Ebola and the terrorism of poverty

October 9, 2014

Rebekah Ward and Nicole Colson explain how racism and structural inequality are at the heart of the spreading Ebola epidemic in Western Africa.

THE PANICKED wall-to-wall coverage on cable news networks of the first case of Ebola diagnosed inside the U.S. showed no signs of abating as Thomas Duncan, the patient in Dallas, died of the disease on October 8.

There are no confirmed reports that anyone who came in contact with Duncan has contracted the disease, yet officials--both in the U.S. and in Liberia, where Duncan was a citizen--made sure to threaten Duncan with prosecution in his final day. Duncan was accused of traveling to the U.S. after contracting the disease--though it isn't clear at all that Duncan knew he had been in contact with an infected person before travelling.

To date, Ebola has infected around 7,500 people and caused some 3,500 deaths in West Africa, according to official statistics--though some health experts believe the actual number of cases might be more than twice as high. The vast majority of cases have emerged in three countries: Sierra Leone, Guinea and Liberia.

The U.S. media has been full of scaremongering and racism in its coverage of the Ebola crisis--including irrational calls to halt all travel between the U.S. and Africa, or close all borders between the affected countries in Africa--a move that public health experts say would cause grater unrest and possibly worsen the spread of the disease.

Red Cross workers in Guinea respond to the ongoing Ebola outbreak
Red Cross workers in Guinea respond to the ongoing Ebola outbreak (Jean-Louis Mosser)

For its part, the U.S. Centers for Disease Control has announced they will begin screening all travelers entering the U.S. from Sierra Leone, Guinea and Liberia. That's despite the fact that such screenings rarely work--and can divert resources away from where they would be better put to suse.

For example, Thomas Duncan was very likely asymptomatic when he entered the U.S. But as Larry Gostin, a professor of global health law at Georgetown University, told NPR, "[G]overnments, even if they know better, will sometimes reply to that political outcry. They're under a lot of pressure to do something [to] make the public feel reassured, even if it really doesn't make them safer."

Whether or not they are effective, such public measures are unlikely to quiet the chorus of talking heads using fears about Ebola to justify whipping up racism. Right-winger Dinesh D'Souza, for example, coined the Twitter hashtag #Obola--a combination of "Obama" and "Ebola"--to both exploit the media hysteria and recycle myths about the alleged "Kenyan socialist terrorist" in the White House.

This kind of venomous racism is spilling over into bigoted attacks on African immigrants. As Raw Story reported, some residents of Thomas Duncan's Dallas neighborhood--which has a large African immigrant population--have been turned away from jobs and refused service at local businesses. Of course, no one is bothering to determine whether they came in contact with Duncan in any way.

"Many residents are [saying] that they can't go to work and are being turned away at restaurants based on their appearance," Rebecca Range, executive director of the Vickery Meadow Improvement District, told the Dallas Morning News.


THE THREATS of prosecution and panicked television broadcasts are not only out of proportion to the actual risk of Ebola spreading in the U.S.--they overshadow the terrible toll that Ebola is taking half a world away. We ought to be asking bigger questions about the U.S. response to Ebola--and why more isn't being done by the world's wealthiest countries to stop the spread of a disease that thrives on poverty.

As the Verge reported:

The difference in treatment for U.S. patients and African patients is stark, beyond the use of experimental drugs. Some Ebola-stricken regions in West Africa don't have access to fuel to power ambulances, and many health workers lack the protective gear to stave off infection. Which is why it's so strange that Duncan's health has been used as an excuse to voice concerns about the presence of foreigners in Dallas.

This highlights the racism and inequality of the for-profit approach to health care in general, and especially the health care needs of people of color.

"This isn't a natural disaster. This is the terrorism of poverty," Paul Farmer, a Harvard professor and co-founder of Partners in Health, told the Washington Post after a recent trip to Liberia. "There's a reason the fatality rate is 80 percent in rural Africa and 0 percent for Americans and Europeans who get out in time and get proper medical care."

The Post article pointed out that the current epidemic could have been slowed or even stopped weeks ago--if the necessary resources had been made available. However, the Post reported, "The [World Health Organization], an arm of the United Nations, is responsible for coordinating international action in a crisis like this, but it has suffered budget cuts, has lost many of its brightest minds, and was slow to sound a global alarm on Ebola. Not until August 8, four and a half months into the epidemic, did the organization declare a global emergency."

In West Africa, attempts to treat patients are being thwarted by a lack of resources that could be easily provided. Hospitals and aid workers lack basics like gloves and protective equipment, medicines and rehydration fluid.


