ONCE in a while in human history there is an infectious disease outbreak. To a larger extent, through effective healthcare interventions, we find ways to contain or to cure humankind from such diseases.
However, a similar narrative cannot be given entirely for this Ebola virus outbreak, which has caused incredible upheavals and public panic mainly owing to it being the worst and most devastating Ebola outbreak since the virus was discovered.
According to the World Health Organisation (WHO), the deadly Ebola in West Africa kills seven out of 10 infected victims. Since March this year, Ebola has reportedly killed at least 4546 people in Guinea, Liberia and Sierra Leone and new cases could reach 10000 a week by December if not brought under control.
The unprecedented extent of mortality and morbidity in this outbreak surely ought to concern us all deeply.
Perhaps what ought to concern us even more is that after more than three decades of the disease being discovered and considerable research and technological advances being made worldwide, we still do not have proven Ebola virus-specific treatment.
In this regard it may be important to note that Ebola was first discovered in 1976 with two simultaneous outbreaks – one in Sudan and the other in the Democratic Republic of Congo (DRC). These initial outbreaks led to roughly 151 and 280 deaths in Sudan and the DRC respectively.
Post-1976, Ebola has been a geographically confined health problem of the third world nations in Central and West Africa and one for them to solve. It can be said that the spread of Ebola was essentially contained even though it continued to silently kill about 1590 people over 36 years.
The major reason given for the lack of developing an Ebola virus-specific treatment or vaccine is that for pharmaceutical companies it has not been a profitable prospect to do so. This is what pharmaceutical companies unapologetically admit themselves.
For example William Sheridan, the medical director of BioCryst Pharmaceuticals, the developer of the experimental anti-viral drug BCX4430, has said of the prospects for Ebola treatment research and development: “It just wouldn’t make the cut at a major pharmaceutical company.”
Dr John Ashton, the president of the UK Faculty of Public Health, also wrote a critical opinion piece on the Independent criticising “the scandal of the unwillingness of the pharmaceutical industry to invest in research to produce treatments and vaccines for Ebola, something they refuse to do because the numbers involved are, in their terms, so small and don’t justify the investment.”
Professor Adrian Hill of Oxford University, a leading scientist working on clinical trials for an Ebola vaccine, also recently alluded to the Ebola vaccine being considered a “market failure”, firstly due to the nature of the outbreak; secondly, because the number of people likely to be affected was, until now, thought to be very small; and thirdly, the fact that the people affected are in some of the poorest countries in the world and can't afford to pay for a new vaccine.
In this regard, the economic value of an Ebola vaccine is only realised when the virus has sufficiently reached the shores of developed countries, and when an epidemic makes a strong business case.
Worth noting in this regard is that this matter is not just about a simple economic decision taken by pharmaceutical companies, but the relegation and transfer of power and political responsibility for health from the citizenship to health professions and multinational pharmaceutical companies in particular.
This shifts the issue from simply acknowledging the immediate difficulties surrounding Ebola to looking at how we ought to interpret the “politics of health” and not limit it to the “politics of healthcare”.
By this I mean in order for us to gain a better understanding of Ebola and importantly what it represents, we must not be trapped into debates of diagnosis, treatment, and prevention of disease, but must enter a discourse of how politics, power and ideology influences and underpins people’s health.
A disease epidemic ought to stimulate robust debates that seek to characterise the socio-political environment in which our decisions on health are fundamentally embedded, and identify its problems.
What is true in this regard, is that the modernisation of society has been coupled with the deliberate depoliticisation of many aspects of life, including health.
For example, nowadays health is seen a product of an individual’s situation, including genetic heritage and/or lifestyle choices. In this regard health is an individualised commodity produced and delivered by the market or government health services. And poor health is attributed to the individual failing in their choices or a failure in how healthcare products are produced, distributed and delivered, including by healthcare services.
This narrative might partly hold water but it surely hides certain crucial facts, which is that determinants of health are extremely vast and socio-political in nature and include among others, class, culture, ecological environment.
Acknowledging these underpinning determinants makes us quickly realise that fundamental and long-lasting interventions for our health challenges such as Ebola lie outside the health sector and require non-health sector policies.
In principle the extent of underdevelopment, poverty and poor health practices in West and Central Africa create ideal conditions for any infectious disease epidemic. Ebola, for example, is spread between animals and humans. This is of particular concern since there is scientific evidence pointing to the plausibility of several species of wild rats, fruit bats and monkeys – which are part of the consumed diet in West and Central Africa – being reservoirs of diseases like Ebola.
Now massive international donation will be off-loaded to help in the research and development treatment of Ebola, but what will remain long after the Ebola outbreak are the unchanged socio-economic conditions of West and Central Africa. The masses will continue to rely on bush meat for food security and a livelihood. And once in a while another infectious disease outbreak will visit our fellow Africans and we will once again deploy a troop of healthcare workers to assist the devastated areas.
The lesson from this Ebola outbreak is twofold. Firstly, as responsive citizens we must reclaim from the hands of private multinational pharmaceutical companies our power to inform decisions on our health. Secondly, in order to successfully combat current and future disease outbreaks in Africa, the conditions in which people live must be enhanced.
