Unbenign Neglect: Dealing with neglected tropical diseases

Côte d’Ivoire, July 1997. A convoy of deluxe 4x4s emerges from the cocoa and cashew trees and pulls into a village. The Land Cruisers stop at the only brick building: the health centre. The waiting villagers breathe in the dust and look on.

 A door opens. Out steps the country’s Minister of Health, followed shortly by his honourable Japanese guest. The two men greet the villagers, who mutter a ragged response. As custom dictates, the Minister asks about their families, their crops, their well-being. Everyone is fine, just fine. But one of them appears to be missing chunks of his face. His foot, too, is missing a large patch of skin – the red lines of knotted muscle show plainly when he moves.

The Japanese visitor turns to the Minister and speaks softly so the villagers can’t hear. “What’s that?” He nods towards the disfigured man.

“An infection.” says his host. “It eats your flesh.”

“An infection?” says the Japanese. “You know, I saw something like that back home.”

They tour the health centre, chat amiably with the patients and nurses (there is no doctor), and eventually return to their 4x4s. Switching on the aircons, they blast down the dusty roads back to the capital.

 

Starting to end neglect

And there the story would have ended, and the neglected tropical disease would have continued to be neglected. Except that the visitor was Dr Hiroshi Nakajima, Director-General of the World Health Organization. This chance encounter in Cote d’Ivoire stuck in the DG’s head and, when he returned to Geneva, he set up a tiny team – Dr Kingsley Asiedu from Ghana, and an assistant – initially with almost a zero budget, to investigate what he learned was called the Buruli ulcer, after the place in Uganda where it was first noticed.

Nakajima lobbied in his home country and got the Nippon Foundation to fund a new global partnership: the Global Buruli Ulcer Initiative. Work started in earnest.

As luck would have it, I met Dr Asiedu shortly thereafter. I was on a consultancy mission to find out more about WHO’s global partnerships. On a hot summer’s day, I walked along the endless corridors to a remote part of the huge WHO building. Previously I had seen the big, well-staffed, multi-million dollar partnerships – Roll Back Malaria, Stop TB – and this was going to be my first taste of a small one.

 

We don’t know anything!

I didn’t realize how small. Kingsley Asiedu, a tall, well-built Ghanaian, was at his uncluttered desk. The blinds were drawn against the heat. An old air conditioner stuttered behind him, and he mentioned that his assistant was away. He was alone, and I had the sudden thought that he might really be alone – the one person in the world who was tackling the mysteries of the Buruli ulcer. It wasn’t true, of course, as there were a few other Buruli researchers scattered around the globe. But still.

“We don’t know anything about it, really,” he said. He seemed tired – matter-of-fact, but not unconcerned. There was a quiet resolve, perhaps passion. “We have no facts – we don’t know how many people have it, what causes it. Actually, we don’t know anything.”

“So how do they treat it. Is there a cure?”

“Nope, no cure. Only surgery.”

“What, they just cut out the infected bits?”

“Yeah. It usually leaves people looking like monsters, but what can you do?”

I looked at the large, empty office, with its few scattered books and manuals, a few papers stuffed into the shelves. As the aircon flapped ineffectively in the shaded room , a feeling of hopelessness swept over me. How could one person do anything? And how odd that the barbarous horror of a flesh-eating disease was being pursued in the heart of genteel Geneva.

 

Small individual causes with big collective effects

Buruli ulcer is the classic neglected tropical disease, or NTD – one of many NTDs which affect too few people for anyone to want to do much about them. Drug companies don’t consider it worth investing research money, so medicines don’t get produced. Overburdened health systems in affected countries focus their scant resources on the major health problems, not the minor ones. And politicians inevitably address their priorities – and budgets – only on conditions affecting their biggest voting blocs.

However, while each of them only affect small populations, collectively NTDs occur in 149 countries and affect a billion people, costing developing economies billions of dollars every year. They mainly affect populations living in poverty, without adequate sanitation and in close contact with infectious vectors and domestic animals and livestock.

