Greg Laden, writing at ScienceBlogs, addresses the argument that diseases like malaria still pose a greater threat in Africa than the Ebola virus, and whether Ebola is taking attention away from other diseases (at least one person went so far as to call Ebola the “Kardashian of diseases”). Africa is a big place, and while it’s easy to say that malaria is a bigger danger than Ebola in places that have few or no Ebola cases, the same cannot be said in the countries that are directly being affected right now. Laden looked at the annual death rate due to malaria in Liberia, Guniea, and Sierra Leone, divided those numbers by twelve to get an estimated monthly rate, then compared those numbers to the average number of deaths per month in the 3-6 months of the Ebola outbreak:
- Liberia: 142 malaria, 92 Ebola
- Guinea: 49 malaria, 67 Ebola
- Sierra Leone: 145 malaria, 144 Ebola
It’s not the most scientific survey, but it does indicate that while of course malaria is a huge problem, Ebola is a crisis in those countries right this second.
Laden also addresses the question of resource allocation:
[C]onsider the thought experiment where you have $10,000,000 that you want to give to either developing an Ebola vaccine, or a Malaria vaccine. Since billions have been spent on developing a Malaria vaccine and there still isn’t one, your donation would be a drop in the bucket. Retrospectively, it would be equivalent to something like the combined costs of couriers and mail by researchers working on a Malaria vaccine over the last few decades. Or the cost of coffee and donuts in the break room. Or conference travel fees. Or something like that. The point is, a bunch of millions of dollars might actually produce an Ebola vaccine given the starting point we have now, or at least, move us a good deal in that direction.
At Quartz, Gregg Gonsalves writes about people’s tendency, when faced with something unfamiliar and scary, to focus on the personal:
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.
I won’t be as polite: Very few people in this country gave a flying f*** about Ebola until there was a chance, however, tiny, that it might affect us—and even now, there’s little political will to do anything except panic. Gonsalves goes on to say:
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.
***
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.
