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Paul Farmer’s last book teaches still more about pandemics

With a great deal of storytelling, Farmer emphasizes that it’s a mistake when policymakers focus on controlling spread rather than delivering health care

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This week the World Health Organization will meet to determine whether the ongoing monkeypox outbreak constitutes what’s called a “public health emergency of international concern” (PHEIC). Meanwhile, the coronavirus pandemic, which has killed more than 6 million people since 2020, continues to sicken millions around the world.

Why is it so hard for governments to respond effectively to urgent public health crises? My research dives into that question, examining the complicated politics of pandemic response.

That research relies profoundly on lessons I’ve learned from the work of the late Paul Farmer, a giant in public health for both his advocacy work and his scholarship. I continue to learn from that work. This installment in the African Politics Summer Reading Spectacular discusses his last book, “Fevers, Feuds, and Diamonds: Ebola and the Ravages of History,” which examines the Ebola pandemic in West Africa that ran from roughly 2013 to 2016 (although the book discusses how hard it is to pick an “end” date).

This book could hold open a heavy door. Truthfully, other books by Farmer were initially hard for me to read. As someone who came late to enjoying reading, I found this book too daunting to start. But I promise, dear reader, it’s worth its weight and then some.

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In some key ways, this book differs from Farmer’s other books, although in others it is much the same. “Fevers, Feuds and Diamonds” has a lot more storytelling. Reading it, I felt immersed in the places and moments Farmer explores through the stories of some of the people most deeply affected by the Ebola outbreak. It begins with the stories of people who survived — and people who died of — the disease. Those stories launch readers into the rest of the book, which explains how things got so bad.

Two questions drive the book. First, why did Ebola spread rapidly in some places and not in others? Second, why did Ebola kill some of the afflicted while sparing others? The short answer to these questions is care — or the lack thereof.

Here, Farmer’s central argument is that pandemic response almost uniformly focuses on control rather than care. Decision-makers looked to contain Ebola and keep it from spreading — but did so without providing safe and effective care. Ebola emerged in what Farmer called a “medical desert,” an area that doesn’t have the “staff, stuff, and space” that Ebola patients need to have a chance at recovering. Farmer is specific about what’s needed: emergency rooms, intensive care units, operating rooms and clinical laboratories and so on.

Farmer also examines what shapes epidemics and society’s responses to them. He concludes that the Ebola pandemic was as deadly as it was because of few key social factors: “extreme economic and physical insecurity and the absence of anything resembling an effective health-care system, capped by the effects of civil war.” But, first, he gives us the historical background we need to understand why West Africa found itself in that position.

Farmer covers a lot of ground, situating West Africa’s Ebola pandemic in a broader historical context that includes slavery, colonialism and a post-colonial period shaped by resource extraction, armed conflict and austerity policies — all of which meant that those in power neglected to care for ordinary citizens’ health.

In doing so, as with his earlier books, Farmer fills “Fevers, Feuds, and Diamonds” with rich scholarly and historical sources, enabling readers to learn more about the book’s places, events and themes. For example, he devotes much of one chapter to West Africa’s experience with World War I and the concurrent influenza pandemic of 1918-1919. Farmer explains that the influenza pandemic was catastrophic for West Africa because of “the nature of the pathogen, the failure of preventive efforts, ineffective therapies, and a dearth of supportive and critical care.” In other words, how the world response to the Ebola pandemic merely continued a long history of neglect for Africans’ health.

To show this history as shaped by racism while both producing and reproducing inequities, Farmer relies on voices not usually encountered in typical academic texts, including “memoirs and correspondence of former slaves, recaptives, and black abolitionist ship captains, and on the works of dissident African American writers, radically revisionist historians from the colonizing nations, West African scholars, and the odd novelist or poet.” In doing so, Farmer teaches us to go beyond recognizing that racism and inequity shape pandemics and to learn from the pandemic experiences of the people marginalized by racist, unequal systems.

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Farmer finished this book as the coronavirus pandemic was emerging. While it did not figure prominently in the book, his epilogue devoted to covid-19 notes that the social factors that shaped the Ebola pandemic — inequities in access to quality care — remain. As the World Health Organization meets to discuss the spread of monkeypox, it might consider responding with attention not just to control but to care.

Read more in this summer’s APSRS:

‘Born in Blackness’ is a compelling, unforgettable read

Find all the books in our ninth African Politics Summer Reading Spectacular here.

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