Ebola Isn't a Medical Problem, It's a People Problem

An Ebola isolation ward in Lagos, Nigeria. (Image via Flickr Creative Commons user CDC Global)

Medicine has a huge problem, and it’s this: a whole bunch of things exist that simply shouldn’t exist. For example, children in Western schools sick with the measles, or polio in Pakistan, which has seen more than 200 people affected this year alone. The latest and scariest is the large-scale Ebola epidemic still raging in Western Africa.

None of these things should be happening. We have mass immunisation programmes and safe and effective vaccines for measles. The same goes for polio, which looked unlikely to see the 21st century at one point. Ebola cases are to be expected, but this isn’t a virus that’s really capable of world domination – there’s just no good reason why an epidemic on this scale should ever have happened.

But it did. So why?

In a word: people.

The spread of the Ebola virus in West Africa isn’t a medical problem so much as a social or a governmental problem. There may not be a proven cure for Ebola yet, but as I wrote previously, the virus isn’t great at spreading in the first place. As long as you have a well-functioning health system, trained staff, antiseptic environments to work in, basic medical supplies and a good set of procedures in place, any outbreak can be swiftly contained.

The trouble is, almost none of those things are true in the parts of West Africa where this outbreak flared up. In fact, you’d struggle to find a worse place for an outbreak to happen if you tried. The virus appeared on the border between Sierra Leone, Liberia and Guinea – countries ranked 163rd, 183rd and 179th richest in the world by the IMF, out of 187. If that doesn’t mean anything to you, consider this – in 2006, recovering from a brutal civil war that destroyed most of its hospitals and clinics, Liberia had a grand total of roughly 50 doctors in the entire country. And now they’re dying of Ebola, too.

Aid agencies like Medecins Sans Frontieres aren’t just pottering around offering help and blankets, they’re trying to act as a national health service on a budget of just a few tens of millions of dollars, and the job is basically impossible.

As if that weren’t bad enough, conspiracy theories abound. In August, a clinic in Liberia was attacked by an angry mob chanting, "There’s no Ebola!", echoing a widespread belief that the disease is a hoax. Newsweek reported that, "In September, an article published in the Daily Observer, a major Liberian newspaper, called the Ebola virus a “genetically modified organism” that was tested on Africans by aid agencies at the behest of the Western governments.”

Sound silly to you? It’s no worse than some of the theories being aired in the West. Rush Limbaugh suggested that Obama wants the virus to kill Americans as "revenge for slavery", while former public figure Chris Brown told his Twitter followers that the virus was a form of "population control".

The factors here are eerily similar to what we saw with polio in Nigeria. A vaccination drive working its way across Africa had left the continent almost polio-free by 2003, until medical staff met resistance in several northern states of Nigeria, areas with a high Muslim population. Officials there had convinced themselves that the vaccine was part of a Western plot to spread AIDS and cancer, their fears not exactly eased by the growing War on Terror. The attempt to eradicate the virus failed and Nigeria went on to become an exporter of the disease.

So are these people crazy? Well, think of it this way: imagine you’re sitting in your living room and a group of doctors with strange accents and uniforms knock on your door waving a needle around. What do you do? Let them in and offer your arm up for a jab, or go and hide your kids under the bed? Exactly.

That’s before you even consider the history of West Africa. Sierra Leone, where health officials have admitted defeat in the face of the epidemic, has a past that’s basically a five-century catalogue of violence, rape, slavery and oppression.

The other easy thing to blame is education: "If only that ignorant lot were better educated, they’d understand the error of their ways and accept the vaccine." This type of argument is called the "deficit model", a largely discredited theory that “attributes public scepticism or hostility to a lack of understanding, resulting from a lack of information”.

Response volunteers in Nigeria (Photo via)

The problem is, giving people more information hardly ever works. We’ve talked about this in this column before. Last year, the Royal Statistical Society ran a survey in which they found out that the British public are basically wrong about everything. Worse than that, even when they were given the correct answer to questions like, "How many immigrants are there?" they simply refused to believe it. In fact, as the MMR panic showed, more knowledge can even have the opposite effect. The parents who stopped their children from getting the MMR vaccine during the scare of the late-90s and early-00s were more likely to be university-educated and to read up about the vaccine from a wide variety of sources.

In all of these cases – MMR, polio, Ebola – we’ve effectively reached the limit of what modern medicine can ever hope to achieve. You can create the most sophisticated medicines and vaccines in the universe, but none of that matters if most countries can’t afford them – or even afford to train doctors in the first place. Or, of course, if parents refuse to allow their kids to take them.

This isn’t a remote problem, either. You can set up all the screening programmes you like, but sooner or later some of these plagues will make their homes here. It won’t be Ebola, but more contagious diseases (like malaria) used to be common on our shores and could easily return in my lifetime. Viruses and bacteria don’t really care about human borders. We’re all part of the same global system, and if we don’t work to eradicate these enemies abroad, we can’t be surprised when they eventually find us at home.

Everything I said in my last piece on Ebola remains true. The panic in the West isn't proportional to the tiny threat the virus poses here. Still, it’s an important reminder, a canary in the mine. However well defended we think we are by our medicines, vaccines, antiseptics and hazmat suits, we will never be safe until we deal with the failings of people. Ebola may not be The Big One, but the next disease could be.

@mjrobbins

This article was updated at 11.43AM on Wednesday, 15th October.