West West Africa

liberia-ebolaAt some points the fighters jumped off and pushed the skiffs over a sandbar into a cut of water…Just like in the wadi, there was concerns about the Americans. They sought to keep themselves out of sight under the branches. Uncle Sam knew nothing, Uncle Sam saw everything.        –J. M. Ledgard (2011)

TV comedian Stephen Colbert savagely satired media hysteria over West Africa’s Ebola outbreak,

Folks, I’m so glad you’re joining us tonight. If you are joining us, we tape the show at 7 o’clock, so by the time you’re seeing this you’re probably dead. Because this week the Ebola outbreak that’s been ravaging West Africa finally spread to West West Africa–America.

Real estate developer and Miss USA owner Donald Trump out-Harvey-Wallingered Colbert, tweeting about the two infected missionaries returned to the U.S. for treatment,

The U.S. cannot allow EBOLA infected people back. People that go to far away places to help out are great-but must suffer the consequences!

Sounding much the parody account, @realDonaldTrump continued,

To all the liberal do gooders, this is the Plague you idiots! No cure! @ You may have confidence in the CDC, but I don’t!”

Rush Limbaugh politicized the virus, sticking liberals, who the right-wing radio talk show host dubiously characterizes as the ‘left,’ with said charge,

‘What do you mean, politicizing a disease?’ Ever heard of AIDS? You think that wasn’t political? One of the very–well, not first–one of the most intense efforts to undermine support for Reagan was hatched through AIDS. So don’t think for a moment–I mean, the left politicizes everything. They look at everything within the realm of whether or not it can move their agenda forward. Maybe even be added to their agenda.

Rush’s rant and the ‘left’s’ critical comments underneath Raw Story’s coverage share the presumption it’s fighting dirty pretending pathogens arise out of politically derived circumstances. The complication, as we point out here, here, and elsewhere on this blog, is that as a matter of material etiology they do.

Representative Louie Gohmert (R-TX), never one to miss a chance at nuance, meanwhile warned refugees–“undocumented Democrats”— fleeing state and structural violence the U.S. supports, are transporting diseases, including Ebola, stateside,

“This administration doesn’t have the desire, doesn’t have the will to actually stop it,” Gohmert told radio host Tim Constantine on Wednesday. “Because they see people coming across as undocumented Democrats. And so, they want to keep the surge of people coming in illegally, even though it includes a big spike in Other-Than-Mexicans, OTMs as we call them.”

“It includes a spike in people from countries where terrorism abounds,” he continued. “We have people coming in from countries where Ebola is located.”

“And, gee, since they’re coming across our border, and you know, they don’t get checked, and most of them don’t get really thoroughly checked, they could be coming in with disease that we simply do not need.”

The Texas Republican insisted that he was not “fear mongering.”

In the face of such inanity, Ebola continues to burn through West African populations and territory alike. The official count stands August 29 at 1,546 deaths from 3,052 confirmed, probable and suspected cases.

The World Health Organization, however, warns the tallies are “vastly underestimated,” this past week estimating the outbreak would ultimately infect 20,000, a ceiling likely to be repeatedly raised.

Still churning through Guinea, Liberia and Sierra Leone, Ebola has now spread to Nigeria, at 170 million-plus souls the most populous country in Africa. The first twelve cases there originated with a Liberian doctor who made the trip to Lagos by plane, putting a crimp on brightside notions Ebola, like early HIV before it, is, while deadly, little contagious.

The virus has since made its way to Port Harcourt further east along the Nigerian coast and this week Senegal.

The tension between the political trappings of epidemiological fallout–some of it uproariously dreadful–and the demonstrable seriousness of the outbreak manifests in other largely unremarked upon ways.

*

Trump and Limbaugh, for one, playing the useful idiots, detract from the extent to which ostensible moderates and technocrats cased with responding to the outbreak are themselves invested in what is turning out a utilitarian virus.