Aphiwe Bewana is the ANC’s Eastern Cape policy coordinator and a PhD candidate in environmental and geographical science at UCT
Combating Ebola is more complex than finding cure
However, a similar narrative cannot be given entirely for this Ebola virus outbreak, which has caused incredible upheavals and public panic mainly owing to it being the worst and most devastating Ebola outbreak since the virus was discovered.
According to the World Health Organisation (WHO), the deadly Ebola in West Africa kills seven out of 10 infected victims. Since March this year, Ebola has reportedly killed at least 4546 people in Guinea, Liberia and Sierra Leone and new cases could reach 10000 a week by December if not brought under control.
The unprecedented extent of mortality and morbidity in this outbreak surely ought to concern us all deeply.
Perhaps what ought to concern us even more is that after more than three decades of the disease being discovered and considerable research and technological advances being made worldwide, we still do not have proven Ebola virus-specific treatment.
In this regard it may be important to note that Ebola was first discovered in 1976 with two simultaneous outbreaks – one in Sudan and the other in the Democratic Republic of Congo (DRC). These initial outbreaks led to roughly 151 and 280 deaths in Sudan and the DRC respectively.
Post-1976, Ebola has been a geographically confined health problem of the third world nations in Central and West Africa and one for them to solve. It can be said that the spread of Ebola was essentially contained even though it continued to silently kill about 1590 people over 36 years.
The major reason given for the lack of developing an Ebola virus-specific treatment or vaccine is that for pharmaceutical companies it has not been a profitable prospect to do so. This is what pharmaceutical companies unapologetically admit themselves.
For example William Sheridan, the medical director of BioCryst Pharmaceuticals, the developer of the experimental anti-viral drug BCX4430, has said of the prospects for Ebola treatment research and development: “It just wouldn’t make the cut at a major pharmaceutical company.”
Dr John Ashton, the president of the UK Faculty of Public Health, also wrote a critical opinion piece on the Independent criticising “the scandal of the unwillingness of the pharmaceutical industry to invest in research to produce treatments and vaccines for Ebola, something they refuse to do because the numbers involved are, in their terms, so small and don’t justify the investment.”
Professor Adrian Hill of Oxford University, a leading scientist working on clinical trials for an Ebola vaccine, also recently alluded to the Ebola vaccine being considered a “market failure”, firstly due to the nature of the outbreak; secondly, because the number of people likely to be affected was, until now, thought to be very small; and thirdly, the fact that the people affected are in some of the poorest countries in the world and can't afford to pay for a new vaccine.
In this regard, the economic value of an Ebola vaccine is only realised when the virus has sufficiently reached the shores of developed countries, and when an epidemic makes a strong business case.
Worth noting in this regard is that this matter is not just about a simple economic decision taken by pharmaceutical companies, but the relegation and transfer of power and political responsibility for health from the citizenship to health professions and multinational pharmaceutical companies in particular.
This shifts the issue from simply acknowledging the immediate difficulties surrounding Ebola to looking at how we ought to interpret the “politics of health” and not limit it to the “politics of healthcare”.
By this I mean in order for us to gain a better understanding of Ebola and importantly what it represents, we must not be trapped into debates of diagnosis, treatment, and prevention of disease, but must enter a discourse of how politics, power and ideology influences and underpins people’s health.
A disease epidemic ought to stimulate robust debates that seek to characterise the socio-political environment in which our decisions on health are fundamentally embedded, and identify its problems.
What is true in this regard, is that the modernisation of society has been coupled with the deliberate depoliticisation of many aspects of life, including health.
For example, nowadays health is seen a product of an individual’s situation, including genetic heritage and/or lifestyle choices. In this regard health is an individualised commodity produced and delivered by the market or government health services. And poor health is attributed to the individual failing in their choices or a failure in how healthcare products are produced, distributed and delivered, including by healthcare services.
This narrative might partly hold water but it surely hides certain crucial facts, which is that determinants of health are extremely vast and socio-political in nature and include among others, class, culture, ecological environment.
Acknowledging these underpinning determinants makes us quickly realise that fundamental and long-lasting interventions for our health challenges such as Ebola lie outside the health sector and require non-health sector policies.
In principle the extent of underdevelopment, poverty and poor health practices in West and Central Africa create ideal conditions for any infectious disease epidemic. Ebola, for example, is spread between animals and humans. This is of particular concern since there is scientific evidence pointing to the plausibility of several species of wild rats, fruit bats and monkeys – which are part of the consumed diet in West and Central Africa – being reservoirs of diseases like Ebola.
Now massive international donation will be off-loaded to help in the research and development treatment of Ebola, but what will remain long after the Ebola outbreak are the unchanged socio-economic conditions of West and Central Africa. The masses will continue to rely on bush meat for food security and a livelihood. And once in a while another infectious disease outbreak will visit our fellow Africans and we will once again deploy a troop of healthcare workers to assist the devastated areas.
The lesson from this Ebola outbreak is twofold. Firstly, as responsive citizens we must reclaim from the hands of private multinational pharmaceutical companies our power to inform decisions on our health. Secondly, in order to successfully combat current and future disease outbreaks in Africa, the conditions in which people live must be enhanced.
Aphiwe Bewana is the ANC’s Eastern Cape policy coordinator and a PhD candidate in environmental and geographical science at UCT
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