The Origins of the Ebola Crisis
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Sid Shniad
2014-10-12 19:51:27 UTC
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October 10-12, 2014Is Microsoft Medicine the Solution for Ebola?The
Origins of the Ebola Crisis*
*The solution to these epidemics is not the magic bullets of vaccines and
it is not sending in the troops. It’s structural, it’s social, it’s
economic, it’s environmental and it is putting in all the public health
measures. *

*Vaccines are not what these countries need. It’s proper redistribution
and public health measures. All the great reforms, all the great collapse
of infectious disease epidemics was actually not down to drugs and
vaccines, it was to redistributive measures, which included sanitation,
nutrition, good housing and actually above all a real democratisation. by
Tariq Ali and Allyson Pollock *

*Tariq Ali:* *Today we are going to discuss medicine and what is going on
in Africa but not just there, in other parts of the world too, and how
privatised medicine is now dominating the field except in a few oasis there
are still left Cuba, Venezuela, etc. **With me is Professor Allyson
Pollock, one of the best known public health scientists and experts in her
field anywhere. Ebola. What are its origins and how did it spread so
quickly in these three African countries and is now causing panic

Allyson Pollock: Well Ebola is a virus, nobody quite knows what the origins
are, some think it might be from the bat, and it is spread through bodily
fluids, so that is an important mechanism. In most normal situations it
should be very easily contained by quarantine and by isolation but the big
problem in the countries where it is most prevalent, which is Sierra,
Liberia and Guinea, is that these are very, very poor countries, where the
infrastructure has increasingly been ripped out, especially in terms of
health systems and the, um, virus is now in urban areas where there is
close human contact, so it makes it very difficult to control and contain
especially when it is happening in areas where there is a lot of
overcrowding and poverty and poor sanitation.

*Tariq Ali: And the Western health community, so to speak, the World Health
Organisation, was slow to react, I felt, in terms of what could have been
done at an early stage of this disease.*

Allyson Pollock: Well I suppose the WHO was hoping, as in the previous outbreak
- large outbreak in the 1970s, that it would be fairly easily contained.
Perhaps what happened that they hadn’t reckoned with the fact that these
countries where it is emerging are actually among the very poorest
countries? Liberia and Sierra Leon have been through their own long
periods of civil war, conflict with displaced refugees where the gross
domestic product and the economy has very badly suffered and what we have
seen in all these countries is a real hollowing out of all sorts of public
services but especially health systems. So it is very, very difficult to
contain it and we have got real issues of poverty. So, I suppose the first
hope was that these would be fairly, err, the disease would be fairly
easily contained but actually of course it is a virus that has a very high
case fatality rate, they say about 55% chance of dying if you contract the
virus. So this is very serious but one of the big problems is that the
Western world, especially the US government is coming back with solutions
of guns and magic bullets so we’ve been here before; the announcement by
Obama that he is going to send in 3,000 troops and the parallel
announcement that they are going to focus on rapid vaccine production. And
this is a complete removal from the social and structural determinance of
public health because the origins of all public health are in very simple
and basic solutions. It’s about clean water, sanitation, good nutrition –
so the evils of poverty. And, on top of that you need very good health
systems with proper doctors and nurses and facilities that you can isolate
people and you can also do what’s called ‘contact tracing’ so you need to
go back into the community to find out who the affected individuals have
been in contact with so that you can then quarantine and isolate those
individuals to make sure that they actually then don’t get the disease and
then pass it on during the incubation period. And all of that has been
stripped out.

This is what these countries are looking at, they’ve had a total erosion
and collapse of their public health care systems and this is the tragedy.
So the population has very, very few doctors and nurses. They simply
cannot cope and of course the public facilities that are there are
overcrowded, they are in terrible conditions and they are completely and
utterly understaffed. So this problem of an epidemic was going to hit
them, it could have been Ebola, it could be something else – it could be
cholera or whatever. This was actually going to come home to hit these
countries very hard indeed. This was entirely predictable and it’s been
predictable for more than 20 years and it is what the public health lobby
and the public advocates have been talking about. The solution to these
epidemics is not the magic bullets of vaccines and it is not sending in the
troops. It’s structural, it’s social, it’s economic, it’s environmental
and it is putting in all the public health measures.

