Reflections on African politics, policy and development

The word Ebola is conjuring up fear around the world; breakdowns in Western infection control procedures have led to cases in Spain and the US, and have given the non–African world a taste–or a foretaste–of a disease already ravaging core areas of three African countries.

Liberia, Sierra Leone and Guinea are neighbors, and are all marked by political instability and corruption. Terrible and protracted civil wars devastated Sierra Leone and Liberia, while Guinea’s recent history has been one of division, military rule, and an effort at civilian government that has marginalized opposition and caused continuing tension and urban bloodshed.

Low agricultural productivity and the unreliability of food supplies have left many relying on “bush meat,” one of the main routes through which the virus may have spread to humans in this present outbreak.

Unhygienic slums and closely packed taxi–vans mean sweat and other bodily fluids are being exchanged, or clog in the drains beside shacks, infecting the water supply and raising the spectacle of a tipping point where deliberate under–development suddenly slides into chaos and disease.

And this is the true scandal of countries whose health budgets have been ransacked by government after government, civilian or military–or where governments have simply not cared about health provision, health education, or the reliability and safety of food chains, public health infrastructure or anything at all to do with sanitation and public welfare.

Myth and mystification

Liberia could not muster 100 doctors in a country of 4.5 million, and ranks close to the bottom of world rankings for per capita healthcare spending. Why are there no medical staff? Many doctors have of course left the country, but a country that doesn’t pay its doctors will lose them.

Granted, there are not yet any assuredly effective drugs. The joke of course is that the West will suddenly “discover” drugs as soon as the African epidemic becomes a pandemic encompassing the lands of the rich. But this is simply not true.

There simply has been little concentrated research on this African disease–partly of course because it has indeed been an African disease, not a Western one; partly for the related reason that pharmaceutical companies would not make much money selling hugely expensive drugs to Africa; and partly because there is a long time period involved in completing even basic stages of research, basic stages of development, and setting up the industrial capacity for manufacture.

Yet even if the disease hit the US with sudden severity tomorrow, and drugs were “discovered” the day after, there would be no capacity to manufacture them to cope with any but a very small number of cases–and that’s with short–circuiting the entire approval process, the entire clinical trials process, and all other regulatory processes. All of which exist to protect us from lethal unforeseen side–effects.

Nor can there be a sudden recourse to generic versions of the new drugs–particularly if they are vaccines that rely on immunization. And no one knows whether immunization could work.

If it did, the possible spectacle of a dozen Indian generic manufacturers competing with Western pharmaceutical companies for supplies of infected Liberian bats to harvest the disease from them for use in drugs defeats the imagination. So for now, cheap and snide comments about the sudden “discovery” of drugs will remain little more than colorful (if understandable) cynicism.

Boxed in

Because of the relative difficulty of transmission, proper quarantine measures to isolate the infected can stop Ebola spreading. But this depends of course on effective quarantine procedures. And in the countries affected, the appalling healthcare response means that people forcibly contained in quarantined slums in close proximity to infected neighbors are effectively being dealt a death sentence, or at least the strong possibility of one.

Because of the way quarantining measures have been implemented, slums that have long been the most deprived have been even more harshly treated and abandoned. The quarantining of slums without any food provision for residents also demonstrates the extreme callousness of the governments for those they are responsible for governing.

Even if the nightmare scenarios of millions of fatalities are simply deeply pessimistic guesses that ultimately prove wrong, the long–term and very real question of responsibility still lingers.

After years living under violent kleptocracies, many in the affected countries will now be wondering if the governments and ministers who have stolen the health budgets over many decades should be assembled and condemned to live in the slums that they have decided to quarantine. Perhaps this is what should happen when you steal your citizens’ healthcare.

And perhaps the threat of personally experiencing the consequences of their own corruption is all that could improve the abysmal governance in these states–whose people now face a very different terror to the endless terrors of war they already know.

By Stephen Chan

Professor of World Politics at SOAS, University of London