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Ebola 2014. Chronicle of a well-prepared disaster

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A French version of this piece was originally published in Libération on 18 September 2014.

“It is useless to laboriously interpret disaster movies in terms of their relation to an ‘objective’ social crisis or even to an ‘objective’ phantasm of disaster,” wrote Jean Baudrillard in 1981. “It is in another sense that (…) it is the social itself that, in contemporary discourse, is organised along the lines of a disaster-movie script.” In its Saturday, 13 September edition, the French daily Libération devoted several columns of its paper to the analysis of apocalyptic films, which reflect our anxiety in the face of pandemics. The Ebola virus epidemic which is raging in several western African countries calls for a more radical critique.

The current crisis is not a nightmare unfolding in front of our eyes, as in a “disaster movie.” It is not an anomaly or an accident which has afflicted public health services unexpectedly. It is also not, to use development gobbledygook, an organisational, financial and political “challenge” for the international community and humanitarian workers. Quite the opposite: the Ebola crisis is the result of two decades of political choices and actions. It is a disaster, well-prepared not only by the systematic undermining of African health-care systems by neoliberal reforms, but also by the strong mobilisation of public and private public health stakeholders to bring about a new era of “global health”. With this mobilisation, marked since 2005 by the incredible increase in health aid to the global South, Africa became a priority in the name of global health security. The time had arrived (or returned) for success stories, the eradication of disease, and glossy pamphlets with pictures of laughing children. Bill Gates and Big Pharma shared the podium; a new era was opening before us where smartphone applications, “public-private partnerships” and “responsible innovation” were going to solve Africa’s health problems, one after another. Forget rundown clinics, power failures and drug shortages: global health was the poster child for a better African future. The disaster unfolding under our eyes is the direct result of these security-oriented, spectacle-driven, scripted health policies, which have been implemented at the expense of African health systems and the people working in them.

“Pandemic preparedness” was one of the most important instruments of global health, both in the North and in the South, since the SARS and avian flu crises in 2003-2005. In the wake of the American post-9/11 mobilisation, research funds devoted to “bioterrorism” and “emerging diseases” – for which, by definition, pathogens do not yet exist – have drained public research funds, especially under the Bush administration. Contrary to what you may have read recently, Ebola was not neglected: since the first epidemic in 1976, the virus was an extraordinary means of obtaining funds for fundamental research in virology (notably the construction of high-security laboratories, beginning in the early 80s) and to render preventive and social-action medicine obsolete. No press release on ‘bio-security’ would fail to mention the Ebola virus as it embodied the quintessential emerging threat.

For 20 years, Ebola has been, along with SARS, smallpox and avian flu, the “raison d’être” of government pandemic preparedness programmes. With full-scale simulation exercises and secured warehouses filled with disposable gloves and surgical masks, preparedness was the political rationale of the new century, partly inherited from Cold War military programmes. In 2009 it developed full-scope during the H1N1 flu outbreak episode. Never had the world prepared so much.

Africa did not remain a bystander in these efforts. Under the aegis of the WHO, the US Center for Disease Control and Prevention (CDC) and European research institutions, African states “prepared” with the same enthusiasm. And the continent did not lack experts to lead the initiative: in several African countries the ‘search for emerging viruses’ employed scores of international researchers and their local partners; in recent years, it led to considerable progress in the knowledge of animal-borne pathogens (derived from bats and large apes), such as Ebola and HIV. As in Europe, the threat of new pandemics, especially influenza, drove the implementation of preparedness programmes. Most of them began with “simulation exercises” – scripted role-plays intended to test the readiness of authorities in the face of a (virtual) pandemic. However, in the context of African states, the simulation was indeed a simulation. Ministers and WHO experts, gathered in a large conference room and simulated military, police and public health interventions – with all participants knowing full well that these were devoid of any real bearing on the ground due to the woeful lack of equipment, troops, police personnel, and medical infrastructure. The very idea of preparedness was ultimately absurd: public health amounted to a simulated struggle against an imaginary threat. Never had Africa prepared so much: in fact, it did only that.

A major issue is that these pandemic preparedness exercises siphon off a large part of African health authorities’ energies and resources, even as they are confronted with far more urgent health emergencies. Thanks to Wikileaks, we now know that the US Embassy in Sierra Leone was already worrying about this state of affairs in 2007.  But the main problem with these simulation exercises is that they represent, in pure and unadulterated form, the new paradigm of global health, Africa style:  a type of intervention where real action on real diseases has become secondary to vast, assumptive and speculative programs. Some classic examples of this kind of speculation include the “Global Viral Forecasting initiative” of the Californian virus hunter, Nathan Wolfe,”Treatment-as-prevention” programs for HIV, and “mobile-health” projects which saw smartphones as a way of overcoming distance, the lack of personnel, and the shortcomings of African institutions. Lets take an analogy: global health is just as disconnected from “real” health as finance is from the “real economy”. Ebola 2014 has the appearance of a crisis – the bursting of a speculative bubble.

“Just as in a disaster movie”, as Baudrillard writes, reality and fiction are intertwined. With pandemic preparedness, the scenario and role-play have become a full-fledged political technique, a way to “organize the social itself”. It pushes the preventive approach of “old” public health services into the background, thus laying the groundwork for old epidemics like cholera (25 000 cases in 2013 in Africa) to resurface. The advent of global health is nothing but the last phase of a destructive historical sequence initiated by structural adjustment plans in the 1990s, which morphed African hospitals into a Mad Max scene of ruin and rust. The key to survival is telling a good story, perhaps the only thing that matters in the world of global health.

The superstars of the struggle against future pandemics, like the biologist Nathan Wolfe in the United States, completely blur the lines between fiction and reality, public health action and cash machine: Dr Wolfe, who forged a career thanks to his work on emerging viruses (including Ebola) in Cameroon, has appeared on numerous television shows in the past 10 years to promote his project on the surveillance of African pathogens. The fact that his work did not result in anything tangible is irrelevant. His latest book, The Viral Storm, earned him a 6-digit deal with his editor; he transformed his research team into a start-up, financed among others by the Google Foundation, which offered to pay him 1 million dollars for each new virus he identifies; his nicely-staged TED conferences play in a loop on YouTube and move the audience; and he was the scientific consultant for the apocalyptic zombie movie I Am Legend, featuring Will Smith. His small company, Metabiota Inc. rapidly positioned itself in the current Ebola epidemic. As of May 2014, the virologists of this start-up were contracted by the US Department of Defence to organize the “preparedness” of Sierra Leone at a time when the Ebola epidemic was raging in neighbouring Guinea: “a success story”, they declared on May 12. Sierra Leone “is uniquely prepared.”

We know how the movie ends.

 
Guillaume Lachenal is a Lecturer at the Université Paris Diderot, a Junior Fellow of the Institut Universitaire de France and an Associated researcher at the Centre d’Etudes des Mondes Africains.  He is the author of Le médicament qui devait sauver l’Afrique. Un scandale pharmaceutique aux colonies, (La Découverte, 2014)  and co-editor – with Céline Lefève and Vinh-Kim Nguyen of La médecine du tri. Histoire, anthropologie, éthique (Presses Universitaires de France, 2014).