Introduction
Even as early back into the history as fifty years ago it accounted for a common assumption among healthcare professional that the risk of new pandemics (such as Black Plague and Cholera) beginning to represent a clear and present danger to the civilisation’s very existence has been effectively eliminated. The realities of the 21st century’s living, however, proved this assumption utterly fallacious. The reason for this is that as the outbreak of the Ebola virus disease (EVD) has shown, the continuation of the ongoing social and technological progress does not make humanity any less susceptible what can be referred to as the disease of “organisational inefficiency”, which has a strongly negative effect on the society’s functioning, as a whole. In its turn, this results in establishing the objective precondition for the outbreaks of different viral epidemics to continue taking place in the future and for the scope of the associated societal dangers to grow in size. In my paper, I will explore the validity of this suggestion regarding the outbreaks of EVD in Uganda (2000-2001) and Sierra Leone (2014-2015), as described in the 2015 case study “Ebola in the context of conflict-affected states and health systems: case studies of Northern Uganda and Sierra Leone” by McPake et al.
Summary of the case study
In their article, McPake et al. provide many in-depth insights into what predetermined the epidemic occurrences of EVD in both countries while expounding on the main qualitative aspects of the concerning developments in question. According to the authors, there is a positive correlation between the likelihood for a particular country to experience a prolonged period of social instability/civil war and the measure of its population’s susceptibility to Ebola. Such a situation is objectively predetermined, “It is well understood that conflict and population displacement on a large scale poses significant risks for infectious disease, combined with livelihood disruption and food and water shortages” (McPake et al. 2015, p. 9). At the same time, the authors point out the fact that there are many factors at play defining the epidemic’s genesis in each individual case.
As it appears for the case study, whether the first Ebola outbreak proved thoroughly manageable, there is still much uncertainty as to what will account for the overall epidemiological effects of the most recent one. McPake et al. explain this by outlining the specifics of how the World Health Organisation (WHO) and the national (Ugandan and Sierra-Leonean) governments have gone about trying to prevent the epidemic from attaining an exponential momentum. According to the authors, the comparative successfulness of the deployed containment-tactics in the case of the Ugandan outbreak of Ebola is best explained with respect to the fact that Uganda’s government never ceased remaining in full control of implementing the basic control measures, such as the “early diagnosis with patient isolation, infection prevention control, contact tracing… (and) disinfection of contaminated objects” (McPake et al. 2015, p. 5). The case study also shows that the government of Sierra-Leone has failed miserably, in this regard – not the least due to the de facto absence of any governmental authority in the country’s areas affected by the ongoing civil war.
As it can be inferred from the case study, the WHO bureaucrats are to be partially blamed for this, as well. McPake et al. conclude their article by suggesting that the affiliated external circumstances (both social and environmental) exert a strong influence on defining the qualitative aspects of just about every Ebola epidemic. Consequently, this presupposes that “Despite the unfavourable conditions of a conflict-affected environment, effective containment and swift control can be achieved” (McPake et al. 2015, p. 5). The article’s conclusion appears strongly reflective of yet another idea, subtly promoted by the authors – there is nothing impossible about the task of keeping Ebola well-contained, for as long as those in charge of doing it have a basic understanding of the disease’s replicative pattern and the socio-economic situation in the affected areas does not deteriorate too rapidly.
Discussion
There can be only a few doubts that the case study does contain many valuable clues, as to what accounts for both Ebola’s pathogenesis and the foremost reasons behind the apparent failure of the international effort to prevent the disease’s Sierra-Leonean outbreak from growing to represent one of the major global issues. In this respect, we can refer to the authors’ insistence that there is nothing incidental about the spatial characteristics of the last two outbreaks of EVD, as such that have taken place in the most impoverished parts of Africa, where people continue to cling to a number of the essentially primaeval rituals/traditions – something that creates a perfect “breeding ground” for Ebola (Kent 2015). After all, people preoccupied with trying to find food are much more likely to come in contact with wild animals, proven to be the actual carriers of the Ebola virus, such as bats and monkeys – just as it was shown by McPake et al.
At the same time, however, there is one important weakness to the line of argumentation, deployed by the authors. It has to do with the case study’s implicit promotion of the idea that the foremost challenges of keeping Ebola well contained are “technical”. For example, among such challenges, the authors mention “The flight of health professionals from conflict-affected states” (McPake et al. 2015, p. 3). There are, however, a number of good reasons to believe that the main difficulty in this respect has to do with the worldwide (with the possible exemption of Russia and China) deterioration of the very paradigm of healthcare that has been triggered by the adoption of Neoliberalism as the semi-official ideology in most Western countries (and their allies in the Second and Third World).
The rationale behind this suggestion is quite apparent – Neoliberalism calls for the privatisation of the public sphere. As Braedley (2012) pointed out, “Neoliberalism is a political philosophy that places individual human freedom from particular kinds of servitude and coercion as its highest value: human freedom that is defined as the right to compete and to choose in markets, in order to pursue self-interest and wealth” (p. 73). In its turn, this presupposes that the delivery of healthcare services should be excluded from the governmental domain and transformed into yet another commercial pursuit – presumably to increase the overall efficiency of these services.
Ever since the early 2000s, the functioning of the UN/World Health Organisation (and the Western-based pharmaceutical industries) became strongly reflective of the specified ideology’s “freedom-promoting” provisions, as well. After all, the manner in which both international organisations addressed the 2014-2015 outbreak of Ebola leaves very little room for doubt that, as of today, it indeed became a commonplace practice in the West to invest in developing new vaccines only for as long as there are good reasons to believe that such an undertaking will allow the would-be affiliated pharmaceutical companies to generate a short-term commercial profit (Semalulu et al. 2014). This explains why, even though both outbreaks of EVD did pose an acute epidemiological threat to the world, there is still no Ebola vaccine in existence (Marzi & Feldmann 2014; Dawson 2015) – the populations of Uganda and Sierra-Leone are among the world’s most impoverished.
