Two weeks ago, Laurie Garrett, a senior fellow at the Council on Foreign Relations, captured Foreign Policy readers’ attention with a post titled, “You are not nearly scared enough about Ebola.” She used buzzwords meant to invoke fear in Western media audiences: chaos, civil war, Boko Haram terrorists and frightened young soldiers. The piece was not out of character for Garrett, who has been making the rounds on TV and radio talk shows as an Ebola expert. Perhaps Garrett is engaging in what Dan Drezner has called scare-mongering because she wants to raise awareness about and garner more resources for the ongoing Ebola outbreak in West Africa. However, it is not clear how scaring “you,” presumably a Western reading public, accomplishes this.
We agree that the Ebola epidemic – the worst on record – is deserving of attention and resources. The World Health Organization (WHO) estimates that 1,552 people have died from Ebola while at the same time admitting that it is probably underestimating Ebola’s impact.
But we disagree with the tactics used to raise awareness and resources to respond to the Ebola outbreak. Although fear can be effective at raising awareness about an issue, it has proven to be damaging in its effects.
The negative effects of fear-mongering
Amidst irrational fears of infection through air travel, multiple international airlines have ceased flights to West Africa. Fear has even halted travel to unaffected regions, revealing the spillover effects in our ‘map-challenged’ world: there are reports of airlines canceling flights to East Africa – where there are fewer people infected with Ebola (zero) than in America (two). There is also evidence that Ebola-fueled racism is on the rise in Europe. In the U.S., over a quarter of Americans think they or their families are at risk. When news of the Ebola-infected American missionaries’ repatriation to the U.S. hit, fear, anger and suspicion echoed through social media. News of suspected cases of Ebola in Ohio and New York gave rise to sensationalist headlines and almost boastful statements of how success in previous Ebola outbreaks will produce the same outcomes in this one.
The fear-mongering rhetoric to which Garrett subscribes is all too familiar for those of us who study the history of tropical disease and medicine — the antecedent of what we are now calling global health. It places Africans in two categories: hapless victims and contagious threats. It is enough that the people in the affected West African countries are now vulnerable to Ebola and continue to experience the loss and debility of their loved ones. Do they also need to witness and experience the dehumanizing rhetorical violence that such talk engenders?
How sober are solutions packaged with fear-mongering rhetoric?
Though Drezner questioned Garrett’s scare-mongering tactics, he found her suggestions for responding to Ebola “sober.” We respectfully disagree. In line with Garrett’s fear-inducing rhetoric, a primary solution she offers in curbing transmission of Ebola is the cordon sanitaire, a public health term used to describe the quarantine zone around the regions most affected by the current outbreak. In her recommendations, Garrett often draws on her experience reporting on the Ebola epidemic in 1995 in Zaire (the work that won her a Pulitzer Prize). During this outbreak, Zaire’s ruler, the notorious Mobutu Sese Seko, isolated Kikwit, the affected region, with military force to keep people from leaving the city of 400,000 people. Honestly: Is Mobutu’s a model of health governance we want to repeat? Under his militarized quarantine, prices of food escalated, and people were deprived of common household goods. There is growing evidence that this is happening in Sierra Leone, Liberia and Guinea. (It is important to note that even Mobutu lifted the blockade between Kikwit and Kinshasa within a week of its installation under advisement of local medical committees).
The use of a militarized cordon sanitaire is particularly problematic in the context of the current Ebola outbreak. Two of the three most affected nations emerged relatively recently from civil war. The restrictions on people’s movements, the financial speculation on goods and services, the scarcity of ordinary items, are said to remind people of their wartime experiences. Clashes with authorities over Ebola response in Monrovia’s West Point shows all too well how a history of marginalization and the threat of state violence may enliven existing tensions and propagate more violence. The institutions responsible for providing care in times of crisis should be very cautious about any health program that approximates military intervention. Already, one young man has lost his life because of the heavy-handed response of soldiers enforcing the quarantine in West Point, an informal community in Liberia’s capital Monrovia.
Alternative solutions to curb Ebola, as noted by researchers and responding medical staff
So what can we offer in lieu of Garrett’s cordon sanitaire recommendation to curb Ebola transmission? Individuals who have fallen ill with Ebola and their families need to see teams trained in quality clinical care instead of teams trained in military combat. Improving health-seeking behavior, an essential component of managing this outbreak, requires offering good care. As Briand and colleagues wrote in a recent special issue of the New England Journal of Medicine, “the provision of clinical care to affected populations could be used as a basis for reducing people’s movement.” Quality care that gives people hope of living beyond their Ebola infection stands a chance at keeping sick people from evading health care.
One suggestion of Garrett’s we would like to amend is her call for more health workers from organizations such as Doctors Without Borders and the Red Cross to respond to the Ebola outbreak. Because we recognize the great disparities in health care provision around the world, we know that health workers from Western countries will have had specialized training and will bring more resources to their response. However, waiting for Western aid alone is a shortsighted and narrow strategy. The Doctors Without Borders emergency coordinator for Monrovia says they’ve already brought in all available international staff with Ebola experience and that “they don’t actually need that many more international experts to expand the treatment centers, just enough to train the Liberians who would do most of the work.
Most of the health workers responding to the Ebola outbreak are West African. Many more are capable of doing so. In fact, given their particular knowledge about health-seeking behavior (not to mention local languages, etc.), they are arguably even better equipped to respond than Western health workers. However, they have been overworked and under-protected. More protective gear, more training, and better recruitment within the region are necessary to address this gap.
We do recognize, however, that West African health workers are few and that the epidemic is sufficiently large that reinforcements from abroad will be necessary. Medical staff who have experience responding to Ebola are particularly useful. A truly international – and not just Western – team of well-trained and well-supported experts and health providers will help put a stop to this already devastating epidemic. For example, the top Ebola expert in the Democratic Republic of the Congo has gone to Liberia to offer his expertise.
Responding to Ebola is hard work. The Ebola outbreak in West Africa is a constantly shifting situation that requires a nimble response. Letting fear dictate how we interpret the epidemic confines our strategies for responding.