AND THEN there is the role that Big Pharma has played. In the U.S., not one federal or state agency has expressed an interest in pushing the pharmaceutical industry to increase the pace of drug approval or production to halt the epidemic. Several experimental Ebola vaccines and another experimental treatment been denied to West Africans. The cause? Profit.

Because these experimental treatments and vaccines are now in high demand, they can be sold at exorbitant prices. Norway, which purchased the purported last dose of the promising Ebola treatment zMapp on October 7, will not disclose how much the government paid for it, but a Norwegian nurse who was working in Western Africa is the person who will receive this treatment.

The only African countries that successfully purchased zMapp received a few doses for doctors who were affected. One of those doctors died, likely because he received the drug too late. This is in contrast to the American health care workers Dr. Kent Brantly and Nancy Writebol. The drug was flown across the Atlantic to ensure it was taken shortly after infection in both cases--and they were then brought back to the U.S. for further treatment.

There are currently four Ebola vaccines in development. Two are close to clinical trials in humans after having been shown to be effective in other primates. However, profits come people in this case, too.

One of the vaccines, which may make people exposed to the Ebola virus resistant to getting the disease, has supplies for approximately 1,000 doses--but they are stalled in a warehouse in Canada.

NewLink Genetics, the owner of the intellectual property rights for the vaccine--and partners with the producers of zMapp--says it is working as quickly as possible to move to trials, but needs the proper contracts and insurance before it can release the serum. Critics say the delay is designed to maximize NewLink's profits. Virologist Heinz Feldmann, who helped develop the vaccine while working in Canada, said, "It's a farce; these doses are lying around there while people are dying in Africa."


THE INABILITY to begin vaccine trials stands in stark contrast to the long history of the use of Southern and Western African peoples for other drug trials. This Ebola outbreak has highlighted the love-hate relationship between Big Pharma and Africa--when a drug isn't in demand, it's tested often unethically on Africans, and when it is scarce or when Western nations want it, it is denied.

Because it is usually cheaper and easier to find participants, and ethical regulations are lax, drug trials in "developing countries" have increased 16-fold over the past 10 years, a stunning example of racism in bioethics.

Examples of Africans used as little more than guinea pigs for the drug industry abound. Take South Africa during controversial HIV prevention trials in the 1990s: One group of HIV-positive pregnant women was given the current standard for treatment (a long course of anti-retroviral drugs) while another was given a placebo (a pill with no drug, only sugar or salt). The women were not properly informed of the purpose of the study or the placebo parts of the study. The trial resulted in a rate of HIV infection among infants born to the women that was twice as high with the placebo than with the drugs.

Essentially, hundreds of infants were purposefully allowed to contract HIV in order to promote the effectiveness of a very expensive drug.

Another example comes from Nigeria, where in 1996, the antibiotic Trovan, from the drug company Pfizer, was tested on hundreds of children to determine its effectiveness in treating meningitis, an infection affecting the nervous system. Although Pfizer claimed it informed all study participants of the risks, many parents of children given the drug say they were not even told that it was part of a study, much less informed of any possible side effects.

One of the parents, Muhammadu Mustapha, told BBC News, "My son was ill, and we took him to the hospital like any other family would. Then the Americans and some local Nigerian doctors injected Anas with this evil drug." His son Anas will suffer from fatigue and muscle weakness due to nerve damage for the rest of his life.

According to the New York Times, "In all, 11 children died in the trial: five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial. Others suffered blindness, deafness and brain damage."

Pfizer eventually agreed to a settlement of $75 million, but documents from the muckraking website WikiLeaks suggest that in order to prevent further payouts, Pfizer hired investigators to dig up a scandal about the Nigerian minister of health.

Nor is racism in the pharmaceutical industry restricted to Africa. There is a long history of unethical drug testing on people of color in the U.S. as well. One of the most famous examples is the so-called "Tuskegee experiment" conducted by the U.S. Public Health Service.

In 1932, 600 impoverished Black sharecroppers in Macon County, Ga., were told they needed treatment for "bad blood." What they were really being studied for was the progression of syphilis. Two-thirds of these men had contracted syphilis prior to the start of the study. When the antibiotic penicillin was shown to be an effective treatment for the debilitating disease in 1947, none of the subjects were informed or treated. Instead, the study was continued to observe how the disease progressed.

In exchange for their participation, the men were offered free meals and burial services. It took 27 years before an out-of-court, $10 million settlement for the families made any reparation for this cruelty.

Today, racism is fueling the Ebola crisis in Western Africa, with African lives seen as worth less than those of Westerners. As the disease rages, we should point the finger at the failure of Western governments and drug companies to deliver the needed resources. They are more concerned with enforcing borders and protecting profits than with stopping an epidemic that threatens the lives of untold thousands.

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