By Adelaide Davis
In Fall 2014, the Ebola epidemic in Western Africa was dominating headlines. Conspiracy theories spread nearly as rapidly as the virus itself with some journalists and politicians only serving to fan the flames.
Provocative headlines abounded online. CNN called Ebola the ISIS of Biological Agents, while outlets such as the Irish Examiner, Reuters and Foreign Policy debated whether Ebola represented a real “World War Z.” Despite journalists’ attempts to dispel rumors about Ebola, inflammatory headlines distorted debates and public understanding.
Could the virus secretly be spread orally? Was the international community intentionally blocking Ebola cures to curb population growth in Sub-Saharan Africa? U.S.Senator Ron Johnson even argued that the Islamic State would use Ebola as a bioterrorism weapon. He claimed they were intentionally infecting themselves to spread the virus even though Ebola would be an extremely difficult, if not impossible, pathogen to weaponize. The public narrative became increasingly frantic, diverging from West Africa’s reality. Fearful rhetoric often overwhelmed meticulous reporting, only heightening panic about the magnitude and spread of the virus.
In 2016, global panic returned, this time thanks to the Zika virus. Again, the public searched for someone or something to blame. The Daily Mail circulated a fabricated story, identifying genetically modified mosquitos as the source of the virus. The article gained traction, and fact and fiction were blurred again.
From HIV/AIDs to bird flu to Ebola, sensationalist, fear-inducing rhetoric around disease outbreaks has dominated the public discourse for decades. Media outlets are too often dominated by crisis narratives to capture public interest. This narrative gives the impression that we are at war with infectious diseases, and perhaps the diseases are winning. Simultaneously, global health policy has shifted towards treating non-communicable diseases, such as cancer and heart disease, decreasing the funding available for the prevention of infectious disease outbreaks.
Infectious diseases are typically caused by pathogenic microorganisms such as viruses or bacteria. They are spread both indirectly and directly from one person to another. These disease outbreaks reach epidemic or pandemic status when they spread more rapidly than normal, sometimes creating the impression that their spread is uncontrollable.
Truthfully, while global deaths from infectious disease are slowly decreasing, infectious disease epidemics have been growing at historically unprecedented rates over the last few decades. The list of infectious diseases that have the capacity to become epidemics is numerous. When combined with a growing worldwide resistance to frontline antibiotics, the danger posed by infectious disease outbreaks is concerning, and deserves to be treated as a global crisis.
According to the World Health Organization, roughly one-quarter of annual global deaths are a result of infectious diseases. However, deaths are largely concentrated in the most impoverished and vulnerable echelons of developing countries where access to sanitation and medical supplies is scant.
The epidemiological transition, one of the pillars of global health, tells us that as countries develop, infectious diseases should decline. As such, infectious diseases are not dissimilar to canaries in a coalmine – where there is disease, systemic problems are ignored. Poor health is intrinsically linked to poverty. The very conditions of poverty – poor sanitation and water quality, malnutrition, overcrowding, environmental degradation and the scarcity of shelter – enable infectious diseases to spread uncontrollably and devolve into epidemics.
It is no accident that disease outbreaks like Ebola frequently originate in countries with broken health care systems. Poorly staffed and under-equipped hospitals in chronically overwhelmed health systems provide a climate where viruses can explode. Hospitals in West Africa, for example, often lacked basics including electricity, plumbing, running water, essential medicines, and even hospital beds. In the region,less than $100 is invested per person in health, a number that is significantly lower than in developing countries where thousands are spent per person per year.
In 2014, Ebola killed hundreds of health professionals and the dearth of adequate supplies led others to abandon their jobs out of fear. These countries already bore a deficit of appropriately trained doctors and nurses. Ebola only exacerbated an already dire situation.
“Our health infrastructure was not designed to cope with the kind of outbreak that we had,” Liberia’s Minister of Health Bernice Dahn explained to the Wall Street Journal after the Ebola epidemic.
The country was not equipped at to monitor the spread of infectious diseases at the time, and most health workers were not properly trained about the best practices to prevent the spread of the virus.
As a result, the responsibility fell on the international community to coordinate a response. Yet, recent restructuring of the international aid system has reduced the capacity of international organizations like the World Health Organization (WHO) to respond to epidemics. WHO, an arm of the United Nations, is facing massive budget cuts and subsequent reductions in staff due to the global financial crisis. Laurie Garrett, a senior fellow at the Council on Foreign Relations, described WHO as a “shadow of its former self,” having lost much of its credibility.
WHO was caught completely unprepared for the Ebola outbreak. It took the organization nearly six months to declare a crisis in West Africa and, even then, there was no clear understanding of how the response was being coordinated. Despite initial support, the mobilization from the international community stalled within months, allowing the virus to spread uncontrollably with diminished support.
