Why are affected West African states so spectacularly ill-prepared to deal with Ebola

I was in Conakry when reports first surfaced of cases of the Ebola virus disease (Ebola) in the Forest Region of Guinea. There had never been an Ebola outbreak outside of Central Africa before. Initially, my colleagues and I were unconcerned about its ability to impact our lives. We joked about switching from handshakes to fist-bumps. We teased one colleague that he would now have to forego bushmeat for lunch. When I returned home to Freetown in Sierra Leone later that month the customs officials asked for my yellow fever card and nothing else.

Since making flippant jokes about it in March, Ebola has spread to Liberia, Nigeria and Sierra Leone. Since the epidemic started December 2013 and 14 September 2014, a total of 4507 cases were reported to the World Health Organization (WHO). At least 70% of these people are dead, by WHO estimates released earlier this week. The WHO admits, however, that this is likely an underestimate as hundreds have probably died without seeking treatment, either because it was inaccessible or they perceived it as ineffectual or even dangerous. And the WHO now claims that “… if control does not improve now, there will be more than 20,000 cases by Nov. 2, and the numbers of cases and deaths will continue increasing from hundreds to thousands per week for months to come.” No one is laughing at Ebola now.

On July 31, President Ernest Bai Koroma of Sierra Leone declared a State of Emergency. On August 7, I left Freetown feeling unsettled and guilty—knowing that the US passport in my pocket meant I was one of the lucky few that could easily get out of harm’s way. As my plane took off I wondered how Ebola had been able to spread so far so quickly and why the governments involved were so spectacularly ill-prepared to deal with this crisis.

With few exceptions (like this and this), most news reports so far have focused on Africans’ enduring ignorance as the main reason for the transmission of Ebola.  Little has been written about the political and economic structures that have shaped the rise and spread of Ebola. Yet, the fundamental drivers of the Ebola epidemic—inadequate public health infrastructure, neglect of tropical diseases and environmental destruction facilitating the rise of new pathogens—are all symptoms of an even more fatal disease: neocolonialism.

Neocolonialism is that alliance between foreign governments and local elites that emerged after independence in the 1960s and 70s to perpetuate the exploitation of African labor and natural resources for the benefit of foreign investors. Most Western politicians, scholars and journalists, of course, prefer to blame poverty exclusively on Africans themselves, on Africans or their leaders’ innate corruption. For example, at the recent US-Africa Summit, Vice President Joe Biden delivered the “familiar lecture from Western governments” to African leaders on the need to curb corruption to foster economic growth. This explanation conveniently ignores the role of Western governments and corporations in creating and perpetuating Africa’s poverty. The US-Africa Summit itself just continues this ignoble tradition.

Neocolonialism robs African governments of the resources necessary to invest in social development. First, there is a decided lack of transparency in the extractive industry which allows foreign companies to make sweetheart deals with corrupt local politicians where they pay obscenely low royalties and taxes. Second, African governments have spent too much money servicing debts that were often borrowed by authoritarian regimes. Western banks are complicit in capital flight, helping African elites to conceal and protect their ill-gotten gains. Historically, Western governments have supported dictatorial governments as long as they are welcoming to Western investors (or, during the Cold War, in sync with Western interests). As a result, Africa is actually a net lender to the rest of the world. Instead of investing Africa’s economic surpluses in its productive base and in the health and education of its peoples, African and Western elites connive to transfer Africa’s savings to the West.

Neocolonialism also denies African governments the policy space to pursue autonomous economic development. Since the 1980s, the World Bank and the IMF have forced African governments into neoliberal reforms through Structural Adjustment Programs (SAP). SAPs require countries to slash spending in public health and education and drop barriers to trade and foreign investment in exchange for debt refinancing and relief. These “pro-market” reforms strangle infant industries in their cribs and preclude the industrial policies that have been necessary for economic development nearly everywhere else.

