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Ebola: Is the virus attracting the wrong kind of attention? The outbreak of Ebola in West Africa has been described as “out of control” by Medecins sans Frontieres. VoR’s Tim Ecott hosts a discussion with four expert guests on a virus which is thought to have killed more than 400 people this year. Joining Tim in our London studio were:

Dr. Mahlet Zimeta, lecturer in Philosophy at University of Roehampton, honorary research associate at Department of Science and Technology Studies, UCL

Sulayman Jengassistant editor of Kibaaro News (Gambia)

Dr Ben Neuman, virologist from the University of Reading’s School of Biological Sciences and by Skype from Liberia:

Agnes Umunna, journalist and founder of human resources development project Straight from the Heart


BN“On a case by case basis, Ebola is one of the most deadly pathogens that we know about. In the current cases it affects and actually kills somewhere between 50 percent and 90 percent of the people who are infected. However, the good side is that the virus doesn’t spread very well. When it does spread it actually makes your body essentially attack itself: the white blood cells that would normally be cleaning up the virus infection are provoked into releasing a lot of harmful chemicals that degrade the inner lining of your blood vessels, and this is what eventually causes death due to organ failure.”

“In a hospital, as I understand it, the treatment is generally bed rest, you try to keep the patient well-hydrated and comfortable for the duration of the virus, which sometimes can last as much as a month.”

“In the laboratories people have found some drugs that seem at least in cell culture to be effective against the virus, but, as far as I’m aware, these haven’t been used in a clinical setting and we don’t know if the damage they will do to the people will be preferable to the disease.”

AU: “I don’t think people are worried about the outbreak of Ebola, because there’s not much awareness in Liberia, and people are running away from doctors, some lock their doors, because there’re rumours about how the diseases are spreading, and I think there should be more sensitisation on the Ebola sickness. People in Liberia think that the WHO just wants to get funding and that government officials are not doing enough sensitisation to educate people about it. And another question is they don’t have labs to test those who are dead from the diseases to see if it’s really from Ebola.”

“It’s not just Liberia, all countries in precaution mobilise emergency response mechanisms and call on the international community to mobilise resources. The government is not really doing much, because if they did we should have sensitisation. In Lofa County they have five new cases reported, and 11 people died in Lofa. So health teams should go to Lofa County and they are being driven away. So the government has to do more education about this, I do not know if and how they are doing it.”

SJ: “Gambia has a high level of preparedness for an outbreak of Ebola. The Gambian government through its ministry of health and social welfare has set up preparatory mechanisms through its partners and stakeholders. What the government did in the first place is when they heard an outbreak in Guinea and in Liberia, they set up a control mechanism, flights from affected areas were banned, but what the government was able to achieve is the control of people coming into Gambia with the virus. Planes were only allowed to drop people and not to pick up anyone. The government also made a nationwide assessment of the resources and materials that they have on the ground and in the health facilities in case there is an Ebola epidemic. The Gambian government has also initiated a nationwide sensitisation programme and they have created sub regional technical advisory committees and local authorities on Ebola for each region.”

BN: “What happens is that as the disease progresses the person starts to feel worse and worse, and it’s about the time when person starts feeling really bad they are most likely to be able to transmit the disease. These people wouldn’t want to move, from what I understand, you just want to lie down and be still during this time. So it may be that people are incapacitated enough that they don’t spread it, but there is certainly no physical barrier to spreading the virus overseas by air travel.”

MZ: “I don’t know if I think that Ebola has been ignored in terms of medical research, but I think there are practical economic constraints that make it harder for African researchers to lead work in this area. So if you want to do the research on Ebola, you need to be working in labs that have the highest level of biosafety, biosafety level 4. And there are about 43 of these labs known to be in existence, and only 2 are in Africa. A lab like this costs about 2.5 million euros annually to maintain, and the physical security of it – one researcher described it as a submarine inside a bank vault, very restricted access. The cost of maintaining these labs means that it’s difficult for African universities and African governments, researchers based in Africa to pioneer research in this field.”

BN: “Africa is where the disease always comes back, and about every 2 years it seems to rear its ugly head again, so people in Africa have a vested interest. These are the people who are going to be infected, and these are the people who I would think, would most want to do research. Yes, it’s really a shame that there are no more category 4 high containment laboratories there to enable them to do this.”