So when Nakajima decided not to neglect the Buruli ulcer, he was doing something quite unusual. In the 1998 conference launching the Global Buruli Ulcer Initiative, he said,

I decided to place emphasis on the fight against Buruli ulcer for the following reasons. In the 21st century, where infectious diseases are concerned, the world will have to find the means both to control major long-standing scourges such as tuberculosis and malaria, and also to deal effectively with emerging diseases such as Buruli ulcer. I am convinced that these two different sorts of challenges will have to be tackled simultaneously. If we fail to do so, the prevalence of infectious diseases as a whole is likely to increase worldwide, and the severity of specific diseases may well increase too.

This is still a good summary of why we should care about neglected tropical diseases.

To bring the Buruli story up to date, here is what we now know: Buruli ulcer is caused by the Mycobacterium ulcerans bacterium. It exists in at least 33 countries around the world. In 2014, 2200 new cases were reported. It mostly affects children. The good news is that 80% of cases detected early can be cured with a combination of antibiotics, rather than surgery.

The Global Buruli Ulcer Initiative has drawn together global expertise and led mobilization of needed resources. More than 40 nongovernmental organizations, research institutions, and foundations are now participating in the Initiative.  Nonetheless, Buruli ulcer remains a neglected disease and much work, at all levels, needs to be done to improve prospects for control.

Is Access to Information a Human Right?

Do we have the right to access information that is essential to human development? Isn’t it a human right? The short answer is no, although quite a few people think it is. Meanwhile, copyright has a basis in human rights – although nobody thinks so.

There are two levels at which the access to information is addressed by legal frameworks. At the visionary end, there are various international declarations of human rights, with the Universal Declaration of Human Rights (UDHR) at the summit (together with its implementing instruments such as the International Covenant on Economic, Social and Cultural Rights). These declarations have no direct statutory effect, but nevertheless they have a powerful rhetorical and moral impact, and influence the framing of legislation. At the more practical end is a thicket of international and national legislation seeking to convert the ethical and moral conclusions of these declarations into action or (more usually) into barriers to action, following the format of the Ten Commandments: “Thou shalt not…”.

In this posting, I will take a look at the first level of information rights and consider the question: Does the UDHR and its associated covenants grant a right of access to information essential to human development?

Being a robust and legally well-drafted document, the UDHR is admirably ambiguous, ambivalent and even-handed. Little is explicit, lots is implicit: lawyers purr at its loopholes. Here is a gentle examination of the clauses related to an access right (the original text is given in italics, and my comments are given in normal type):

Article 18: Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.

The freedoms of thought, conscience and religion are all what I would call “internal rights”, in the sense that they apply to what is going on within a person. Nobody can prevent someone merely thinking freely, having a conscience or believing in a religion. These rights can all be exercised in perfect safety by a silent, uncommunicative human being, without breathing a word about it to anyone.

In this article, the internal rights are complemented by the external right to “manifest” your religion – essentially to speak and write about it.

The freedom to think is not the same as the freedom to access the expression of other people’s thoughts, as manifested in books, films or music. This may be implicit, but this article does not explicitly offer the right to such access.

Article 19: Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers.

This article is often taken to assert an access right, but does it? I think not. Let us take the text to pieces slowly and carefully:

As with Article 18, the right to “freedom of opinion and expression” comprises an internal and external component: “opinion” and “expression”.