In a series of Center for Disease Control and Prevention press conferences meant, in a common dissonance, to reassure the world about a disease neither controlled or prevented, the agency equated the outbreak to a forest fire. As asymptomatics or even active cases with mild or noisy symptoms take to the global airline network, as the Nigeria case illustrated, other countries are likely to be hit.

At the risk of a anthropomorphism, the virus appears to be attempting a classic shift in geographic scale. To make the HIV leap.

In an age of climate denial, creationist science and corporate interference in the sciences, the contradictory assurances appear anxious arguments by authority: ‘Listen to us. We are scientist-priests, and we know what we are talking about.’

While setting aside undue alarmism has its place, health officials are also notorious for assimilating surprise to a fault, conflating familiarity and safety.

There appears too a more acute (and opportunistic) sense of relief. Ebola has redirected attention away from a bad couple months for CDC.

Last month the agency fessed up to shipping virulent H5N1 to the USDA, instead of benign H9N2, a mistake the agency’s brass only learned of a month later.

The comedy of errors continued with a hot potato of deadly anthrax, the details of which are jaw-dropping,

On June 2, according to the report, a lab supervisor called a scientist at another lab who had done similar work on a different bacterium, brucella, which can cause fevers and swelling in humans.

The written protocol for preparing brucella for the test was sent to the bioterrorism lab, and the supervisor told a scientist to follow it while preparing eight dangerous pathogens, including anthrax. But anthrax forms hardy spores, while brucella does not.

In addition, the brucella protocol required that bacteria be killed in a bath of formic acid for 10 minutes, and that small samples of it be incubated for 48 hours to be sure it was dead.

But a mix-up occurred when the instructions were conveyed over the phone. The scientist incubated the test samples for only 24 hours before sending the bulk of the bacteria to less-secure labs. Some of the bacteria were not filtered to remove spores.

After 24 hours, one scientist tried to sterilize the test plates in a high-power steam autoclave. But its door was stuck, so the plates were returned to the incubator. It was an inconvenience that would prove extremely lucky.

Over the next few days, scientists in two other labs where breathing equipment was not used agitated the bacteria and sprayed them with compressed gas, which could have blown spores into the air.

On June 13, one scientist checked the incubated plates and saw that anthrax was growing. If the door to the autoclave had opened properly and, as the report noted, the plates had been sterilized, “the event would not have been discovered…”

By looking at videotapes and the use of door key cards, managers tried to figure out who might have been exposed. They discovered another safety violation: staffers often “piggybacked,” following colleagues through doors without using their own cards.

CDC Director Thomas Frieden testified to Congress that the lab breach was left unsecured, letting staff track in and out. Lab workers were untrained in decontamination, with no one in apparent charge of the clean-up. The clinic in charge of examining employees was overwhelmed, delaying physicals. The amount of anthrax involved and its location went unrecorded.

“It is ironic that the institution that sets U.S. standards for safety and security of work with human pathogens fails to meet its own standards,” Richard Ebright, a professor of chemical biology at Rutgers University, commented to the Times, “It is clear that the C.D.C. cannot be relied upon to police its own select-agent labs.”

If these pratfalls are happening within its walls, it begs how the “the reference lab to the world” will respond to an actual deadly outbreak outside its offices.

*

And yet CDC dealt with the fallout by clearing out the riffraff on the National Science Advisory Board for Biosecurity who criticized the very flippancy that led to the latest lab fiascoes.

If such accidents are occurring at the CDC they are likely also happening, as we discussed here in December, at the growing number of BSL-3 and -4 labs worldwide.

The problem, Laurie Garrett describes, isn’t just the lapses in biosecurity, but the kinds of gain-of-function experiments conducted, including at CDC, producing deadly diseases on purpose.

