What is happening in Liberia and across West Africa is not only an Ebola epidemic, but is an affront to humanity. Ebola, like other infectious diseases including AIDS, TB, Malaria, and the like has one common vector. That vector is poverty. Infectious diseases follow the path of least resistance and the least resistance follows the path of inequality - a path laid down by a history of colonialism, imperialism, racism, and global capital.
In an interview a few days ago with Amy Goodman, Dr. Paul Farmer makes clear,
The Ebola outbreak, which is the largest in history that we know about, is merely a reflection of the public health crisis in Africa, and it’s about the lack of staff, stuff and systems that could protect populations, particularly those living in poverty, from outbreaks like this or other public health threats....
...I think the most important thing to understand is that this is a reflection of long-standing and growing inequalities of access to basic systems of healthcare delivery, and that includes the staff, the stuff and, again, these systems. And that’s what—that’s how we link public health and clinical medicine, is to understand that we’re delivering care in the context of protecting the health of the population. And so, if you go down to each of these epidemics—that are, of course, one epidemic—and you ask the question, "Well, do they have the staff, stuff and systems that they need to respond?" the answer is no....
...here are the impact of health disparities in general, right, pre-Ebola epidemic, right. That is, you’ve got some people living in Medieval conditions still in the 21st century and some people living in the 21st century. And how do we move more people from here to here? Like, you don’t have to have—you know, treble your GDP to start building a health system. Health systems help grow your economy, investing in health and education. So, to me, that’s the big picture—rich world, poor world—rather than a narrow view of an incident, although I think we should be commenting on them.
The question is this where has everyone been? It's not like this is something new. The people of Guinea, Liberia and Sierra Leone needed adequate healthcare services before this outbreak happened. Are we to expect that a healthcare system from out of the last century which is incapable of coping with regular day to day disease is suddenly somehow going to cope with the likes of ebola?
Paul Farmer again refers to all this as structural violence. He says the real fight in the war against infectious diseases is the fight against poverty and injustice. He is right health problems are, in many ways, the product of social organization, and to deal with them , we have to take on the social conditions and social organization that give rise to them. Today, that has to mean taking on global capital. Long before the latest outbreak of Ebola, inequalities have powerfully sculpted not only the distribution of infectious diseases, but also the course of disease in those affected. Speaking about AIDS back in 1996, Dr. Paul Farmer wrote:
AIDS has always been a strikingly patterned pandemic. Regardless of the message of public health slogans—“AIDS is for Everyone”—some are at high risk for HIV infection, while others, clearly, are at lower risk. Furthermore, although AIDS eventually causes death in almost all HIV-infected patients, the course of HIV disease varies. Disparities in the course of the disease have sparked the search for hundreds of cofactors, from Mycoplasma and ulcerating genital lesions to voodoo rites and psychological predisposition. However, not a single association has been compellingly shown to explain disparities in distribution or outcome of HIV disease. The only well demonstrated cofactors are social inequalities, which have structured not only the contours of the AIDS pandemic, but also the course of the disease once a patient is infected.
It isn't just AIDS or ebola.
Nearly 9 million people develop active TB disease each year - and an overwhelming 95% of these cases occur in developing countries.
Studies have proven that not only are infectious diseases a plague of poorer nations, they are a plague of the poor living in rich nations.
A paper by Zulfiqar A. Bhutta, and others found at Infectious Diseases of Poverty notes:
‘The infectious diseases of poverty’ (IDoP) is an umbrella term used to describe a number of diseases, which are known to be more prevalent among poorer populations rather than being a definitive group of diseases 1]. Apart from the ‘big three’ infections—tuberculosis (TB), malaria, and HIV/AIDS—IDoP also comprise a set of neglected tropical diseases (NTDs) . These infections are not only attributable for almost nine million annual deaths globally, but are also responsible for the massive economic burden due to their associated disabilities . These are not restricted to low- and middle-income countries (LMICs), but manifest in poor populations globally with a significant proportion of mortality among children under five years of age. Apart from TB, malaria, and HIV/AIDS having specific targets outlined in the Millennium Development Goals (MDGs), other infectious diseases have, by default, slipped into the ‘neglected category’.[
I'm thinking if these were not diseases of the poor they would not have, "slipped into the 'neglected category." Let's face, the billions of people in the world have also slipped into the neglected category.
