|SocialismToday Socialist Party magazine|
Issue 183 November 2014
Ebola inaction: symptom of a diseased system
In November 2013 there were no reports of the Ebola disease anywhere in the world. On 6 December a two-year-old boy died in Meliandou, a village in the forests of Guinea. His sister, mother and grandmother died in the following four weeks. A nurse and midwife were the next victims and are thought to have spread it to neighbouring villages, from where it reached the town of Guéckédou by February.
Eleven months later, 9,000 people in Guinea, Liberia and Sierra Leone have been infected, with the numbers doubling every four weeks. About 70% of patients have died. Cases occurred in Nigeria and Senegal, which both contained the outbreak, and now Spain and the USA.
The world’s "disastrously inadequate response" means that many people are dying who could easily be saved, Dr Jim Yong Kim, head of the World Bank, said on 1 September. "We should have done so many things. Healthcare systems should have been built. There should have been monitoring when the first cases were reported. There should have been an organised response". Instead, the World Health Organisation (WHO) had axed 300 of its 2,400 jobs in 2011 – cuts in governments’ contributions slashed its budget by 20%. Its director-general, Margaret Chan, described "a new and enduring era of economic austerity".
One of the first international aid workers to reach the Guéckédou area of Guinea in March was an Italian nurse from medical charity Médecins Sans Frontières (MSF). He noted: "In all the meetings I attended… I never saw a representative of the WHO. The co-ordination role that WHO should be playing, we just didn’t see it. I didn’t see it the first three weeks and we didn’t see it afterwards".
MSF described the Ebola outbreak as being out of control in spring, but it took until August for WHO to declare a "health emergency of international concern". Dr Jennifer Liu, MSF’s medical director, commented: "Who feels responsible? At the moment, no one feels responsible. WHO considers itself to be a technical agency answering to member states. Somehow people left it to a private organisation to take the lead. There’s something wrong there". WHO, like other United Nations institutions, does not act independently of the corrupt capitalist governments that constitute it. The profits of the capitalists they represent are put before the needs of poor and working-class people throughout the world.
The dangers of the Ebola virus are well known. It normally lives in fruit bats, which can fly long distances (and across national boundaries). Since its discovery in 1976 there have been seven outbreaks in east and central Africa, which were brought under control quite quickly. The borders between Guinea, Liberia and Sierra Leone are artificial relics of colonial empires, with families often living on either side, crossing to markets – or funerals. The infection spread quickly from villages to towns to cities, making the isolation of patients and quarantining of contacts far more challenging. Increasingly, Africans live in cities, as do the majority on every continent.
Five years after its 14-year civil war, which ended in 2003, Liberia had just one nurse or midwife for every 3,600 people, and one doctor for every 71,000. Local health services, already overwhelmed by ‘normal’ illnesses like TB, malaria and dysentery, are now beginning to collapse. People are dying not only of Ebola but from these other conditions too. Hundreds of health workers have died due to inadequate training, protective clothing and healthcare facilities.
Twenty-two million people live in Liberia, Guinea and Sierra Leone. Of 187 countries worldwide, they are the poorest 175th, 179th and 183rd respectively – but they are rich in natural resources. Imperialist exploitation has stolen this wealth, leaving basic services unable to cope. Around a fifth of the population struggles daily to survive in extreme poverty.
Sierra Leone’s iron ore mine in Marampa is one of its biggest employers with 1,400 workers, accounting for 10% of its gross domestic product. Owned by London Mining, it has been building a 130-bed Ebola treatment centre. "A strengthened healthcare system is essential for safeguarding the health of our employees and our host communities", said its managing director. But it has just gone bust! A collapse in global iron prices has pushed the company into debt, its share price falling from £4 in 2011 to 0.75p. The private financing of health services is at the mercy of the stock market.
Parliament’s International Development Committee reported in September that UK aid to Sierra Leone and Liberia was to be cut by nearly a fifth, from £85.9 million in 2013-14 to £71.4 million in 2015-16. Since 2008, £20 million had been contributed by the UK government towards a Liberian health programme providing free healthcare for infectious diseases, maternal and child health. The government stopped this funding in March 2014. The Liberian government is now proposing the reintroduction of patient fees.
The EU gives £18.5 million to Liberia for healthcare. Yet only £2.4 million went from the Liberian treasury to the health ministry – and none at all this year. Where did the money go? In June the Liberian government doubled the pay of nurses after many had already died and others faced pressures to leave their jobs because of the dangers they faced. But the World Bank instructed the government to cancel the offer, as it would have broken the health budget. The National Health Workers’ Association of Liberia has taken strike action demanding better protective clothing and pay.