Mathematical epidemiologists Marc Lipsitch and Alison Galvani recently modeled probabilities a research program designed around selecting for virulent influenza would deliver the very pandemic it ostensibly aimed to block,

From the conservative estimate of the rate of laboratory-associated infections of two per 1,000 laboratory-years, it follows that a moderate research program of ten laboratories at US BSL3 standards for a decade would run a nearly 20% risk of resulting in at least one laboratory-acquired infection, which, in turn, may initiate a chain of transmission. The probability that a laboratory-acquired influenza infection would lead to extensive spread has been estimated to be at least 10%. Simple branching process models suggest a probability of an outbreak arising from an accidental influenza infection in the range of 5% to 60%. Such probabilities cannot be ignored when multiplied by the potential devastation of an influenza pandemic, even if the resulting strain were substantially attenuated from the observed virulence of highly pathogenic influenza A/H5N1, the subject of much of the published [potential pandemic pathogens] work to date.

 
That is, buffoonery aside, all systems go, the experiments at their best, driven by anti-terror Keynesianism, are targeted for a Crichtonesque appointment in Samarra more Edwin than Edward Jenner.

*

The commotion over Ebola, sluggardly in comparison, also represents an act of metaphysical alchemy.

To one House Committee on Foreign Affairs subcommittee in early August, Director Frieden simply disappeared causality behind allusions to general conditions, local customs, and the failure of emergency services,

Following an initial response that seemed to slow the outbreak for a time, new cases flared again due to weak systems of health care and public health and because of challenges health workers faced in dealing with communities where critical disease-control measures were in conflict with cultural norms. As of earlier this week, the outbreak surpassed 1,600 cumulative reported cases, including nearly 900 documented deaths. The effort to control the outbreak in some places is complicated by fear of the disease and distrust of outsiders. Security is tenuous and unstable, especially in remote isolated rural areas. Just recently, health care workers were confronted by an angry mob, leading them to retreat back to safety. Further, many of the health systems in these countries are weak, and do not reach into rural areas. Health care workers may be limited, or may not reliably be present at facilities, and those facilities may have limited capacity. Local traditions such as public funerals and cultural mourning customs including preparing bodies of the deceased for burial, make efforts to contain the illness more difficult. Furthermore, the porous borders among the three countries and remoteness of many villages have greatly complicated control efforts.

Yet Central Africa suffers as frangible a medical infrastructure and never hosted an outbreak of this extent. Indeed, the West Africa death toll already outstrips all previous outbreaks combined.

Even structural analyses dedicated to capturing the outbreak’s bigger picture are caught in such absolute geographies, confounding place for cause, divorced from capitalism’s relational economics.

James West, for instance, connected the bushmeat trade to increasing deforestation and mining,

In Ivory Coast, the risk of Ebola transmission from bushmeat, which is a popular menu item at rural maquis—roadside outdoor grills—is considered high enough by federal health officials that it was recently banned altogether. But according to my colleague Tim McDonnell, who is in the country right now, there is no way to enforce the ban, and bushmeat is still being sold and eaten.

What is becoming clearer, however, is that human activity is playing a major role in the initial outbreaks of these zoonotic diseases—those that jump between animal and human—like Ebola. Humans are venturing farther and farther into forests, putting more and more pressure on local ecosystems through small-scale gold and diamond mining, deforestation, and conflict. In remote West Africa, where human populations meet the forests, people are increasingly coming into contact with animals, and that, combined with traditional hunting practices, is driving up the risk of a “spillover” occurring, where Ebola can leap across species.

MinuteEarth’s Kate Yandell explains why the implicated bats, Ebola’s likely reservoir, are such a source of deadly new human pathogens. West’s deforestation expands the interface between the bats, livestock and humans, while mammalian flight selects for increased immunity in bats and increased hardiness in viruses.

The ecohealth explanation, necessary but insufficient, undergirds a liberal version of Trump’s tweets, one that externalizes its indignation abroad, seeking to fence in indigents than keeping out immigrants:

“I’m getting fragged with Ebola monkey!” cries out VICE News’s Kaj Larsen, as two Liberians eat monkey he bought them from a local market. Larsen’s telling report offers a clash of imaginary etiologies inside a modern day framework of racist declensionism.