AU: “Since the outbreak’s begun 24 people died in Liberia, 49 in Sierra Leone and 264 in Guinea, and there’s no lab to verify any of these deaths. So I think the most important thing is to build a lab in Africa, where they can verify if these deaths are caused by Ebola. And there are so many health issues that are affecting Africans, Liberians and other people. Recently a Canadian came from Liberia and he was very sick, people thought he had Ebola. So the most important for us is to talk about health issues. So my idea, the people or the WHO needs to create a lab in Liberia. All those viruses we transport to Europe to the think-tanks, by the time the results come 12 or 20 people are dead, just to test this on. So I know there is no more need, but the most priority is that the government and president can do is to create these labs for us in Liberia or in Africa, we should have something in Africa, especially in West Africa where these viruses can be found now.”

SJ: “It is a priority, because the president is very much interested in this Ebola case, and recently he has bought a very sophisticated machine that could test the virus that cost 50 million Dalasi. So with the level of preparedness that Gambia has in place. I think if there should be a laboratory in Africa it should be Gambia.”

“I do agree with you on that level, but it is also that every country has its specific health issues. In Gambia we used to have malaria as a major killer disease. Of late the government, like with Ebola, has sensitised the general public on how to prevent the malaria disease, protect themselves from mosquito bites (like nets that they soak in incense that people use overnight), so it reduces the level of infection, so it’s no longer a major killer disease in Gambia. Like with the Ebola case, when they had an outbreak in Guinea, the government set up a preparedness plan, which they put forward through their stakeholders and partners. And recently the WHO donated leaflets and other materials that will also help to enhance the sensitisation.”

It depends on the government’s interest. Because if you look at Africa, most of the governments have more political priorities than other, health, socio-educational facilities.”

AU: “Even when it comes to controlling movements of people from affected regions there’s no improved screening and checkpoints, people crossing borders from West Africa from Guinea and Sierra Leone to Liberia.

I think they should call on the international community and the WHO to mobilise resources in West Africa to control movement and create screening points.”

MZ: “My concern is not that Ebola is attracting too much attention, but maybe the wrong kind. There’re at least two things going on there, one is ‘disaster pornography’, where we have this almost pornographic attention paid to catastrophes, calamities, disasters, earthquakes; it’s visually shocking and it’s spectacular, it’s understandable that it attracts immediate attention, but the consequences of this kind of pornography are worrying, because it rewards a short-term attention and not a meaningful, informed engagement.”

“There’re sort of colonial fantasies going on there, but generally in terms of how illness is understood, Susan Sontag, philosopher and writer, has done some interesting work on that: when we don’t have a cure for an illness, it becomes a location of our fantasies, such as in the 19th century it was tuberculosis. Because we didn’t know how to cure it, it became this romantic and deadly illness, people had it as a moral judgement on themselves and it was taboo, you couldn’t talk about it, if you had it you were socially shunned. And then it moved to AIDS, HIV, you know, ‘that’s the plague’, if you got it you have to keep it quiet. Ebola, because we don’t have a cure for it, it’s taking that place, and I’m a bit concerned at the policies of containment that are being followed, because that’s not the WHO’s recommendation. They said in fact containment is not needed.”

“They only want to stop people moving about because there’s been a problem in communication; as far as I understand, Ebola is transmitted through bodily fluids, it’s not an airborne virus, so it can’t be transmitted by travel, by trade, by closing the border.”

SJ: “The main reason for containment of travel, as you said, is because there’s no proper understanding of the disease itself, how to identify it and prepare proper labs where you can test how X has contracted the disease, the real understanding of how it is transmitted through body fluid.”

AU: “My strong belief is the international community has to collaborate with the ministry of health in their countries and address three key areas: education, communication, behaviour change, and surveillance in terms of trafficking and contact with suspected cases. And I think it has to come from the ministry of education how to go about it and reach the communities.”

BN: “I see that all around me, but I think it’s not the reason why we should go after this virus and try to stop it. I think the reason is that this is a very controllable and very potentially curable problem. You’ve got a virus that is always going to be in a band, it runs right through the middle of Africa, it’s going to keep coming back, but each time it comes into people, it burns itself out in a few months, the studies have shown that you only need to control a little bit of the virus, if we knock back 90 percent of the virus with a drug or something, and the person can potentially survive.”

Lots of small labs around the world are already putting their money and time into coming up with possible solutions, and there’s a wide range of these, things from antibodies, little proteins, lots of different drugs that seem to be at least promising, it’s just at the next step, getting it to something that we know is safe to use and effective in the clinic. This is very, very expensive. And, frankly, I’m not sure whether individual countries can afford this or would have a reasonable vested interest in putting in that kind of money. And I think it’s a much easier problem to solve than HIV which, once you have it is yours forever, cancer, which is basically a mutation of you, it’s almost too much life, or even something like tuberculosis, which hides inside our cells, and is very difficult to root out. Yes, Ebola can be fixed.”

