“Ebola emerged nearly 40 years ago. Why are clinicians still empty-handed, with no vaccines and no cure? Because Ebola has been, historically, geographically confined to poor African nations. The R&D incentive is virtually non-existent. A profit-driven industry does not invest in products for markets that cannot pay.” World Health Organisation Director-General Dr. Margaret Chan
The outbreak of an Ebola epidemic in West Africa over 2014 has exposed the collapse of public health systems in many African countries affected and the paralysis of the wealthy West to be able to mount a response in time to prevent the outbreak killing tens of thousands and possibly millions.
In contrast revolutionary Cuba and its medical internationalism has emerged as an example to the world of what is possible when ethics replaces cold calculation. The world has been forced to acknowledge a debt to that small island nation of just 11.2 million people who are now the front guard of the fight to stop the spread of the virus.
Medicines San Frontiers (Doctors Without Borders) had been one of the few voices warning the world since at least March of this year of the spreading disaster. They had 248 international volunteers and around 3000 locals they had trained to combat the disease present in the ebola zone. Cuba has sent 256 medical personnel with another 205 more to go soon. They serve a minimum of six months. “While consultants from the U.S. Centers for Disease Control and Prevention are lodged in Radisson Blu resort,—at more than $200 a night—the 165 Cuban medics are living three to a room in one of Freetown’s budget hotels,” reports the Wall Street Journal.
Cuba’s single country contribution of trained doctors and nurses dwarfs that of any other single country. Those sent so far are selected from 15,000 trained Cubans who had volunteered to go. Cuba has a pool of health professionals without equal in the world. The Guardian reported the ethical outlook motivating the Cubans:
Speaking before they flew to Liberia, two Cuban doctors told Reuters that competition to join the west African mission – which attracted 15,000 volunteers – had been fierce. “There have been fights breaking out, heated arguments, with some doctors asking, ‘How come my colleague gets to go and I can’t?’,” said Dr Adrian Benítez. His colleague Leonardo Fernández said the volunteers had felt compelled to help. “We know that we are fighting against something that we don’t totally understand. We know what can happen. We know we’re going to a hostile environment,” he said. “But it is our duty. That’s how we’ve been educated.”
The US and UK have sent military personnel to build emergency treatment clinics. “The 3,000-strong American mission will not treat patients,” the New York Times reported September 25, “but will build as many as 17 treatment centres, with a total of 1,700 beds, and train 500 health workers a week.” The Times noted that “It is unclear who will run” the centres once they are built.
At the end of October the WHO estimated there had been 13,500 infections and 5000 deaths, although the official figures are probably under reported. It is thought infections could reach 10,000 a week by December. As reported in New Scientist in late October, “A new forecast model by David Fisman and Ashleigh Tuite of the University of Toronto in Canada – the first to take account of efforts to fight infections – suggests that if things continue as they have been up until now, 700,000 people could have had the virus by the time the epidemic in Liberia, Guinea and Sierra Leone subsides – in early 2016.”
The countries most affected are Liberia, Sierra Leone, and Guinea-Conakry and each suffer extreme economic and social underdevelopment. Before the latest crisis, they had one or two doctors per 100,000 people, compared to 270 for a country like New Zealand. Liberia has (or had) just 51 doctors for its 4.3 million people and one hospital bed for every five Ebola patients. Sierra Leone has just 120 doctors for six million people. Guinea-Conakry, with 1.2 million people, has 120 doctors. All of them are rich in mineral deposits. All of them have been victims of the slave trade, colonialism and imperialist exploitation. All of them have been carrying out neoliberal policies involving cutting taxes on foreign corporations while starving the public sector (including health care) to pay the $200 million a year in debt service costs they collectively owe.
Christian Aid says that in Sierra Leone, “A major concern about the practises of foreign mining companies is their failure to pay adequate levels of tax.” The agency estimates that Sierra Leone “will lose US$131m from 2014-16 alone due to corporate income tax incentives granted to five mining companies – an average of $44m a year. Nearly all of these losses are, according to Christian Aid, the result of agreements with two British mining companies: African Minerals and London Mining.” These tax concessions dwarf Sierra Leone’s health budget expenditure.