Yes, the smug blanquitos on either side of the mic, including epidemiologist Joseph Fair Larsen interviews, omit while there are dangers in a commodity chain of animals spooling direct out of a forest epizoology, there are (qualitatively different) dangers in raising and distributing billions of animals–bushmeat cow, pig and chicken–across factory epizoologies.

Closer to home a Newsweek cover story rode the Trump Trojan Horse to slip in a more sensible-sounding fear-mongering that Bronx-based African immigrants were trafficking in Ebola by illegal trade in bushmeat, part of a long (and ugly) tradition, as Laura Seay and Kim Yi Dionne describe, of “Ooga-Booga” journalism offloading epidemiologies on ‘the other,’

There is a persistent association of immigrants and disease in American society. The Immigration Act of 1891 explicitly excluded from entry to America all “persons suffering from a loathsome or dangerous contagious disease.” Fast-forward one hundred years and we see Haitian refugees who tested positive for HIV “confined like prisoners” at the naval base at Guantanamo Bay — despite knowledge at least five years earlier that HIV was not casually communicated. In the 2003 SARS epidemic, New York City’s Chinatown was identified as a site of contagion and risk despite never having a single case of SARS.

Specific to Ebola, an earlier [Washington Post piece] reported on the [baseless] concerns raised by retired physician and current U.S. Rep. Phil Gingrey (R-Ga.) that migrant children crossing into the United States from Mexico were likely carrying Ebola — as well as other “deadly diseases” that are “not indigenous to this country.”

The Newsweek story implies increased vulnerability to Ebola in the United States, which psychology research shows will likely amplify negative reactions to people heuristically associated with the disease — in this case, the many African migrants living in the Bronx (and potentially elsewhere in the United States) accused by Newsweek of liking bushmeat (never mind that Newsweek’s investigative reporters were never able to locate any for sale). The negative reactions to increased vulnerability include having more xenophobic attitudes. Relatedly, a recent review of public attitudes toward immigration by political scientists Jens Hainmueller and Daniel Hopkins points out how prejudice and ethnocentrism can engender support for more restrictive immigration attitudes.

But left unremarked upon by West, Larsen and Newsweek (and other such reports) are the greater shifts in neoliberal development we reviewed here back in April. Probably in part because these originate in circuits of capital extending back to New York, London and other financial centers backing globalized commoditization driving the changes in land use that expand the interface in West Africa between Ebola-carrying wildlife, the local population, and subsequent modes of spread.

In an analysis published in PLoS late July, Daniel Bausch and Lara Schwarz, connecting ecology and economy, asked, “why Guinea and why Guéckédou?” where the outbreak apparently originated, 

Certainly this is not the only place bats migrate. Unfortunately, Ebola virus outbreaks typically constitute yet another health and economic burden to Africa’s most disadvantaged populations. Despite the frequently promulgated image of Ebola virus mysteriously and randomly emerging from the forest, the sites of attack are far from random; large hemorrhagic fever virus outbreaks almost invariable occur in areas in which the economy and public health system have been decimated from years of civil conflict or failed development.

But which operations, funded how, drove failed development in Guéckédou (and in West Africa more generally)?

If we are to distinguish this piece from our own–aside from our more polemical tone–it would be the scope of political economy by which each characterizes the outbreak. Clearly, as described here, Guinea has undergone significant internal shifts leading to the dedevelopment (and deforestation) Bausch and Schwarz observed.

The FP piece, however, also connects to broader changes at the level of the latest land rush the U.S. and intergovernmental agencies charged with responding to the outbreak encouraged in the first place.

*

The structural failures the neoliberal program offloads onto the indigent lends credence, if only in a roundabout way, to everyday Liberians’ notion that Ebola is no more than a government invention–as oft-explained–to squeeze international donations.