  • The first of these, the right (or “freedom”) “to hold opinions without interference” is similar to the internal rights in Article 18: nobody can prevent someone merely holding an opinion. It is only when you express your opinions that you can run into trouble.
  • So what about the external right of “expression”? The first thing to observe is that, as written, Article 19 surely asserts this right only in relation to opinions. If this interpretation is correct, the “information and ideas” it mentions are restricted to the means by which you express your opinions and learn about the opinions of others.
  • Does this include a right to collect information and ideas about non-opinions – things like scientific and other knowledge, for example? It could be argued that the scientific method is actually the expression of opinions about the nature of things. According to Karl Popper, scientific progress involves the falsification of existing, well-formulated, falsifiable theories, which, in the light of new evidence, are superseded by new falsifiable theories. In that case, scientific theory looks very much like a set of opinions with which one can disagree by adducing new facts. However, even if scientific theory can be made to fit this article as “opinion”, the key applications of science and what we call “the evidence base” of essential information – these are surely not “opinion”. and if they are not opinion, then Article 19 does not assert a right to access such essential information.
  • The main practical use of Article 19 by campaigning organizations such as the aptly named Article 19 has been in combating censorship. With a focus on the freedom of expression part of this right, the Article19 website states that “freedom of expression is key to the development, dignity and fulfilment of every person”, and provides examples of how States benefit from the freedom of expression: each of the examples turns on political debate and governance; opinion, thus, rather than fact. What they call the “development, dignity and fulfilment of every person” is the development of our ability to speak for ourselves in the battle of opinion.

In conclusion of this mini-analysis of Article 19, the “information and ideas” to which we have an access right are generally held to be expressions of political and other current social opinion – the sort of thing you find in newspapers – and not, for example, practical information related to human development – as contained in journals, books and manuals.

This distinction is important. Article 19 focuses on expressing (seeking, receiving and imparting) political opinions. The kind of educational access to information essential to human development fits more within the ambit of Article 26 – in fact, the very existence of Article 26 is an indication that the UDHR framers did not consider that education was covered by Article 19. This is also true of Article 27 regarding culture and authorship. So let’s take a quick look at these two articles:

Article 26: 1. Everyone has the right to education… Technical and professional education shall be made generally available and higher education shall be equally accessible to all on the basis of merit. 2. Education shall be directed to the full development of the human personality and to the strengthening of respect for human rights and fundamental freedoms…

While Article 26 offers a right to education, it does not mention the fundamental tools for education – knowledge in a written or other fixed form. You obviously need to access information and other educational materials if you are going to have an education, so this may be considered to be implicit, although it is not stated. The UDHR explicitly mandates the teachers and classrooms, but not the books.

Article 27: 1. Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits. 2. Everyone has the right to the protection of the moral and material interests resulting from any scientific, literary or artistic production of which he is the author.

Again, the right to participate in “cultural life” and to “share in scientific advancement” in the first clause seems to be conferring an implicit access right: how can you experience culture without access to such cultural products as books and films and music, and how can you share in scientific advancement without reading about it? And yet this is again not stated.

It begins to be clear in the second clause of this Article, which may be surprising to many. This clause confers a “right of protection” of the “moral and material interests” of authors. Rather than giving people the right to read, it gives authors the right to prevent people from reading.

Does this imply that copyright is a human right? Not according to the Committee on Economic, Social and Cultural Rights, a body of independent experts reporting to the UN Office of the High Commissioner for Human Rights, whose commentary on the UDHR and Covenant is taken as holy writ. In their Comment 17, they explain that copyright is not a human right because human rights go deeper. attach to a human (rather than a publishing company or producer), and last a lifetime.

But if copyright is not a human right, the second part of Article 27 of UDHR surely provides its ethical basis. And it places the right to control the work firmly in the hands of the author. This is why access to information is not a human right: If authors/creators have a human right to control their output, which allows them to decide all significant further uses (publishing, reading, playing, etc) of their work, then nobody else does.

Of course authors want to be read, musicians to be heard, and so they are not usually the main barrier to access. But to be read or heard, they have to descend from the cloud of human rights into the marketplace of copyright. They have to sell, license or barter their rights to publishers, producers and others in the media chain, who end up being the main “rightsholders” benefiting from copyright legislation rooted in Article 27(2). From a human rights standpoint, thus, this clause sanctions the entire copyright edifice of modern publishing, music and film. Once this lobbyists’ fingerprint is visible, it ceases to be a surprise that you don’t find an access right to information in the Universal Declaration of Human Rights.

Personally, I am in favour of authors retaining the rights to their work – both as copyright and in their “moral rights”, the full European droits d’auteur. But I am also in favour of the needy populations of the world having unconditional access to information essential for human development. How to reconcile these positions will be the subject of my next few blogs.

