It has been suggested that the Ebola crisis is less a public health crisis than an inequality crisis. My first response upon hearing this was, “Ya think!?” No blame to Jim Wallis for saying it; I’m glad he did. But the fact that it needed to be said is troubling, to say the least.
Thus far, the American political and media response to the news about Ebola has left me feeling ashamed of my country. Our outbreak of posturing and wagon-circling has been American Exceptionalism at its tawdriest. Respected people, astute enough to sit on the Congressional Homeland Security Committee, urgently demand that we “seal the borders! Ban flights from West Africa!” Why hasn’t Obama done that already?
Seal US borders?
Among the many reasons why that’s a bad idea, the most obvious is that there are hundreds of alternate routes; for a ban to be effective, it would have to be worldwide. But, it would be impossible to enforce a worldwide travel ban; people would sneak into all manner of places, making exposures that much harder to track down. Also, there is wide agreement that the need for people and resources to help fight the West African outbreak is so great that it cannot be met without the resources of commercial airlines.
I suppose it’s understandable, though, that we’d be a little freaked out by a gigantic outbreak in West Africa of a fatal disease that manifests itself in such symptoms as high fever, headache, vomiting and diarrhea. In Sierra Leone, currently the epicenter of this outbreak, some 7,500 people, mostly children, have died of it in the past year.
No, I’m not speaking of Ebola, but another disease: malaria. Sierra Leone has the world’s highest death rate from malaria. (It also has the world’s highest death rate from tuberculosis, which kills even more West Africans than malaria does.) This year, Ebola has killed a (comparatively) modest 3,000 people in Sierra Leone.
Not All the News from Africa is Bad
There has been some good news out of Africa recently. Economic growth is taking off, and a new middle class is emerging in many countries, skilled at leapfrogging into 21st-century communications via mobile phones. Innovative entrepreneurs are creating devices that bypass infrastructural deficiencies to meet the needs of real Africans. South Africa and, especially, Botswana are making real strides against government corruption. At the moment, the most compelling piece of good African news is the way Nigeria has carefully, methodically — and so far, successfully — controlled the threat of an Ebola outbreak. It could have gone far differently. Lagos, Nigeria’s capital, is a city of 21 million people.
If Nigeria, a country that’s infamous for epic mismanagement and corruption, can do what it takes to contain an outbreak of Ebola, then surely the United States can do it — and, initial missteps aside, the US almost certainly will do it. But, it is a costly, and tricky, process. Ebola is only contagious when victims have already begun to show symptoms — which occurs after an incubation period of up to 21 days. Those symptoms include severe vomiting and diarrhea, and patients can decline rapidly. As their disease becomes more acute, the concentration of the virus in bodily fluids increases; this means that health workers (or family members) caring for acute Ebola patients are at the greatest risk.
Equipment, and techniques, exist for dealing with such patients. However, they are expensive and cumbersome; practitioners have to be carefully trained. It can be done, though: in late September, CNN aired a report on how one woman in Liberia cared for four family members with Ebola without getting infected. We all hope the two Dallas nurses who contracted Ebola will recover soon. It is not the least bit surprising, though, that there would be initial hiccups in a nation’s response to such a tricky disease. Make no mistake, though: nobody, anywhere, thinks that people in the United States need to panic (nobody, that is, except the cynical self-promoters who seek to gain from our panic).
Sierra Leone & Liberia
Sierra Leone and Liberia have made great strides toward economic and social stability in recent years. With their devastating civil wars behind them, their economies have been growing at rates of 11-13% . Two Liberian women, Ellen Johnson Sirleaf — the first woman to be elected President of a modern African nation — and peace activist Leymah Gbowee shared the Nobel Peace Prize in 2011. Liberia and Sierra Leone are comparable in size to North and South Carolina. They have long, lovely Atlantic coastlines, and are amply endowed with arable land and various natural resources.
The Carolinas have a combined economic output (GSP, Gross State Product) of $656.4 billion, while Sierra Leone and Liberia have a combined output of only $13.4 billion (GDP). Alas, these two nations are in no shape, in terms of medical infrastructure, to even combat the devastating diseases they were struggling with before the Ebola outbreak, diseases including: malaria, AIDS, dysentery, etc.
Some selected statistics (from the CIA World Factbook) should be enough to illustrate the point:
|Sierra Leone||Liberia||United States|
|People under age 14||41.9%||43.2%||19.4%|
|People per doctor||50,000||100,000||416|
|Female literacy rate||32.6%||56.8%||99%|
|GDP per capita||$1,400||$700||$49,800|
|Population below poverty line||70.2%||80%||15.1%|
In June of this year, Sierra Leone closed all schools due to the Ebola outbreak. In October, a school-by-radio program was announced. Its effectiveness will be limited, however, because only about 25% of families in the country own radios.
I have been emphasizing Sierra Leone because it is simpler to gather numbers for a single country, but most of what I’m saying about Sierra Leone applies to Liberia even more strongly. Indeed, it’s not easy to see why they benefit from being separate countries. Sierra Leone’s colonial history was tied with Great Britain while Liberia’s was with the United States, but their colonial, and post-colonial, politics were the same. Both powers cultivated tribal elites for powerful “overseer” roles that transferred intact into post-colonial politics. Recently, aided by the machinations of Liberian warlord (and convicted war criminal) Charles Taylor, both countries became embroiled in brutal civil wars. The war in Sierra Leone killed 50,000 people; Liberia’s killed more than 200,000.