MZ: “I thought what Dr. Neuman said was very interesting, and it was new to me. He said that it may not be affordable to individual countries, and if that’s right it means the Ebola virus recurs, and recurs in Africa. And what would be a shame is if each time we got this kind of hysterical media frenzy, this fancy of Africa, the Dark Continent from which death is going to come.”

AU: “It matters to me, because, as I said, HIV came from Africa because of monkeys, so why should Ebola be an African disease? That guy that came from Liberia to Canada, as soon as he came he was treated. And I think they suspected he had Ebola, but because there’re treatments and health services there, he was treated. But if someone’s suspected of Ebola in Liberia, there’s no place for diagnosis. It’s not an African disease; they just want to stick it to Africa.”

SJ: “It is a two-way: the West is tied to Africa, and Africa always relies on the West to resolve their problems for them, personally I think Africans should step up and try to resolve their problems without relying much on external forces or agents like the western world.”

“It depends on how you define poverty, when it comes to resources, Africa has more than Europe; Europe relies a lot on Africa for raw materials to develop themselves. So if Africans step up and become more responsible, they could develop the resources they’ve got themselves instead of relying on the West to do it all for them. This is the case of Gambia, for example, if the government was complaisant, they would not have any national assessment of facilities they have, they would not come up with any plan to prepare the state in case of an epidemic, they would not sensitise the public. But the public is aware, as you mentioned before, because Gambia is a small state, so it is easier communicate with its citizens, but if government is not interested in educating the people, they won’t be educated.”

BN: “I suppose that’s the problem, I may not care where a particular virus comes from, I’m interested in a virus, but my funding body probably does. If it’s a UK-funding body, they only want to fund things affect the UK interests.”

MZ: “I agree with Sulayman when he says that how you define poverty is crucial. Africa is not poor in resources, nor in will or energy, it is economically poor, but it’s about mastering those resources. I think we mustn’t forget the history of dividing rule and exploitation, so I’m a bit wary when we seem to portray African governments as intrinsically incompetent and malicious, and forget the conditions under which they are operating, which are exploitative, and international agreements to which they are held to by other parties.

“There’s this thing called the Nagoya Protocol, to follow Dr. Neuman’s point about funding for certain kinds of research, the Nagoya Protocol was set to protect biodiversity and insure that the benefits of this kind of research were shared internationally and equally, the idea would be that would motivate the indigenous peoples in rural areas to cooperate with big pharmaceuticals or governments of other countries or international organisations. The actual agreement of the protocol has been widely spread in the so-called developing world, and very minimally taken up in the developed world; they are not interested in equal sharing of resources or mutual benefits. A county in South East Asia (I believe it was Indonesia) refused to handle over samples of the most recent version of bird flu to the WHO, because it was trying to sign an agreement with a drug company to develop a vaccine with a cure suitable to its own population. Because if they hand it over to the WHO, and then the international cure is developed, they are not going to be the first country that gets it and they won’t be able to afford it. So I think we are seeing interesting reactions from the countries in so-called developing world, and there’s a reason for this. We mustn’t forget the history of exploitation, and its current history isn’t being addressed.”

BN: “The main cost is in people, as I suppose every aspect of research is. Somewhere around $100 million to $200 million will be the low end and it can go a little higher than that. It’s the cost of getting doctors to the right place, renting hospitals, putting all that equipment there, manufacturing the drug, making a factory to manufacture the drug, yes, there’s a lot that goes into it, more than just handing a person a pill and see if it works.”

AU: “I don’t know how to calculate these things, but in West Africa, there are weak public centres for people. And more has to be done to prevent Ebola from spreading into communities. But, as I said, my president is the iron lady in Liberia, the first African president in Liberia, I know how much money she raised for the election and campaign, and she can raise that for a lab in Liberia just for Ebola.”

MZ: “I’m not sure that’s for me to say, because in the wider context, I think if a government spends that money on an Ebola cure, then they might be criticised for not spending it on education or on famine and malnutrition, or sexual health. So in the context of all other problems governments have to deal with – I can’t say. But going back to my point of disaster pornography, what I think would be good is if the attitude towards the victims was closer to empathy and compassion rather than seeing them as a spectacle.”

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