References/Acknowledgements

The Article19 website is at http://www.article19.org

The Committee on Economic, Social and Cultural Rights: General Comment 17 can be found at http://www.refworld.org/docid/441543594.html  Thanks to Mark Perkins for drawing my attention to this.

An excellent recent book on international copyright is Blomqvist, Jorgen, Primer on International Copyright and Related Rights, Edward Elgar Publishing Ltd, Cheltenham, UK, 2014

Popper, Karl, The Logic of Scientific Discovery, Basic Books, New York, NY, 1959.

The Universal Declaration of Human Rights http://www.un.org/en/documents/udhr/

An Information Gap in Human Rights

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I’m going to review an old bit of copyright law and try to make it sing. More, I’m going to try and convince you it is important, and even something in which it is worth your investing a little passion. Finally, I hope you will agree it might be worth reviving in some form or other.

What is it?

Let’s start with the Berne Convention, which is still the principal document setting out just what copyright is and what it covers – including any exceptions, exclusions and limitations…Berne was launched in 1886 and first “completed” in 1896, and has been revised several times since. Altogether 168 countries have signed it – including the USA, which finally inked its accession in 1988, after nearly a century of resistance.

The “old bit of copyright” that fascinates and depresses me is a forgotten right buried in a lowly Appendix. This Appendix was added to the Berne Convention in 1971 when it was last revised in Paris; the whole instrument is known as the Paris Revisions, or Paris Act.

Why it is fascinating and depressing?

The Appendix is fascinating, since it is the only text in the Act that specifically addresses the information needs of developing countries (reproduced in the Universal Copyright Convention).

And depressing, since – despite having been successfully enacted in the teeth of fierce opposition from publishers, and despite allowing developing countries the right to re-publish copyright materials whether the publishers allow it or not, under a compulsory license – it seems that little use has ever been made of it by any developing country.

And yet again, fascinating, because it provides an approach to defining information that is considered important – or even essential – to human development: “Ah yes, but who can say what is essential?” you might ask. Well the Paris Act provides a broad description that has survived the scrutiny of hordes of repudiating publishers and arrays of lawyers, many of them paid to be bite-your-ankle hostile. The definition must therefore be at least good enough (I will come back to the topic of essential information in a later blog).

And yet, it is depressing again because, as it stands, the text is limited to analogue material. The Appendix was somehow forgotten during the whole decade during which the Geneva-based World Intellectual Property Organization (WIPO) worked on producing a digital extension for the Berne Convention, as enshrined in the WIPO Copyright Treaty. No digital extension was ever produced for the Appendix.

And thus – finally – fascinating, because if it was revived now, it could serve as a vehicle for raising developing country concerns relating to essential information in the digital age. This is what could make it compelling today.

A bit more detail

In six short Articles, the Appendix sets out the conditions under which developing countries can issue compulsory licences to translate and republish “for the purpose of teaching, scholarship or research” anything that has been published abroad – whether the foreign publisher wants to allow it or not. “Anything” is specified as “natural and physical sciences, including mathematics, and …technology [and] fiction, poetry, drama and music, and … art books.”

As I mentioned earlier, the Appendix doesn’t cover anything digital. However, what it does cover is admirably broad: “print and analogous forms of reproduction… works which are composed mainly of illustrations [and thus arguably photographs and graphic/art works]…broadcasts… [and] sound or visual recordings of a translation… [and] audio-visual fixation”.

So the Appendix covers the translation and republishing/rebroadcasting of all subjects, in virtually all non-digital media, as long as the purpose is non-commercial and educational.

Sounds good, but there are many conditions and hoops for the developing country to jump through – starting with having to declare that it can’t “make provision for the protection of all the rights as provided for” in the Berne Convention, because of its “economic situation and its social or cultural needs”. Unique in the copyright world, this amounts to a declaration of incompetence. So it is not surprising that countries are reluctant to sign on.