Forty percent of farmers in Sierra Leone are said to have abandoned their fields, leaving crops unharvested. Hunger and movement away from infected areas to look for work elsewhere will increase the risks of infection. Belatedly, it has begun to dawn on world governments that this crisis is not restricted to small countries in west Africa. It will have an impact around the world. "If the outbreak is not stopped now", said Barack Obama on 18 September, "we could be looking at hundreds of thousands of people infected, with profound political and economic and security implications for all of us". He fears the destabilising effects this could have on world capitalism.
A nurse in Spain and two in the USA have been infected while caring for infected patients in their hospitals. It seems incredible that highly advanced hospitals like the Presbyterian in Dallas, Texas, failed to prevent its nurses from contracting Ebola. According to the New York Times, it has long been "regarded as one of the finest hospitals in Texas". After the two were infected, the hospital issued statements seeming to blame them for not following procedures. A group of nurses contacted the union, National Nurses United, although they were not previously members.
The union reported that hospital authorities resisted moving the patient to an isolation unit, told nurses to use tape to cover bare areas of their necks when wearing protective suits (making them more difficult to remove safely), had inadequate waste disposal procedures, and had not sent the nurses on mandatory Ebola training. National Nurses United leader, RoseAnn DeMoro, said the nurses were upset after authorities appeared to blame the nurse. "This nurse was being blamed for not following protocols that did not exist… The nurses in that hospital were very angry, and they decided to contact us".
Texas Health Resources, which runs the Presbyterian along with 24 other hospitals, describes itself as non-profit making. Yet its 2012 operating profit was $473 million! Twenty executives were paid over $600,000 each with the highest-paid on $2,685,000.
Thomas Duncan – the Liberian admitted to the hospital and subsequently found to be infected – did not have medical insurance, like many poor Americans. The average cost of a day’s stay in the Presbyterian is $2,766, with extra to pay for physicians and treatments. Without insurance or Medicare/Medicaid cover, Duncan would have had to rely on being a charity patient. Did this influence the initial decision to send him home when he first went there, complaining of fever and abdominal pain? The USA’s healthcare system – the most expensive in the world – has failed at its first test.
Trade unions in health services, transport and airports, border control, emergency services, undertakers and other potential areas of direct exposure to infected people need to draw up a programme of suitable protection for their members. Relying on employers who are making cuts in public services or prioritising profits can only result in more cases like the Presbyterian hospital in Dallas.
The USA, Britain and France are now putting more significant efforts into healthcare in their three former African colonies, using their armed forces. Almost $400 million has been given to UN agencies and aid organisations, following an appeal launched in September for $988 million. The UN is also seeking another $1 billion for an Ebola trust fund, "to provide a flexible source of back-up money to contain Ebola". After one month the trust fund had received only $100,000 – from Colombia – with $20 million pledged.
There is an urgent need for many more treatment centres, trained staff and basic infrastructure like clean water and electricity. Imperialist governments cannot be relied on to provide them. After all, they have failed to do so ever since seizing the African colonies in the 19th century. Governments now want to use aid to build their influence in the region with the hope of gaining future trade. Their actions are governed by the interests of the capitalists they serve.
Workers in every country need to take charge of the aid programme. Two regions of the Unite trade union have proposed it should establish a fund for health workers in the affected countries through their unions. That is the type of support needed: sending aid to those who know what is required, cutting out government corruption. But trade unions do not have funds on the scale required, unlike big business, which has more than enough money to bring the Ebola outbreak to an end.
Banks, mining companies, the pharmaceutical industry and other big corporations need to be brought into public ownership and their resources used. Armed forces have training in useful skills and have plenty of vital equipment to quickly build treatment centres, assisting hard-pressed and over-stretched local services. But they should be democratically controlled by elected rank-and-file servicemen and women and work in co-operation with democratic local committees – not used as a modern-day colonial force.
The pharmaceutical industry has been exposed as the profit-seeking vulture it is. In the 38 years since the virus was identified, the industry has refused to invest into researching a preventative vaccine or looking for a cure. While there were small numbers of poverty-stricken casualties every few years, there was no ‘business case’ for this research.
Now the numbers are growing rapidly and government money is available, research is being carried out hurriedly. The industry must be nationalised – not only in Britain, but also in the USA, Germany, Switzerland and everywhere else it has factories and laboratories. These resources need to be planned democratically to produce medicines and vaccines for need, not just for profit.