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Monday, November 10, 2014

Flawed Global Health Policy and Racial Attitudes Undermine Ebola Response

In a relentless sweep across Guinea, Liberia, and Sierra Leone, the largest outbreak of Ebola – a virus that causes dramatic internal bleeding and often quick death – has now claimed  4,960 lives from 13, 268 reported cases since February 2014.

Named after a river in the DR Congo, the Ebola virus is among the deadliest of any known virus, with between 70 and 90 percent mortality. At present there is no cure for Ebola. The global epicenter of this epidemic are three west African countries of Guinea, Liberia and Sierra Leone.

The Ebola virus is spread through contact with infected fluids. Once an individual is infected, the virus swiftly attacks internal organs, causes severe bleeding, vomiting, and dementia. The typical cause of death is multi-organ system failure. 

Accounts of the disease paint African culture as an obstacle to prevention and epidemic control efforts, associating Ebola eruption with practices such as burial traditions or consumption of bushmeat.

The association between African culture and Ebola amounts to racialization of the epidemic. In a sense race and culture are instrumentalized as “risk factors” for Ebola infection. African “otherness” is presented as inimical to enlightened Ebola control efforts. African immigrants living in Dallas have reported fewer handshakes and more frequent curious glances since  a Liberian man, Thomas Eric Duncan, become the first person diagnosed with Ebola in the United States of America. But thankfully, nothing clinically differentiates vulnerability on account of skin color. 

Glaringly absent in the Ebola conversation is what in my view are the larger structural determinants of the patterns of the epidemic. Globalization of Africa’s extractive resource sector – mining and forestry, ecology, political and economic factors offer a more credible explanatory power of the emergence and proliferation of the Ebola virus.

Guinea, Liberia and Sierra Leone have one thing in common. They have experienced unprecedented rates of deforestation. For instance, the rainforest has declined to less than a fifth of its original size. In Liberia, loggers have decimated half of the forest. Similarly, Guinea has lost about a quarter of its forest. According to UNEP, with only 4 percent of forest remaining, Sierra Leone is on track to be completely deforested by 2018.

Deforestation creates ideal conditions for vectors to breed and spread diseases. The association between deforestation and the emergence of zoonotic, vector-borne diseases is well established. Deforestation alters ecosystem structure and invariably changes breeding habitats for disease vectors. Research has shown that deforestation enhances mosquito reproductive fitness, increasing mosquito population growth potential in the western Kenya highlands.

Deforestation is known to lead to increased contact between humans and wildlife. In 2005, researchers from Johns Hopkins University and the Consortium for Conservation Medicine showed that 75 percent of infectious diseases, including Ebola, are caused by pathogens, which started in wildlife and then jumped to humans. Moreover, there is evidence that Ebola outbreaks in West Africa are strongly associated with deforestation.

The Ebola epicenter in Guinea is in the south east of Guinea, close to the iron ore reserves in the forest. Mining has become big business in the region, employing thousands of workers who make excursions into bat territory to access the mines. More mines in the forest means more frequent contact between bats and other wildlife. Fruit bats carry the Ebola virus, but do not die from the virus.

I have argued in this column that the Ebola virus has and continues to expose Africa’s soft underbelly. Ebola is not just a medical emergency. National and global efforts to combat Ebola – build hospitals and  enhance medical response capacity – are supremely well intentioned but miserably reductionist, hence limited.

At the heart of the Ebola epidemic is an unfolding environmental catastrophe that is upsetting the balance of nature and creating a perilous situation where infectious diseases jump, easily, from animals to humans. At the core of the Ebola crisis is conflict, corruption and governance incapacity, all of which have eroded the capability of a majority of African governments to deliver vital social services; healthcare, education and economic opportunity.

It is not enough to stop the hemorrhaging. We must tackle the systemic dysfunction, which underwrites the governance incapacity of African states.

As African scholars and public intellectuals we have a solemn obligation to re-shape the narrative on the Ebola emergence and re-contextualize global health policy and action frameworks taking into account of ecology, poverty, political economy and globalization. 

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