But there are more unwelcome oddities in this short text. You can only apply for a compulsory license after you have tried to get a license from the rightsholder and you have been refused it, or if you can’t find the rightsholder. This is very onerous for a developing country translator – prohibitively so. The foreign rightsholder actually has to refuse permission for the translation before you can start. A hint of paradox there.

Then, while developing country publishers are not allowed to publish and sell commercial editions, they are nevertheless obliged to pay “just compensation” to the foreign rightsholders. The Appendix even helpfully considers possible foreign exchange problems in this regard. This too seems a contradiction in terms: you may be producing information materials which you intend to give away – and you have to pay a foreign rightsholder for the pleasure?

As a former translator, it tickled me to note that the Appendix calls for “national legislation to ensure a correct translation” – surely a first. Has any country ever introduced legislation to make bad translations illegal? I wish they had it in the UK, as I would be extremely litigious! Very unlikely that any developing country would waste intellectual steam and resources on cooking up such an absurd law.

Finally, the Appendix descends into gobbledygook. I accept it may be my intellectual laziness that prevents me from understanding the last Article. I won’t quote it, but the title gives a hint of its obscurity: “Possibilities of applying, or admitting the application of, certain provisions of the Appendix before becoming bound by it”. I spent a suffering hour unsuccessfully trying to digest the 161 words in the first clause. I think it allows you to set up a compulsory licensing scheme by dickering with the Convention itself, rather than using the Appendix. But wouldn’t swear to that. In any case, the wording is one final unnecessary hurdle for developing countries wishing to translate and publish information essential to their citizens’ development.

A conclusion

To date, only 16 of the 168 Convention signatory countries have also signed up for the Appendix, and I have been unable to trace any actual application of its provisions. So here we have an instrument used by almost no country to do almost nothing. If the publishers’ lobby wanted it to fail, they have succeeded admirably.

But here’s a what-if: What if we did for the Appendix what WIPO has already done for the rest of the Convention? Bring it up to date for the digital age. Add the internet, CD-ROM/DVD, the whole glorious excesses of technology. Subtract deliberate confusion. Clarify and make usable. Promote actively.

This should be easier than the initial struggle for the analogue version. It wouldn’t cost the rightsholders anything – the most they would lose is markets where they earn nothing anyway. Rightsholders have learned from such initiatives as HINARI – which provides developing countries with free access to electronic versions of journals – and which are based on precisely this concept. Making copies of existing electronic versions costs publishers nothing, apart from a very small administrative overhead, while the enhancement of their public image, rosy feelings of self-worth, and (joking apart) future sales when the countries shed their “developing” tag – makes it all worthwhile.

An international copyright expert I discussed this with pointed out that you can’t just change the Appendix, you have to reopen discussion on the whole Berne Convention. And nobody wants to do that, neither publishers nor the developing countries.  Trying to tilt at that particular windmill, he said, would indeed be quixotic.

Well, it may be quixotic, Sancho Panza, but it is a key part of the discussion of an access right to information, which we will be exploring further in this blog. If the right of access to information essential for human development in the digital age cannot be discussed in the context of updating the Appendix to the Berne Convention, or as a component of an expanded WIPO Copyright Treaty, then how can it be tackled?

Because this is certainly a gap in our acknowledged human rights.

What do you think?

Dying Trying: The UN’s Development Agenda for the Next 15 Years

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UN Secretary General Dr Ban Ki-moon today presented his synthesis report on the post-2015 Development Agenda. Entitled “The Road to Dignity by 2030: Ending Poverty, Transforming All Lives and Protecting the Planet”, this is Ban Ki-moon’s updating of the Millennium Development report (which Kofi Annan rather more modestly called “We the Peoples – The Role of the United Nations in the 21st Century).

I note in passing that the former penchant for having development “Decades” covering distinct topics has now swollen into a 15-year catch-all cycle. WHO’s Health for All, which all of us were supposed to be enjoying by the year 2000, was taken over by the UN and prolonged into 2015 in the Millennium Development Goals (MDGs). This is now being extended to 2030 in a new set of Sustainable Development Goals (SDGs) launched by the Secretary General’s report.