*Tariq Ali: **But the entire world capitalist system as it functions is
basically not in favour of public health services, they are in favour of
privatised solutions, privatised facilities which means that in most
countries increasingly you have a two or three tier system; you have very
good quality hostpitals for the rich and people who can afford them, you
have a second tier for more middle class people who also have to pay but
not so much and their facilities aren’t so good and then you have public
hospitals, not just in Africa but in countries like India and Pakistan and
Sri Lanka, which are a total complete disgrace and nothing is done about it
on a global level at all because this is not a priority. I mean it is just
outrageous. Do you think, I mean, given that this is how the health system
functions from what you said, the obvious solution, medium-term and
long-term, is to create a strong social infrastructure in these countries
but that is what the International Monetary Fund asked them not to spend
money on, the last four decades so what do you think they can do?*

Allyson Pollock: Well I think you are raising important issues; what is the
role of the IMF, the World Bank, the African Development Bank because again
if we look at Liberia and Sierra Leone and Guinea, which actually have a
lot of natural resources, what is happening to these countries, in terms of
their economics is that increasingly the lands are being privatised and
being occupied by foreign investors who are coming in and they are simply
stripping out the resource and the assets. Liberia has a GDP, gross
domestic product, of a couple of billion dollars, and a population of five
or six million, so how are they meant to rebuild when actually you’ve got
foreign directors coming in and public private partnerships and great flows
of money going out and you don’t have any mechanism for redistribution
because redistribution means you are trying to build a fairer society and
you are trying to put the resources back in.

So it starts with the economy, it starts with what’s happening to the land,
it starts with the fact that palm oil and cocoa and rubber are important
cash crops and there’s land, and these ownership, has been transferred and
I mean this is very well documented by important organisations like Global
Witness but also the Oakland Foundation in the US, who have actually
chartered what is happening to the land and remember, many of the farmers,
for instance in Liberia, 70% of the population, live in rural areas. They
will be subsistence farmers so this is an issue and when you have the
population spending 80% of the money on food and then you have all these
cordons around them, then of course you have got a real problem because the
poverty is actually going to be accelerated in these countries because of
the Ebola virus, because the borders are closing and because you don’t even
have economic flow any more. So I think we need to start with the
economics because that is the cause of the structural problems and then
we’ve got the World Health Organisation, which is the international global
authority on health. It has the law making powers but systematically over
20 years it has been completely starved of funds and such funding as it
gets are tied to all sorts of conditions and those conditions are being set
by large, global NGOs such as the Bill & Melinda Gates Foundation, which
have no democratic base, no accountability and which in turn are doing
untold harm through their vertical disease programmes because they are not
rooted in public health and the public health systems. And a good example
of a vertical disease programme is when you take Ebola and then you bring
in your operation to tackle Ebola and you ignore all the other causes of
disease, such as TB or malaria, or poverty, malnutrition and at the same
time when you focus all the efforts of the industry on vaccine development.

But actually vaccines are not what these countries need. It’s proper
redistribution and public health measures and we learn nothing from
history; that is what is shocking. All the great reforms, all the great
collapse of infectious disease epidemics was actually not down to drugs and
vaccines, it was to redistributive measures, which included sanitation,
nutrition, good housing and actually above all a real democratisation. And
with it came education and all the other measures that we need. Now I’m
not saying we don’t need vaccines, but one of the big problems is that that
vaccine developments itself is now in the hands of these large very
powerful foundations like NGOs, like GAVI – the Global Alliance for Vaccine
Initiative, who in conjunction with big companies like GSK and Merck, are
out to seek patents and the reason why they like vaccines is it gives