“We cannot wait for those high-level meetings to convene and discuss over cocktails and petits fours what they’re going to do,” scoffed Joanne Liu, international head of Doctors Without Borders, when asked by the Washington Post to comment on the UN’s response to Ebola.
It is clear to global health professionals that systemic poverty and overwhelmed health care systems in developing countries provide the conditions for epidemics to spread rapidly. Yet, even international bodies, who are charged with helping struggling health care systems, are poorly equipped to respond appropriately.
During an epidemic, the first instinct of the international community is to contain the disease, which is often linked to a narrative of national security. Policy decisions are made in a climate of anxiety – how can diseases quickly be prevented from flowing across borders? How can we protect our population from becoming infected?
Globalization, rather than poverty, is generally seen as the immediate culprit.. As the WHO explains, “Today’s highly mobile, interdependent and interconnected world provides a myriad of opportunities for the rapid spread of infectious diseases.” Proposed policies usually include immigration and travel bans, intense border screenings, and the quarantining of populations, such as during the 2016 Zika crises when the United States government advised pregnant women not to travel to affected regions.
Narratives disseminated by public figures, politicians, and journalists may provide a necessary push for the international community to respond. It is possible that coverage of Ebola by the international press is what ultimately spurred the global community’s response. It was only after the international press began running front-page stories about the disease that WHO declared it a crisis and began mobilizing the international community.
During crises, the public is often horrified by the international security dangers connected to disease epidemics in a the globalized world. Those who bravely choose to help overwhelmed health care systems are often criticized rather than lauded. American politicians even criticized an American doctor for returning to the United States for treatment after contracting Ebola. Even patients can be dehumanized and stigmatized as dangers to society. The public eagerly digests fabricated horror stories where the infected attempt to flee, bringing diseases to New York, London or Paris.
Yet stigmatizing the infected, who are largely impoverished, only perpetuates the cycle of epidemic outbreaks . Assumptions about diseases – and the people who suffer – can become deeply entrenched.
The panic of crises understandably draws attention to short-term emergency solutions. However, while emergency responses are paramount during crises, it is also necessary to invest in preventative measures. Public figures could use the heightened awareness generated during crises to address and advocate for solutions to the systemic factors causing outbreaks across the world.
Rapid emergency responses do not generally translate into a long-term commitment to improve healthcare access in developing countries after an epidemic is contained. Long term, comprehensive approaches combatting the collective global risk of infectious diseases are deprioritized in favor of emergency response funds. Millions of dollars in foreign aid to developing countries continues to be designated for emergency purposes only. Two years after the Ebola crisis, funding in West Africa is still focused on emergency response. It has not shifted to strengthen health systems or alleviate poverty. Yet, post-Ebola recovery will likely cost billions of dollars, leaving countries with health systems that are completely unprepared if another epidemic were to arise.
Funding would be better served if it enabled health systems to rebuild instead of waiting for the next crisis. Yet, while there has been a growing interest in addressing epidemic prevention as an international development issue, funding remains low.
The fact is that building better health systems and investing in poverty alleviation policies would not only save lives domestically. It would also prevent future outbreaks from spreading globally. Programs investing in the root causes of infectious disease outbreaks – including environmental, political, and economic causes – should be given as much attention as rapid-emergency responses.Improving agriculture, shelter, water quality, sanitation, access to health services and other development metrics would decrease the opportunity for new pandemics to emerge.
Furthermore, the current international aid framework must evolve. Funding is currently concentrated in emergency mechanisms, yet a long-term funding strategy that emphasizes a development approach would be more cost effective. By investing in preventing disease emergence in addition to crisis responses, the international community could create a more sustainable and secure system of disease management.
However, the existing crisis narrative can render development-based approaches unappealing. When the narrative focuses on infectious disease outbreaks, there isn’t room for competing discussions that focus on solutions. Debates about water sanitation do not generate the same headlines as questioning whether Ebola could be used in bioterrorism.
Examples of a more helpful narrative exist:The Washington Post published an article in 2014 examining the root causes in Western Africa that contributed to failure by health organizations around the world to prevent the Ebola disaster. In June 2015, The Wall Street Journal ran a piece about Liberia’s struggle to rebuild its health system after the decimation of Ebola.
Thoughtful pieces like these show how including development in the outbreak narrative can help the international community develop more comprehensive, long-term responses. With funding increasingly focusing on non-communicable, rather than infectious, diseases, it is imperative that sustainable development solutions are given a strong voice. WHO’s decision to label the Ebola outbreak a crisis only after it gained mainstream media attention shows how the images, phrases, and stories that frame an outbreak can help tailor global health policy.
By changing the narrative to create room to address poverty and inequality in global health solutions, the global burden of infectious diseases can be alleviated. But, if the international community continues to get caught up in a reactionary and fearful narrative about health crises, it could become a self-fulfilling prophecy with outbreaks continuing to flourish while development remains stagnant.