Well, health was not achieved by all by the year 2000; nor will all the MDGs be achieved by most countries by next year. With the 17 SDGs more than doubling the eight MDGs, one might conclude that the opportunities for failure are that much greater. While this may be true, in a literal sense, we should recognize that the real value of these efforts lies in providing a coherent structure for development work, and a rational way to measure and assess the results.

“Data” is the big word in Ban Ki-moon’s report. He proposes nothing less than a “data revolution to make information and data more available, more accessible, and more broadly disaggregated, as well as for measurable goals and targets, and a participatory mechanism to review implementation at the national, regional, and global levels.” Whether we succeed or fail, thus, at least we will be able to measure it.

The report presents an obligatory mantra of “Six Essential Elements for delivering the SDGs”, with health categorized under “People: to ensure healthy lives, knowledge, and the inclusion of women and children”. Here is the totality of what Ban Ki-moon says about health:

The agenda must address universal health-care coverage, access and affordability; end preventable maternal, new-born and child deaths and malnutrition; ensure the availability of essential medicines; realize women’s reproductive health and rights; ensure immunization coverage; eradicate malaria and realize the vision of a future free of AIDS and tuberculosis; reduce the burden of non-communicable diseases, including mental illness, nervous system injuries and road accidents; and promote healthy behaviours, including those related to water, sanitation and hygiene.

No surprises there, then.

It is a little disappointing that the “knowledge” part of the Essential Element on People focuses only on asserting a right to education for children and adolescents. However, the implication that knowledge is essential for development appears under various guises throughout the report. For example, Ban Ki-moon calls upon Member States to scale up cooperation for the sharing of technologies, strengthening knowledge and capacity building, and to make the necessary policy adjustments to facilitate these actions. He stresses that such technologies and knowledge should be transferred to developing countries on favourable, concessional, and preferential terms. Moreover, he says, the global intellectual property regimes and the application of TRIPS flexibilities should support sustainable development.

Ban Ki-moon proposes to establish an online, global platform to map existing technology facilitation initiatives, needs and gaps (including in health), enhance international cooperation and coordination , and promote networking, information sharing, knowledge transfer, and technical assistance. Roll on the UN Observatory…

Clearly the report offers plenty of work, which will require a myriad of hands and a mountain of money. We know perfectly well that by 2030 we will not have achieved dignity for everyone, much less ended poverty, transformed all lives and protected the planet. Still, we will have made another start, and there will be plenty of data to scrutinize when the next report is launched in December 2029.

Looking ahead, since we need more superlatives and might as well follow the expansive trend by moving to a 20-year cycle, I propose that the next report be called something like “Universal Nirvana by 2050”, and that it should be positively stuffed with UN-DGs. We won’t reach those either, but we will certainly die trying.

Ebola and Power

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One evening last year in Brazzaville, Congo, as we were playing a lazy game of tennis outdoors under the floodlights, I heard a swishing sound. Little bats used to flit down and sometimes collide with our tennis balls, so I assumed we were in for a bat attack. We were: but, instead of little birdlike pipistrelle, two fruit bats as big as dogs, with wings a metre wide, swept down over the courts. They looked like nothing on earth – feathered chests, bulging eyeballs, fangs… We dived to the ground – all of us, foreigners and Congolese – as they passed low over our heads. We stayed down, expecting another attack, but the bats never came back.

LIKE THOSE HORRORS, ALL OUR WORST FEARS SEEM to come from the steamy tropical jungles of Central Africa. However, it is important to understand which are the rational fears, and which are the wild fantasies, the nightmares.

Around 1900, in a remote part of southeastern Cameroon, a porter for a colonial company picked up the HIV virus from an infected chimpanzee – probably by eating it (about 2 million Africans eat such “bushmeat”). HIV/AIDS spread down the Congo River to Leopoldville (now called Kinshasa). According to the genetic record, all the HIV in the world seems to have come from a single piece of genetic material that existed in Leopoldville at the beginning of the 20th century. Africans spread it in Africa, but it took a Western missionary to spread it to the wider world.