Anyway, let's get back to Ebola where I have an article to attach which has little to do directly with the above, but much to do with it indirectly, if you just give it some thought. One thing it might lead you to think about is Avian Flu of the likes of H5N1. Flu can be and H5N1 could become highly contagious. Flu escapes outside the boundary lines of the poor much more easily and quickly then the above mentioned diseases. A true flu pandemic, I just bet, would not slip into the neglected category. A true flu pandemic of something like H5N1 with a mortality rate of close to 60% would overwhelm not just the healthcare resources of poor nations, but would overwhelm those of the rich as well...such an epidemic might well kill global capital...unfortunately while killing most of us along with it.
The first article below is from Avian Flu Diary. The second article is long and comes from a 2005 issue of Foreign Affairs. In that article it cites an H5N1 with a mortality rate of 20% which is far below the reality. Since that article was written numerous new strains of avian flu have been uncovered in China and other parts of Asia, many very similar to the make up of the 1918 flu, which by the way had nowhere near the mortality rate of H5N1. Anyway, if you are up for it, take a look.
PS: Did I mention that many believe with the growth of multi resistant bacteria we are about to or have already entered a post antibiotic era. Just sayin...
Conventional Wisdom And Epidemic Disease Spread
Not so very long ago (last spring, to be exact) the conventional wisdom was that Ebola was simply too debilitating, and too lethal, to have `legs’ . . . to spread beyond a limited geographic area. Those infected were `too sick to travel’, and small outbreaks would inevitably `burn themselves out’ in relatively short order.
While a horrible disease, Ebola seemed fairly easy to contain. At least, until this summer, when it wasn’t anymore.
Today Ebola is spreading – unchecked – in three countries (Liberia, Sierra Leone & Guinea) and has made inroads into two others (Nigeria & Senegal). The number of infected is easily a magnitude greater than any outbreak previously seen, and the true extent of the outbreak isn’t even known.
We’ve seen official estimates (and they are just that, estimates, based onincomplete information) from the World Health Organization that by the end of the year 20,0000 people could be infected. When that number was first announced two weeks ago (see WHO Ebola Response Roadmap), it seemed an shockingly high number.
Since then, we’ve seen estimates (again based on assumptions and incomplete data) that project potentially an even higher toll.In Science Mag’s Disease modelers project a rapidly rising toll from Ebola, Christian Althaus of the University of Bern suggests that cases could possibly reach 100,000 cases by year’s end. And his isn’t the highest number being bandied about.
Today, Science Editor Tom Clarke of Channel 4 News in the UK has published a blog called the Terrifying mathematics of Ebola, where he interviews Professor John Edmunds, an epidemiologist at the London School of Hygiene and Tropical Medicine – on just how bad this outbreak could get.
Keeping Yogi Berra’s famous caveat in mind, that `'It's tough to makepredictions, especially about the future.’, I’ll refer you to:
Terrifying mathematics of Ebola
Ebola treatment facilities in Monrovia, the Liberian capital, are now so overwhelmed they are turning away up to 30 infected people every day according the medical charity Medecins sans Frontieres.
Given the rate at which the virus is spreading, it says the virus will soon be having an “apocalyptic” impact on the country and its neighbours unless there is a dramatic increase in international assistance.
“It could get very bad indeed,” said Prof John Edmunds, an epidemiologist at the London School of Hygiene and Tropical Medicine. ”And I mean you can’t rule out some sort of nightmare doomsday scenario.”
(Continue. . .)
In this interview Professor Edmunds warns that the number of new cases is doubling about once every two weeks, and that Ebola has the potential to infect half the population of Liberia. Coming from a less credentialed scientist, that sort of speculation might be easily dismissed. But not so, in this case.
While I’m not terribly comfortable with any of the projections offered to date, it doesn’t take a master statistician to see what a doubling of cases every two weeks (or even every month) would mean. Granted, over the long run you’d run out of susceptible hosts for the virus, so you can’t extrapolate that progression forever.
But in the short run, it can add up very fast.
Whether the `right number’ ends up being 20,000 or 100,000 or even more, the real point is we are in uncharted territory with this Ebola outbreak, and no one really knows where this goes from here. While I still believe that with a concerted international effort, this outbreak can still be contained, it is going to exact a heavy human and economic toll.
In closing, I would also note that over the past decade the conventional wisdom has also said that Avian flu viruses (like H5N1) couldn’t cause a pandemic unless they lost considerable virulence because – like Ebola - they are `too deadly’ and they `kill theirs hosts too quickly’ to spread effectively.
That’s the trouble with conventional wisdom. You can only take comfort from it up until the moment it no longer applies.