Manage the politics of epidemics

By Andrew Rugasira

THE headlines lack subtlety: “Uganda races to stop spread of Ebola virus”, “Ebola prisoner escapes...”, “Outbreak of Ebola in Uganda kills 13”. 

CNN, BBC, and Al Jazeera, all transmit stark images of medical personnel wearing white protective outfits hunting down victims of the virus in-between their coverage of the London Olympics.

But the numbers and the media attention just doesn’t add up. The intense media focus is for a disease which has resulted in 859 deaths across Africa between 1976 and 2003. And ironically, no comparable alarm is raised when we are confronted by other shocking public health realities.

According to the World Health Organisation (WHO), one-third of the world’s population has tuberculosis, and 25 million people are living with HIV/AIDS in sub-Saharan Africa. The UN predicts that there will be 50 million deaths from HIV/AIDS in Africa by 2025.

Cancer, today, kills more people globally than HIV/AIDS, tuberculosis and malaria combined, which according to WHO (2010) figures, is over eight million people per year. 

Still, over one million people die per year from malaria in Africa alone one million per year! These are not just depressing statistics but should generate outrage in a world, which has the resources to do something about it.

Yet, we seldom exhibit the same level of alarm and urgency as with Ebola. The 859 deaths are obviously too many. But are they comparable to say the 141 children per every 1,000 that die annually before their fifth birthday in Uganda, or the 435 mothers for every 100,000 delivering mothers, who die in labour every year, or the 16% of under five year olds, who suffer from moderate to severe underweight in Uganda? 

So where is the sustained alarm, the emergency responses, the public outcry? The cataclysmic edge to the language and the graphic imagery employed by the media and public health agencies reinforces a power and resource asymmetry between advanced countries seeking to combat the disease and the poor countries infected with it.

Images of scientists from the advanced world travelling to Africa to contain the disease appear with disturbing frequency. This approach reduces the affected people to transmitters or vectors instead of drawing attention to the underlying social and economic aspects of the disease.

Epidemics are about susceptibility and it is always critical to look at the social, economic, political and gender factors at play. 

Books which document the history and incidents involving hemorrhagic fevers from Africa have been published widely and many Hollywood films made on the subject.

The common thread is the use of highly ethnocentric language to capture the people in danger (Africans) and the scientists and virologists hunting down the disease (western scientists). 

The psychological import is one of the ‘coming plague’ with its ‘nightmare scenario’; the rest is left to your imagination. 

When you call something an epidemic, you have to put money into it. Most money is then likely to be put into vaccine research, emergency responses than say to water and sanitation infrastructure, or improving health care delivery systems that change the public health consequences for the people in affected areas.

Ebola is a horrific disease and we cannot underestimate its destructive potential; but to privilege the attention we give to it over other more pernicious and systemic health care challenges is hypocritical, myopic and self-serving.

This lack of alarm is a manifest failure to address the underlying conditions that give rise to epidemics, exacerbate them and make combating them difficult.

Weak health care infrastructures like poor supply-chain systems, human resource weaknesses, corruption and the theft of public resources all need to be vigorously and continuously highlighted.

We shouldn’t just raise the alarm at dangerous viral outbreaks but also for any death that could have been avoided if we offered more efficient health care. We should be outraged when a mother dies during child birth for lack of adequate medical attention, or when our children die from preventable and treatable diseases.

We should be alarmed when we fall below the measure of what we can achieve. Fear alone cannot be the driving metric; equality and justice should be our overarching values.

Our children are constantly being mentored by the imagery of outsiders coming to our rescue. This doesn’t build confidence in the hope that we can be the masters of our fate and the solution to our problems.

Help is good, but the dignity from self-help is even better and more durable.

The writer is a social entrepreneur