In 1976, near the Ebola River in northern Congo, not far from the source of HIV/AIDS, a new filovirus was first detected in a mission hospital run by Flemish nuns. The first victim was Mabalo Lokela, a 44-year-old schoolteacher. As with HIV, scientists first believed that the source of Ebola was bushmeat, but since monkeys also died from the disease, they could not be its reservoir. Working their way through candidate species, researchers found that fruit bats carried Ebola without dying. This makes them the likely reservoir, transmitting the virus by biting monkeys, apes, armadillos, porcupines – and occasionally humans.

HOWEVER COMPELLING AND FASCINATING THESE EXOTIC ORIGINS MAY BE, the way the diseases spread – and particularly the way the information about the diseases spread – tells us something about colonialism and power.

HIV/AIDS certainly circulated in a low-key way throughout tropical Africa for decades without exploding. Up until the 1950s, it is estimated that only 1% of the adults in major African population centres had AIDS. One likely reason was the predominance of circumcision among African men (circumcised males are 70% less likely to transmit HIV). Poverty is another factor. “Wealthier people — doctors, teachers, politicians, singers — get HIV in completely disastrous numbers. Some of that has to do with access to resources and multiple sexual partners.”[1]

Colonialism undoubtedly helped AIDS spread in Africa – it can be traced coming down the rivers in colonial vessels, along porter paths and colonial trading posts and railroad lines.

With Ebola, the situation was different. Unlike HIV/AIDS, which only really exploded publicly among the gay population of the United States in the 1980s, we knew right away that Ebola was coming from Africa. Although the initial outbreaks were generally shut down as soon as they were observed, Ebola quickly became demonized as a particularly horrible, disgusting, mysterious, EVIL killer.

EBOLA IS CERTAINLY HORRIBLE ENOUGH – YOU GET IT THROUGH contact with the body fluids of the dying and dead – and days or weeks after they have died. What you experience is not nice: high fever, severe headache, muscle, joint, or abdominal pain, severe weakness, exhaustion, sore throat, nausea, dizziness, internal and external bleeding, diarrhoea, dark or bloody faeces, vomiting blood, red eyes, rash, low blood pressure, rapid heartbeat, damage to the kidneys, spleen, and liver, internal and external haemorrhage from orifices such as the nose and mouth… According to the books, “Eventually, Ebola will turn the host’s organs to a mush-like substance.”[2] It takes about three weeks, and up to 90% die. There’s no standard treatment for it, either.

The thing is, as long as you segregate the remains of those who have died of it from the population, you can contain it. This has been the result to date. Typically ten or twenty people die in an outbreak, a tragedy for the individuals, of course, but far from enough to be considered a major public health issue. To get some perspective, at the time of writing, there have been over 15,000 cases of Ebola in the last 20 weeks, resulting so far in about 5,500 deaths. In the same period, some 200,000 children have died from malaria in Africa. Annually, between 250,000 and 500,000 people in the world die from influenza. By these yardsticks, Ebola should be almost invisible as a public health problem. To some, the fact that Ebola has become such a focus of attention is a consequence of “the pathology of the capitalist system”[3].

BUT THE THRILL OF SHOCKING AND HORRIFYING NEWS IS HARD TO RESIST. Richard Preston’s 1994 non-fiction book The Hot Zone was the first to raise the spectre of this African plague in Western consciousness. Subtitled “A Terrifying True Story”, the book didn’t try to resist the temptation to sensationalize the pants off the story. Preston makes the connection between infected animal remains he found in a cave in Uganda and a lab in Reston, Virginia, where a monkey virus similar to Ebola, but which does not affect humans, was discovered. The unmistakable insinuation was that we could expect mass transmission of this African horror to the West.

