades a globally connected activist movement forced the acceleration of scientific research and the development of new medicines; it demanded equality of access to these medicines, insisted that health systems were funded. As a result it brought about the most rapid and far-reaching response in history to any disease.

In the light of this and other demonstrations of people’s power the importance of civil society is now globally acknowledged – or at least it gets a lot of lip service. Interestingly, on 23 September 2014, US President Obama issued an unprecedented ‘Presidential Memorandum on civil society’ recognising that:

Through civil society, citizens come together to hold their leaders accountable and address challenges that governments cannot tackle alone. Civil society organisations…often drive innovations and develop new ideas and approaches to solve social, economic, and political problems that governments can apply on a larger scale.

And yet civil society is precisely what is missing from Liberia, Sierra Leone and Guinea. Perhaps it is because these countries have just emerged from war or because they are dictatorships. But it is the absence of a strong independent civil society that demands better health systems and campaigns for human rights that creates fertile ground for epidemics such as Ebola.

For example, Sierra Leone may be one of the poorest countries in the world, but it is not entirely devoid of resources that could be used for health care, sanitation or housing. According to the IMF, it experienced economic growth of 20% in 2013. Yet half its population still lives on $1.25 per day.

Why again?

Because there is no accountability of government and no civil society to demand it.

In the last few weeks one of the most prominent voices on the Ebola virus has been that of Laurie Garrett (@Laurie_Garrett), a journalist who won a Pulitzer Prize in 1996 for her reporting on Ebola. In her 1994 book, The Coming Plague: Newly Emerging Diseases in a World Out of Balance, Garrett warned that there were 21 million people on earth “living under conditions ideal for microbial emergence.” Garrett described these conditions as being “denied governmental representation that might improve their lot; starving; without safe, permanent housing; lacking nearly all forms of basic health care or sanitation”.

Sound familiar?

She concluded her 600-page tome as follows:

While the human race battles itself, fighting over ever more crowded turf and scarcer resources, the advantage moves to the microbes’ court. They are our predators and they will be victorious if we, Homo sapiens, do not learn how to live in a rational global village that affords the microbes few opportunities.

It’s either that or we brace ourselves for the coming plague.

Was she heard?

Which brings me back to the lessons of HIV. One of the foremost organisations that brought it under control is the Treatment Action Campaign. People’s power organised through TAC helped saved two million lives. People’s power is still needed to get millions more onto treatment and tackle the social conditions that drive HIV, Ebola and microbes we haven’t even got names for.

In 2004 TAC was a nominee for the Nobel Peace Prize. To do its work, it needs a budget of R40 million a year.

In global terms this is small, small change.

R40 million is less than the amount spent on the annual opening of Parliament; one seventh of the cost of Nkandla upgrade; less than Christiano Ronaldo earns in a month; it is a percentage of a percentage of the value of daily transactions on the JSE.

It’s small change for big change.

Yet TAC has raised just one quarter of that for 2015. There’s a demand for social justice, but no market for it.

We must make the market. So think about it this way: if 5,000 good citizens in the world could be persuaded to donate R500 per month to TAC, that would raise R30 million per year. It would be a demonstration of your empathy, solidarity and just plain humanity. It would be an investment in human rights and health.

Now ask yourself: Is that beyond us? DM

To donate to TAC go here.