It’s true that religious beliefs, misinformation and superstition have aggravated the Ebola epidemic. However panic and misinformation typically accompany the rise of new, deadly, infectious diseases.  Let’s not forget the hysteria surrounding the appearance of AIDS in the US. Susan Sered argues that this misplaced focus on sorcery and superstition obscures the fact that longer life expectancy in the US and Europe is the result of government investment in public health infrastructure. If Americans are healthier than West Africans, it is because we have better access to safe water and medical care, not because “we gave up our religious beliefs.”

The health systems in Sierra Leone, Guinea and Liberia are among the world’s worst.  Sierra Leone has the lowest life expectancy of 193 countries surveyed by the WHO. Initially there was only one health facility in the country (the Lassa Fever Ward at Kenema Government Hospital) that could provide appropriate treatment to Ebola patients. There was no hospital in Kailahun District where the outbreak first entered Sierra Leone from Guinea. Health officials had to transport patients to the Kenema Government Hospital on a muddy road in the middle of the rainy season in makeshift ambulances.  Nurses have gone on strike  over having to work without personal protective equipment. Patients are now afraid to go to hospitals for other ailments out of fear that they may get infected with Ebola once there. Nurses and doctors are abandoning their posts given the dangerous working conditions. The WHO warns that the number of Ebola cases could surpass 20,000 before the epidemic is contained. The collapse of the health care systems in each country, however, threatens to kill far more West Africans of malaria and other endemic diseases than Ebola itself.

Western governments, and the international financial institutions they control, deserve much of the blame for the disastrous state of health systems in Sierra Leone, Guinea and Liberia. “In health,” the WHO states plainly, “SAPs have slowed down improvements in, or worsened, the health status of people in countries implementing them. The results reported include worse nutritional status of children, increased incidence of infectious diseases, and higher infant and maternal mortality rates” [emphasis mine].

Colonialism and neocolonialism are also the ultimate cause of the unprecedented emergence of Ebola in West Africa. Although too many scientists think that the natural sciences are free of politics, zoonotic diseases like Ebola that spread from animals to humans do not operate in a context free of economics and politics. Rob Wallace describes the process: “The more the remaining monkey and bats and other animals are collected from deeper in the forests increasingly pressured by logging and mining, the more likely [zoonotic] spillovers are to accrue. And, by a growing, peri-urban transportation network, to spread.” Neoliberal economic policies and large multinational corporations’ operations have devastated West Africa’s ecosystems and communities through logging, mining and land grabs, creating new pathways for opportunistic pathogens to evolve and disperse.

To make matters worse, there is simply no desire on the part of Western pharmaceutical companies to invest in a vaccine or treatment for Ebola. First, as Leigh Phillips explains, Big Pharma knows that treatment of chronic diseases is more profitable than a one-time vaccine so they refuse to invest in life-saving cures. Second, they know that African markets are tiny; therefore “Ebola is a problem that is not being solved because there is almost no money to be made in solving it.” In short, “It’s an unprofitable disease.”

The people of Sierra Leone, Guinea, and Liberia have already had more than their fair share of suffering. Sierra Leone and Liberia recently endured brutal civil wars including mass rape and mutilation and the recruitment of child soldiers (in both cases, the IMF/WB’s fiscal bloodletting certainly contributed to state collapse). Kailahun District, the epicenter of the epidemic in Sierra Leone, has long been cursed by blood diamonds. In the short-term we need to pressure “donor” governments to step up and mobilize the necessary financial and human resources to contain the epidemic. Even the head of the World Bank understands that if the Ebola epidemic had “struck Washington, New York or Boston, there is no doubt that the health systems in place could contain and then eliminate the disease.” Why are West African lives any less valuable? The Onion’s sassy headline says it best: Experts: Ebola Vaccine at Least 50 White People Away.

But the people of West Africa deserve more than our sympathy, we must express our solidarity with the African activists and social movements fighting foreign corporations, international financial institutions and their own corrupt elites for greater democratic control of their governments and economies. Only by curing the scourge of neocolonialism in Africa can we prevent the emergence and spread of more deadly epidemics.

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©Africa is a Country, 2016