What this means is that developing Ebola vaccine will not make much commercial sense and that if WHO insists that this needs to be done, the organisation would have to be willing to subsidise the project – the idea about which the WHO bureaucrats have never been particularly thrilled (Shrivastava, Shrivastava & Ramasamy 2015). After all, the money could be so much more “wisely” spent on holding countless conferences on the dangers of Ebola, during the course of which these individuals get to stay in luxurious hotels and consume most exquisite foods (all taken care by the taxpayers) while becoming increasingly important in their own eyes. Therefore, instead of raising public awareness about the sheer importance of vaccination, within the context of how Ebola epidemics are being dealt with, the organisation’s top-officials decided that it will do just fine providing health workers in the field with access to some experimental drugs (such as ZMapp) for EVD’s treatment, as well as distributing these drugs to a few diseased locals.
Nevertheless, despite its “cost-effectiveness”, the deployed approach for tackling EVD proved an utter fiasco. The simply could not be otherwise. As Rid and Emanuel (2014) aptly observed, “It is difficult to see how complex treatments like ZMapp—which is expensive to produce and requires intravenous administration—can be implemented in resource-poor settings in the near future” (p. 1898). Apparently, the very notion of a viral pandemic implies that the workable containment-strategies must have a strongly defined systemic (or holistic) sounding to them (Obilade 2015). In this regard, Gericke (2015) came up with yet another valuable insight, “There is a need to prioritise the strengthening of health systems over experimental treatments because the treatments are unlikely to have a noticeable (long-term) effect on the epidemic, even if effective” (p. 1). If there was any noticeable effect to the implementation of the mentioned “experimental” approach (suggested by WHO) to dealing with the recent outbreaks of Ebola in Africa, it had to do with diverting the public’s attention from the relevant issues of actual (not imaginary) importance (Levett 2015).
What hampered the Ebola-containment effort even further during the disease’s latest resurfacing was the fact that, throughout the ordeal, it became a popular practice among many Western (especially American) politicians to lend their “valuable” opinions on the significance of EVD, in general, and what should be done to reduce its dangers, in particular. For example, in 2014 President Obama declared the Ebola virus to be a major threat to humanity, along with the ISIS and… Russia (Hodge & Weidenaar 2017). Given the fact that by that time Obama “succeeded” in convincing most people in the West that he is nothing but a pitiful clown who should not be taken seriously, such his suggestion did contribute even further towards encouraging them to underestimate the disease’s dangers. In its turn, this established the discursive prerequisites for the WHO officials to choose in favour of misrepresenting the issue to the public so that the Western pharmaceutical companies could be given a green light to use Ebola-infected Africans as “guinea pigs” for the field-testing of different drugs, most of which were not even intended to treat EVD (Brown 2015).
Essentially the same can be said about the effects of the issue’s intellectual marginalisation by the hordes of self-appointed “experts on Ebola” – one of the latest pandemic’s most distinctive features. As Stratton (2014) noted, “Confused, conflicting, and often erroneous recommendations and opinions from ‘‘health experts’’ (regarding the most recent outbreak of Ebola) have been an embarrassment for the global health community” (p. 553). While speaking on the subject matter, neither of these “experts” bothered to mention the importance of rebuilding healthcare infrastructure in the Ebola-affected areas. After all, if assessed prom from the perspective of these individuals, such a course of action would indeed prove unjustified – had WHO given it a thought, this would result in the drastic reduction of monetary grants, provided to the concerned “experts” by the government, in exchange for these people’s promise to invent a “miraculous cure” for Ebola within a few years (Roca et al. 2015).
Therefore, just as it was hypothesized in the Introduction, there is indeed nothing odd about the qualitative specifics of the 2014-2015 outbreak of EVD – the continual legitimisation of the Neoliberal model of healthcare in the West (and consequently in Africa) naturally results in making the objective of keeping this disease under control ever more challenging. This will continue to be the case into the future, unless the Western healthcare paradigm undergoes yet another ideological overhaul and becomes more systemically sound as a result – a rather unlikely development, given the ongoing intellectual degradation of the public sphere in the “civilised world”.
Conclusion/Recommendations
I believe that the deployed line of argumentation, as to what should be considered the main discursive connotations of the Ugandan and Sierra-Leonean outbreaks of Ebola, is fully consistent with the paper’s initial thesis. Apparently, the failure of both international and national health authorities to address the disease’s most recent epidemic is ultimately concerned with the focal provision of Neoliberalism in the field of healthcare – the lengthier is the governmentally/privately funded struggle against a particular viral disease, the more substantial is the monetary profit to be had by the supposedly contributing parties.
Because of what has been said earlier with respect to the discussed subject matter, the main recommendations as to what needs to be done to diminish the risk of Ebola outbreaks in the future can be outlined as follows:
- Preventing the proponents of Neoliberalism from being able to exert too much influence on the policy-making process in healthcare.
- Ensuring the effective functioning of the no-profit public health sector in the West, as well as in the developing countries – something that calls for the increase of infrastructural investments.
- Allocating funds for the development of Ebola vaccine and conceptualisation of the would-be deployed vaccination strategies in the field.
- Raising public awareness about the essentials of Ebola’s transmission and providing circumstantially appropriate incentives for people in the affected areas to observe the basic rules of interpersonal hygiene.
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