When Thomas Duncan was diagnosed with Ebola at a local Dallas hospital on September 30th, two remarkable things happened: First, in Washington, D.C. and elsewhere throughout the United States, medical officials were ordered to testify to the state of medical preparedness in front of TV cameras . “We do know how to stop Ebola’s further spread”, the Center for Disease Control and Prevention declared authoritatively, “thorough case finding, isolation of ill people, contacting people exposed to the ill person, and further isolation of contacts if they develop symptoms.” Since then, the public has been treated to a continuing barrage of press conferences, news reports, and testimonies from doctors about disease transmission, incubation periods, viral loads, symptoms, quarantine procedures, treatment programs, and mortality rates. The Guardian even put together an illustrated Ebola primer. One wonders how many of its readers will ever find themselves in a situation in which their newly acquired medical knowledge will become practically relevant.
Stop Ebola? Help underfunded systems
Second, the diagnosis of the first Ebola case in the U.S. set in motion a cascade of reports, tweets, and posts that have dwarfed previous levels of attention by orders of magnitude. According to an analysis conducted by Time, global mentions of Ebola on Twitter skyrocketed from 100 tweets per minute to more than 6000 tweets per minute after the Thomas Duncan case had become public (another analysis of Google News data reveals a similar spike). Naturally, the market has already begun to capitalize on the widespread sensationalism: A sneaky Amazon merchant is now selling full-body Ebola kits for the squeamish and the macabre among us.
The two reactions – what one might call the medicalization and the mediatization of Ebola – are noteworthy in part because they have drowned out other responses. Paul Farmer, who is perhaps the foremost (and certainly one of the most prominent) public health advocates on the planet, argued as late as mid-August that our best chance against the spread of viral epidemics lies not with better medical technology or greater medical knowledge but with widespread investments into underfunded public health systems. Take a look at these two graphics, courtesy of Worldmapper:
Number of deaths from infectious and parasitic diseases:
Spending on public health:
The discrepancy cannot be missed. Many of the countries with the highest death tolls (and the highest infection rates) are also among the world’s poorest countries. Epidemiologists have long known that infectious diseases are much easier to contain at their source, when infection rates and the overall number of infections are still low. The more an infection spreads, and the more people are affected, the harder it is to contain it. That’s also the main reason why U.S. airports have now begun to screen passengers on certain flights for symptoms of fever: The best weapon against an outbreak in North America isn’t a well-equipped quarantine unit but the identification of initial carriers of the virus.
In short, epidemics aren’t so much a medical problem as they are a political one: A comprehensive strategy would begin with the recognition that every dollar spent in Western countries on better medical technologies would deliver a greater bang if it were instead invested in the health systems of countries which, for whatever reason, cannot or do not sustain such systems themselves. Indeed, this appears to be one of the few instances in which the altruistic impulse and self-interest align: If some countries do better, everyone stands to benefit.
Why was the global response relatively pathetic until September 30th, despite repeated warnings from agencies like the World Health Organization? Blissful ignorance might be one reason: It’s always hard to forecast the consequences of a development that lacks a direct precedent. It’s always easier to get it right the second time. Possible analogies to the spread of Ebola – for example, the spread of new influenza strains or of HIV – are sufficiently different and sufficiently distant to render them relatively useless.
But there’s another, more disconcerting reason. It’s best expressed in a caricature by the artist André Carrilho. His drawing depicts a hospital ward filled with dying patients. They all appear to be in agony, with red eyes and mouths opened in silent screams. All of the patients are suffering in solitude except one: His bed has attracted several journalists who hover over him in protective gear and attempt to get a quotable statement and a photo. That patient is white; the others are black.
There’s no need to rehash all the ways in which our – i.e. Western – moral sensibilities and political priorities privilege some and exclude others. Susan Sontag, Judith Butler or Gayatri Chakravorty Spivak have already supplied the language and the theory.
But it’s worth to remember – to make ourselves conscious of – the pervasiveness of those patterns of inclusion and exclusion. Says Joia Mukherjee, professor at Harvard Medical School and chief medical officer at Paul Farmer’s NGO Partners in Health: “I think it’s easy for the world — the powerful world, who are largely non-African, non-people of color — to ignore the suffering of poor, black people”. Or, in the words of another doctor:
“Starting at March 31st, Doctors Without Borders said the hospitals in Guinea and in Liberia are overwhelmed, and they were crying for help. As late as September 2nd, they were telling the U.N. and others that the help being provided is a shambles, that this is a disease that is doubling in the number of cases every three weeks. And our response was pathetic. We simply mounted no substantial response. It might have been the best thing that has happened that the first case to leave the African continent came to America, because it brought our mobilization to realize what happens there matters to us here.”
That, perhaps, is the saving grace of current Ebola sensationalism: If it sets into motion a set of actions aimed at tackling infectious diseases at their root (where weekly new infections are rising towards 10,000), the round-the-clock coverage might have been worth the effort. But as long as Ebola is seen primarily as a medical challenge and not as a political challenge that is deeply intertwined with inequalities in public health and health spending, that seems unlikely to happen.
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