because vaccines mean mass immunisation, it means numbers and numbers mean
money. And of course is being paid for by the West and Western governments
when this money could much more easily flow into the governments themselves
to re-build their health systems because we are talking about re-building
public health infrastructure and that includes putting in community primary
health care, community health systems, infection control units at community
level, putting in hospitals and training nurses and doctors. And the big,
other big problem in all of these countries is not just a brain-drain,
because a few doctors and nurses are there, they want to leave and that is
happening also in Nigeria, or they want to work in the private sector or
they want to work for these NGOs because the money is much better and so
the whole public health system is completely hollowed out. And this is a
real problem because the Gates Foundation, Bill & Melinda Gates, do not
believe in the public sector, they do not believe in a democratic,
publically owned, publically accountable.

*Tariq Ali: **So in fact the WHO, because of governmental policies, and the
priorities of the Washington consensus, i.e.. neoliberalism, privatisation
of medicine, inability to control Big Phgarma, has effectively ditched
what it used to do? In the sense that it can’t do what needs to be done,
shore up, strengthen, build if necessary in some of these countries public
health systems.*

Allyson Pollock: Well, there is a very important paper recently in the
British Medical Journal, I think by David Legg, which actually sets out
what has been happening to the WHO over two decades where the US refuse to
give the funding that it should have done and then what you have is when
Western governments and the US come in, they tie it to conditionalities,
which is usually around the Bill & Melinda Gates priorities and not around
the essential public health priories and the WHO has its hands tied. And
actually it is the world health organisation, it has got the law making
powers and yet it has never exercised these functions we are talking about
democratic deficits that are happening when large global funds like the
Gates Fund or the Buffett Fund can actually determine what the world
priorities are and so distort what the priorities should be for public
health because it is tied to the economics, they need to industrialise,
they need to medicalise and they need to pharmaceuticalise. But there is a
big backlash coming, a big backlash in the Western world, much more
critical thought about the ethicacy and the safety and the appropriateness
of the drugs and vaccines and medications and this group is beginning to be
more and more articulate and more and more and more concerned. But one of
the big problems is that because of this huge amount of money that the Bill
& Melinda Gates Fund have, is that the technicians, like myself, the public
health tribes, have been captured because of their success in predicated
upon getting jobs, or research, tied to the interests of the Global Fund.
So the critical thought is being hollowed out and so at the same time are
the essential public health functions because public health is there as
Ibsen would say, to be the enemy of the people, but actually it is there to
be critical, to appraise and to think rationally and to remind everybody
about what the social determinance of health are, and it is not rocket
science. It doesn’t need magic potions or millions of dollars spent on
genetics and the laboratories, it needs very, very basic things, but they
are essential because they are what the public health infrastructures are
built on.

*Tariq Ali: **Contrast this, what’s going on in the bulk of the world with
a tiny country like Cuba, which has managed to construct a public health
system, which is precisely many things that you are arguing for. It is
very oriented to preventive medicines which stop a disease from spreading,
and has now amongst the best record of both public health services and its
affects in terms of what Cuban’s citizens and increasingly because the help
they have given Venezuela, Venezuelan citizens and other South American
citizens who never used to have health are now in much better shape than
many people, for instance, in Eastern Europe which went in for big
privatisation; leave alone Africa and large parts of Asia. You’ve studied
the system I think?*

Allyson Pollock: Well yes I think the Cuba’s system is very inspiriting and
anybody who has been to Cuba can’t but feel the public health benefits of
it. I mean they are a country that really know the meaning of austerity
and yet their GDP, which is the equivalent of many of these poor countries,
but they don’t have this extraordinary inequalities because their vision
and campaign has been around public health and health for all. So they
have done extraordinarily well and quite remarkably well. I mean the real
problem comes as what’s happening now and will they get side-tracked by
neoliberal policies and the need to get drugs to market, and the need to
sell drugs; it is a very important time for Cuba to think about it. But
actually they need to all the time be remembering what their GDP is and
what they’ve achieved with their GP compared with some of these poorer
countries in the world like Sierra Leone and Liberia – Liberia especially.

