Ebola: Not everything is the fault of evil capitalists

Submitted by Matthew on 25 October, 2014 - 12:29 Author: Les Hearn

Paul Vallely (Ebola’s victims: “only Africans”?, 8 Oct) runs the risk of weakening a case by overstatement. 

When Ebola virus broke out this year, no one had any reason to expect it would take such a hold. The average death toll had been 67 a year since its identification in 1976. The current official total of 4,500 is already three times that of all previous recorded deaths in the last 37 years. Who could have predicted that? Who would have been brave enough after the fuss about bird ‘flu where millions of doses of vaccine were stockpiled unnecessarily? Niels Bohr’s quote about prediction is particularly apt.

Indeed, it might be argued that the international response is actually much better than ever before. Only because of the runaway growth of the epidemic is it seen in hindsight to be inadequate. The World Health Organisation has actually admitted that its response to the epidemic was too slow and foreign governments could justifiably say they were waiting for a lead from WHO. Now, however, it is right to call for the most urgent action to deal with not only the medical emergency but the disruption of food production and distribution. Governments in Equatorial Guinea, Sierra Leone and Liberia can plead lack of resources, but they are also plagued by corruption. The Liberian government also managed to provoke a strike of health workers, some 100 of whom have died of Ebola from treating patients.

It is also interesting to observe that in Democratic Republic of Congo the outbreak has been successfully contained, with only about 70 cases. The outbreak there was due to an unrelated strain of Ebola but the different course of the infection seems to depend on two special conditions: in DRC, Ebola tends to occur in remote villages, whereas in the three worst-hit countries it has taken hold in more accessible areas; and crucially, while Guinea, Sierra Leone and Liberia have never had Ebola before, DRC has had six outbreaks since 1976 and its response time is shorter and the measures taken more effective.

The most unfair aspect of Dr Vallely’s article concerns use of the experimental treatment ZMapp. First, he criticises the use of an untested drug; then he accuses someone (medical authorities? Mapp Pharmaceuticals?) of racism for not giving this possibly ineffective and potentially harmful treatment to an African doctor, rather than just white (?) Westerners. These Westerners were in any case also risking their lives to help Ebola victims for humanitarian reasons. However, as a top South African AIDS researcher said, [if ZMapp had been given first to Africans] “It would have been the front-page screaming headline: ‘Africans used as guinea pigs for American drug company’s medicine.’”

In fact, there were only a few doses of ZMapp and African doctors were among the recipients: supplies ran out in August. Some recipients of ZMapp died but most survived. Is this because ZMapp works or because the other care given was effective or because of luck? No one knows.

It is also odd to criticise the use of quarantine to prevent the spread of Ebola. It is in everyone’s interests if people likely to have Ebola infections are prevented from travelling but treated promptly. Even when no cure is available, the best way to avoid spread is to limit travel.

Failing this, people who are unwell and have come from areas where Ebola is rife need to be treated as potential victims and given all appropriate treatment to try and save them. This did not happen with the Liberian Thomas Duncan. Duncan was not ill when he flew to Dallas but went to a local hospital when he developed symptoms. Through phenomenal incompetence and complacency, Duncan was not identified as a potential Ebola case even though he said where he had come from. Diagnosed as simply having a virus infection and lacking health insurance, Duncan was sent home with (ineffective) antibiotics (appallingly bad but inexpensive practice) to potentially infect family and friends.

He was admitted to hospital when he was seriously ill. The medical authorities still didn’t get it and allowed at least two nurses to be infected by not providing proper protective clothing, and then agreed for one of them to be allowed to fly when already showing symptoms. Duncan died when he might have survived and, if there are not several more deaths in Texas, it won’t be thanks to the Presbyterian Hospital, Dallas.

Many things are the fault of evil capitalists, but not everything.