Of course Ebola exists, but Liberia, as Indonesia around bird flu before it, is indeed responding to international pressure.

Recapitulating efforts to fight disease for investment’s sake, President Ellen Johnson Sirleaf’s Health Ministry internalized the outbreak by turning a primary school in West Point, Monrovia’s poorest neighborhood, into the city’s sole holding center for patients without informing local residents (or providing enough food),

Christiana Williams, 52, who lives behind the center, said that locals were bewildered when they learned that the neighborhood school had been turned overnight into an Ebola holding center. Through the weekend, she said she heard cries from inside the center.

“‘We’re not eating,’” Ms. Williams recalled hearing. “‘They’re just spraying us.’ ‘We’re getting weak.’”About 17 patients who were thought to have Ebola left the center for a couple of days before they were brought to the John F. Kennedy Medical Center here, raising concerns that the disease would continue to spread.

The government next quarantined the whole neighborhood with barbed wire and the coast guard on the waterfront, cutting off West Point residents from their jobs in the greater city and, like neoliberalism more generally, setting off food shortages and price spikes.

The quarantine, set up in the middle of the night, drove hundreds of stone-throwing men into running battles with the army manning the barbed wire, leaving a 15-year-old–like another boy in Missouri half a world away–lying shot in the street. Fragged by Ebola indeed.

If the mob was pilloried for its etiological ignorance, the Western media, reporting the outrage at West Point in classic stenography, refused to cop to its own complicity in protecting the all-too-real pathogenesis of multinational land grabbing and structural adjustment.

But as Daniel Defoe learned firsthand three hundred years ago, a spreading epidemic can suddenly depreciate such white privilege valued at first cough. There appears a threshold over which increasingly besieged power is as much unable as unwilling to save even the civilians embedded in imperial logistics or what is called these days global public diplomacy.

The willingness to intervene in the case of missionaries Kent Brantley and Nancy Writebol with ZMapp state power can’t, or won’t, share with most African patients, was accompanied by the failure to rescue reporters James Wright Foley and Steven Sotloff (and even endanger them by example).

At some point, there is a there where crumbling empire can’t project its power.

Should Ebola evade Representative Gohmert’s Maginot Line, the Keystone Docs at CDC continue to legitimize Trump’s gaffes, and, as with pathogens beforehand, the virus find the multiple Fergusons of the metropole–the abandoned West West Africas across a mosaic of ethnicities–we need query the extent to which the Foucauldian state may abandon its populations to an epizoology of its own making.

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2 Responses to “West West Africa”

  1. Rob, Do you have a favored framework or series of steps for teaching students to dig into the kind of complexity that surrounds diseases in a world of our own making? (I’m teaching a raid PBL on 1918 pandemic right now, which has got me thinking about this issue.)

  2. Indeed, I do, Peter. I sequence my students into an interdisciplinary imagination—and the requisite methodologies—with which to study disease dynamics.

    I begin with a review of more traditional biologies—immune kinetics, virion structure, pathogenesis, transmission dynamics, co-infection, phylogeography, and evolutionary medicine. Societal complications impacting pathogen evolution and spread—cultural practices, economics, public health infrastructure, migration, scientific epistemology—are introduced into course discussion week by week. The sequencing gives students the chance to learn each topic in its turn and, at the same time, build an increasingly nuanced understanding of how pathogens evolve in a world as humans have made it.

    The students assimilate the epistemologies by a series of two-pagers on a pathogen of their choice: 1) the microbiology, pathogenesis and epidemiology of the pathogen; 2) its phylogeography; and 3) the social determinants of its evolution and spread.

    The semester ends with a conference on the socioecology of disease, with each student presenting a 15-minute talk addressing a cross-domain question about their pathogen. If you’d like, I can email you a list of topics students have addressed.

    It’s amazing how easily students integrate across domains. They grasp how processes underway at one level of biocultural organization can synergistically affect what’s happening at other levels back and forth.

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