*Tariq Ali: The other thing of course is that the Cubans have sent out a
lot of their doctors to parts of Africa, South America, to whenever there
is a disaster. I remember during bad floods in Pakistan, really bad, a
whole team of Cuban doctors arrived and were taken to the remotest parts of
the country where women were not allowed by their menfolk to see doctors
because most doctors were male. And when they saw the Cuban team, which
was 60% women, 40% male doctors, the men in these communities said ‘ah you
have women doctors; you are doctors, and they said, ‘yes, yes’, they say,
‘okay you can see the women whenever you want’. So amazing rapport
developed between them and the women were very pleased and so were their
kids and a Cuban doctor told me that they said to us, ‘where do you come
from you people?’ and she said, ‘we come from Cuba’. ‘Where is that?’,
and she said, ‘it’s a tiny island in the Caribbean’ and they said, ‘who is
your leader? I mean who/what is the government’. So they were careful
because they were on a medical mission but they said, ‘do you want to see a
picture of Fidel Castro who is our leader’ and said ‘yes’. So they showed
a picture of Castro and the women said, ‘my god, he’s got a beard like they
have in that village 20 miles from here, do you want to go and see those
beards’. [laughs]. But they were incredibly impressed and the entire
media in Pakistan was talking about what they’d done, they said we don’t
want any help from the government, we arrive with our tents, our equipment,
all we want is receptacles in which we can heat clean water and the rest we
will do; we will bring our medicines with us. And the thing is this is the
other point which rises that unlike the health services constructed in
Western Europe after the 2nd World War including the National Health
Service, the governments in these countries never actually set up
pharmaceutical industries to compliment those health services. Nor did
they even seriously consider nationalising them, because that would have
brought the prices of medicine right down and they need never have charged
prescriptions. So let’s come for a minute to a subject you know very well
– the health service in Britain and in the European Union countries, I mean
what is happening to that Allyson? It is one thing to talk about Africa
but what is happening to the health services in Europe.*

Allyson Pollock: What is happening now in Europe as many people are aware
is that, we have got neoliberal policies coming from the US both the health
care industry in the US, which have exhausted the funds of America because
health care is running it about 18, 18% of GDP, compared with 9 or 10%
average in Europe, so the European health care investors need to find new
markets and they are busy attempting to penetrate and open up the health
care systems of Europe. And of course the biggest trophy for them is the
United Kingdom NHS because it was for a long time the most socialised of
all the health care systems. So we’ve had devolution; so Scotland, Wales
and England all have their own health care services and Scotland and Wales
which are very tiny, they don’t cover more than 8 or 9 million people, they
have retained a national health service but England, which many people
don’t realise this, England abolished its national health service in 2012
with the Health and Social Care Act. What remains of the NHS is a funding
stream, or a government pair, and the NHS has now been reduced to a logo
and what the government is now doing is accelerating a break up of what
remains of the national health service under public ownerships, so closing
hospitals, closing services and privatising or contracting out. So just as
we heard in Liberia and Guinea about how the public lands are being
transferred like the enclosures to private owners from abroad, the same
thing is happening with our public services, our public hospitals, our
public facilities are also being enclosed in a way and given over to
private-for-profit investors and this is happening in extraordinary speed
in England. Faster than anywhere in Europe. And this is a major global
neoliberal project, if you like.