This histories of Sierra Leone and Liberia are of course complicated. However, for the purpose of understanding their current health crisis, it is sufficient to oversimplify. They are both a product of colonialism. Boundaries were drawn in line with European interests, pitting rival groups against one another as part of a system of divide and conqueror. A class of elites/political pawns were posted to ruling positions. When independence came, the elites were poised to consolidate their power. In the Cold War political climate of the time, regimes vied for gifts of money and weapons from either the Soviets or the West. Political control bounced back and forth between “socialist” and “anti-socialist” regimes, but domestically the labels made little difference. People’s needs were never well-satisfied, which made them receptive to the promises of each new rebel faction that seized control.
From a distance, people are tempted to ask why these people can’t get their act together — but the reasons are not hard to decipher. According to many experts such as Paul Collier and Pádraig Carmody, perhaps the most important source of continued poverty and conflict in West Africa is natural resources. For example, Sierra Leone’s largest export is unsorted diamonds — precious stones scraped out of the ground and sold for much less than their improved value at, say Tiffany’s. The URF rebels in Sierra Leone paid Liberia’s Charles Taylor in diamonds for the weapons they used to escalate their civil war.
How much would it cost to wipe out Ebola?
I live in Central Maine, which, by US standards, is not a wealthy place. Frequently I see donation jars, in local stores, for a family whose house has been lost in a fire, or who has been visited with a very expensive injury or illness. People invariably fill those jars, but only after disaster strikes are they willing to give. It may be harder for us to wrap our minds around the suffering our neighbors in West Africa -but make no mistake, they are our neighbors. Our esteemed Congressional representatives have been making that point over and over, by telling us how easy it is for them to come and visit us.
At the national level, though, the cost of turning this terrible situation around is comparable to the small change I might toss into one of those local-relief jars. That may be hard to believe, but it really is. After the 2004 tsunami in Indonesia, the US sent 12,600 military personnel to a relief and rescue mission, various governments contributed $5 billion in direct aid, and private donors raised still more. Did that scale of relief effort cause any economic hardship? Does the reader even remember this?
As Ebola accelerates at frightening pace, the World Health Organization estimates the cost of stopping the outbreak at less than $1 billion. The WHO estimates the overall cost of eradicating the much larger and deadlier problem of malaria to be around $6 billion a year for a ten-year period.
The F-22 fighter jet just went on its first combat mission, successfully dropping bombs on an ISIL command-and-control building in Raqqah, Syria. The United States has a fleet of 190 of this state-of-the-art stealth fighter, at an overall cost of over $36 billion.
The US Navy has twelve full-size aircraft carriers. When one of these behemoths goes to sea, it does so with a retinue of ten escort ships; operating a single carrier battle group costs roughly $900 million per year.
According to the US Office of National Drug Control Policy, the amount that Americans spend each year on cocaine has fallen substantially, to a mere $28 billion.
I think we can afford to invest the funds necessary to prevent preventable diseases in West Africa. Don’t you?
Long Term Solution
We need to render such nations less vulnerable, unilaterally — by promoting democracy, transparency, and economic freedom. Economic freedom would consist of taxing these countries’ vast natural resources, and using the funds to improve medical infrastructure, among other things. Oil and diamonds are obvious examples, but the most important resource, one which all countries have, is land. Taxing it as a function of its market value would break up large feudal land holdings, making it available for poor subsistence farmers. In time, such a system would bolster domestic markets and reduce dependence on bargain-priced exports (and foreign loans). But it’s very hard to establish reasonable, sensible, long-term reforms when so many people, especially children, are dying before your eyes.
P.S.: The Impulse to Panic
Since the above article was filed, it has been reported that a doctor who volunteered in Guinea for Doctors Without Borders and returned, symptomless to New York City, has been diagnosed with Ebola. Before that, apparently, Dr. Craig Spencer did some normal traveling about the city. “See! See!” scream our friends at Fox News. Dr. Spencer was very familiar with Ebola’s pathology. He monitored his own condition carefully, and followed established procedures as soon as he developed a fever. (Initial reports that his fever was 103 degrees turned out to be a transcription error: it was actually 100.3.)
A woman, a nurse from New Jersey, was quarantined upon arrival at Newark Airport, and she has since developed a fever. This was done under a new policy announced by Governors Andrew Cuomo and Chris Christie; their two states will go beyond the Centers for Disease Control’s recommendations and impose a 21-day quarantine on medical workers returning from Ebola-stricken countries. New York and New Jersey will also impose tougher screening procedures on people arriving from Liberia, Sierra Leone and Guinea than those required by the federal government.
According to the Centers for Disease Control, it is likely that the NY/NJ restrictions will mean that fewer health workers will be willing to volunteer in West Africa, at a time when every possible hand is needed. The CDC has announced a new “active monitoring” system that seeks to severely limit the risk of new Ebola cases without the harmful effects of a travel ban or automatic quarantine.
Thus far there have been five cases of Ebola in the United States, and one death. It seems that Congressional Republicans and other fear-mongers won’t be satisfied unless there are no new cases — but that is not a realistic goal. We live in an intensely interconnected world, and freedom entails some risk: there are going to be some cases. I wonder how long it will take for the US Ebola death toll to reach 9 individuals. That’s the number of Americans killed, so far in 2014, in school shootings.