The book was a best-seller. Based on this, Outbreak, a high-budget Hollywood movie, was made in 1995 with an A-list of stars including Dustin Hoffman, Morgan Freeman, Cuba Gooding, Jr., Kevin Spacey and Donald Sutherland. The film spread the notion that Ebola could be transmitted through the air – in fact, it can’t. It was a box office and financial success, securing number 1 on its opening weekend. With a $50 million budget, it went on to gross some $190 million worldwide.[4]

Of course, treating “Darkest Africa” as the source of such exaggerated nightmares is both childish and demeaning to the continent. It may betray colonialist and racist attitudes – the fear of being tainted by the “Other” (to use Kapuscinski’s terminology), of being defiled by this vile, alien contagion. One African commentator[5] called this “whipping up anti-African hysteria.” “The media has racialized the Ebola pandemic”.

AMONG THOSE WHO NOTED THE RISE OF A NEW BIOLOGICAL NASTY were the Japanese terrorist group– Aum Shinrikyo, which carried out a bioterror campaign in 1995, dispersing the nerve agent sarin on the Tokyo underground and killing 13 people. Police investigating the cult found Ebola cultures at their headquarters, which members had picked up in Zaire the year before. Fortunately, Ebola cannot be spread this way.

Some commentators, noting that the US government carried out a biological and chemical weapon experimentation project called Project 112 from 1962 to 1973[6], wonder if the present outbreak has anything to do with such experimentation, although this seems most improbable for the same reasons that stopped Aum Shinrikyo – it is simply not so easy to collect, preserve and transmit.

TO CONCLUDE, IT IS WORTH NOTING THAT ALMOST ALL THE EBOLA AID for the three West African countries most affected in the present outbreak – Liberia, Sierra Leone and Guinea – is coming from the three former colonial masters, respectively, the USA, the UK and France, and that each is giving virtually nothing to either of the other two.

China is giving something to each of them, but then China wants something from all of them: “iron ore mining, energy and infrastructure“, according to Professor Sreeram Chaula[7], who develops the theme of “viral aid” in his recent paper. “If the US, UK and France were driven by humanitarian motives,” he asks, “Why did they not contribute to the multilateral UN Ebola response fund that would have distributed the funds more equitably among the three worst-hit West African countries? Thus far, only India and Australia have made sizeable donations of $10 million each to the UN Ebola fund that is woefully undersubscribed.”

The moral of the story is that we should be alert to the stereotypes we are handed by our so-called friends in the media, who want more readers; by our would-be educators in the entertainment industry, who want to sell more tickets and popcorn; by our wise or crafty leaders, who want to exercise their power in former colonies; and even by the impartial, evidence-based medical establishment, which knows which way the political and budgetary winds are blowing.

The giant fruit bats float through the humid forests of Africa as they have for thousands of years. From some genetic mutation they collect a poison virus in their veins. Wheeling in the dark, they dive out of the night to bite their natural prey, completely unaware of the chaos they are sowing among the human race. No doubt, there is more to come…

[1] Rob Waters. AIDS: Why Africa suffers for the West’s sins. Craig Timberg interview. Salon Magazine, 9/3/2012 http://www.salon.com/2012/03/09/aids_why_africa_suffers_for_the_west%E2%80%99s_sins/

[2] WHO advisory to travellers

[3] Ebola Epidemic Exposes the Pathology of the Capitalist System, Amit Sengupta, Newsclick, August 21, 2014, http://newsclick.in/international/ebola-epidemic-exposes-pathology-capitalist-system

[4] Wikipedia http://en.wikipedia.org/wiki/Outbreak_%28film%29

[5] Horace G. Campbell. 2014. Ebola, the African Union and bioeconomic warfare. Pambazuka News 697, 2014-10-08 https://groups.google.com/forum/#!topic/usaafricadialogue/kIOxB6Ve7bs

[6] Horace G. Campbell. 2014. Ebola, the African Union and bioeconomic warfare. Pambazuka News 697, 2014-10-08 https://groups.google.com/forum/#!topic/usaafricadialogue/kIOxB6Ve7bs

[7] Sreeram Chaulia, 2014.Foreign pulse: Viral politics. Originally published in Asian Age. Oct 07, 2014. Available from  http://sreeramchaulia.net/publications/EbolaPolitics.htm