*Tariq Ali: To privatise health.*

Allyson Pollock: Well to privatise not just the healthcare system but also
ultimately the funding. Now in the US, just under half of that 18% GDP is
actually paid for by the government but the government is in effect a tax
payer and then channels the money into private-for-profit corporations.
The government in England abolished the health and social care act because
it wanted to open up new funding streams. So it wants to reduce the level
of services that are available publically, create a climate of discontent
with the NHS, forcing people who are in the middle classes, that’s like you
and me Ali, to go and privately and pay either out of pocket or with our
healthcare insurance, so that we desert, we exit what is left but at the
same time the government is reducing all our entitlements because there is
no longer a duty to provide universal healthcare. That duty that has been
in place since 1948 was abolished in 2012. So that duty has now gone and so
now the government can reduce all the entitlements, reduce everything that
is available and increasingly we are going to have to pay out of pocket or
though private health insurance. And the private health insurance industry
are here, they are here from the US and they are absolutely gearing up with
the new structures the government has put into place to move into
private-for-profit health insurance; that is what we are going to be
seeing. And actually the new system the government is putting in place is
modelled on the US and yet that will come at huge loss and it will also be
a public health catastrophe because it will mean that many, many millions
will increasingly go without care and of course markets render people
invisible, they are not seen. Nobody knows. The doctor in front of you
only sees the patient that come to them; it doesn’t see the many tens of
thousands who are being denied access to healthcare, which is why in the US
the doctors are not out on the street campaigning. But in the UK the
doctors are out on the street campaigning, they are putting in, they are
standing now for the National Health Alliance Party, they are now putting
in candidates to stand against the conventional parties. And so you see
that the doctors are still prepared to fight for universal health care but
once our NHS has gone completely, it’s been abolished, but once all the
remnants have gone, you have to use the parallel of the oak tree, it seems
to be blooming and flourishing but the roots have been severed and that can
take many months or years for that to completely decay. But once it has
gone the doctors will no longer be there. They’ll be like the doctors in
the US interested in themselves, interested in their own pockets and not
interested in universal access to healthcare. And this is the crime of the
century, if you like, the way in which the English coalition, both
Conservative and Liberal Democrat, have actually abolished our NHS but they
have had a lot of help along the way from the Labour government before them.

*Tariq Ali: **Labour more or less set the basis for it when they were in

Allyson Pollock: Absolutely. Alan Milburn the Health Secretary did this in
2000. In 1997 the Labour government had its, had its chance to reverse the
privatisation and marketization policies, to get rid of the private finance
initiative and they had a very good Secretary of State who was quite
determined to some of that

*Tariq Ali: Frank Dobson?*

Allyson Pollock: Frank Dobson. But they got rid of him extra quick and
instead of which we got Alan Milburn and his ten-year plan and now he has
gone off to join the very healthcare companies that he helped to build up.
And I mean I think that is the tragedy as when that bill was going through
parliament to abolish the NHS, many of the peers, and many of the MPs had
conflicts of interests because they had actually interest in the healthcare
companies that they were establishing.

*Tariq Ali: **It is outrageous really. And Milburn himself is one of them.*

Allyson Pollock: Well, it is a travesty for democracy, it really is and as
a public health doctor it is an absolute catastrophe because at the moment
we know, people of all ages, with serious mental illnesses who cannot get
access to health care, people with stroke, people with chronic illnesses,
chronic diseases who are increasingly being denied access to healthcare and
they are voices in the wilderness, they are not being heard because there
is no collective mechanism for them to be heard any more. And the doctors
and nurses are absolutely in despair. Now we do have solution; my
colleagues we’ve written an NHS reinstatement bill which we hope that
whichever party comes to power, they will actually run with to reinstate
the NHS, so there is a solution out there, which is drafted and written and
ready, that would restore and reinstate the NHS.

*Tariq Ali: It is perfectly legitimate to make huge profits from the basic
needs of ordinary people? *

Allyson Pollock: Yes from people’s diseases and people’s illnesses. Well
it began with a pharmaceutical industry and the vaccine production, it is
perfectly acceptable to make profits from them, so why shouldn’t we now go
and make profits from illness and care. But of course the NHS in England
was set up, to be redistributive. It’s funded through taxation, which is
meant to be progressive and the money is meant to flow according to need.
But what we are now beginning to see is that money will flow according to
the needs of shareholders and not patients, and that is a very real
concern. Of course. It is all down to political will. Everything can be
reversed but it comes down to politics, to democracy and people making
their voices heard.

*Tariq Ali: Agreed.*

*Allyson Pollock is professor of public health research and policy at Queen
Mary University of London.*

*Tariq Ali is the author of **The Obama Syndrome
* (Verso).*
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