Cuban Foreign Minister Bruno Rodriguez told the UN General Assembly September 27 that Cuba already had medical cooperation agreements with 32 African countries where 4000 specialists were working before deciding to extend them to the countries most affected by Ebola. The US, in contrast, has military cooperation agreements with 49 of the 54 countries on the continent.
Rodriguez pointed out that in the five decades since the Cuban revolution, “325,000 Cuban health workers have assisted 158 nations of the South, including 39 African countries, where 76,000 cooperation workers have served. A total of 38,000 medical doctors have been trained, free of charge, in 121 countries – 3,392 of them from 45 African nations.”
He then asked an obvious question: “If Cuba, a small and blockaded country, has been able to do it, how much else could be done in favour of Africa with the cooperation from all of us, particularly from the wealthiest states?”
Cuba has also specialised in emergency response teams deployed to crisis zones following natural disasters. For example, 2500 medical personnel went to Pakistan after the 2005 earthquake. They treated 1.7 million people. Cuban doctors treated 40% of the victims of the Haitian earthquake in 2010. Many other countries also sent medical teams to Haiti. The difference with Cuba was that they already had medical workers there before the quake and still have them there today. A brigade of over 1500 personnel with 36 tons of emergency medical supplies was offered to the Unired States after Hurricane Katrina but rejected by then President George Bush. The US bungled its own response and many people went weeks and months without needed medical assistance. Currently, Cuba has about 50,000 medical personnel working in over 100 countries. Cuba has also run a programme over the last decade that has cured millions of people of blindness.
The capitalist approach to medicine can be seen in a New York Times report on October 23 saying that the lacks a vaccine for Ebola today because it wasn’t profitable to produce one:
Almost a decade ago, scientists from Canada and the United States reported that they had created a vaccine that was 100 percent effective in protecting monkeys against the Ebola virus. The results were published in a respected journal, and health officials called them exciting. The researchers said tests in people might start within two years, and a product could potentially be ready for licensing by 2010 or 2011.
It never happened. The vaccine sat on a shelf. Only now is it undergoing the most basic safety tests in humans — with nearly 5,000 people dead from Ebola and an epidemic raging out of control in West Africa.
Its development stalled in part because Ebola is rare, and until now, outbreaks had infected only a few hundred people at a time. But experts also acknowledge that the absence of follow-up on such a promising candidate reflects a broader failure to produce medicines and vaccines for diseases that afflict poor countries. Most drug companies have resisted spending the enormous sums needed to develop products useful mostly to countries with little ability to pay.
Drug companies are willing to spend billions of dollars on treatments for wealthy people in wealthy countries but care little for poor people in poor countries. The ideal drug is in fact something that doesn’t actually cure people but simply prolongs a person life and requires repeat prescriptions. Diseases that kill tens of millions of people in poor countries get little attention.
This includes diseases like Malaria, Dengue Fever, Lassa Fever and now Ebola. The World Health Organisation estimated between 50 and 100 million people are infected with Dengue every year and 25,000 die. Lassa Fever infects 300-500,000 a year and kills 5,000. In the period since the Ebola crisis broke out about 320,000 Africans have been killed by Malaria and 124,000 by TB. HIV/Aids has claimed a staggering 620,000.
Al Jazeera ran a column by Belen Fernandez on October 20 that contrasted the capitalist and socialist responses to this health crisis. She is the author of “The Imperial Messenger: Thomas Friedman at Work”, published by Verso. She is also a contributing editor at Jacobin Magazine. She wrote:
Rob Wallace, a public health phylogeographer at the University of Minnesota, recently explained to me why it is that “this particular Ebola is neoliberal to its viral core”.
“The latest capital-led land rush driving West African deforestation and the structural adjustment that truncated regional medical infrastructure arose together out of the neoliberal programme,” he wrote to me in an email.
“The first expanded the interface between humans and forest wildlife carrying Ebola. The second imposed the inadequate public health responses that amplified transmission. Ebola itself couldn’t have ordered up a more perfect combo.”
A Jacobin essay, “The Political Economy of Ebola”, outlines additional ways in which the free market enables the disease to thrive; in short, Ebola is “an unprofitable disease” incapable of seducing pharmaceutical companies.
It is perhaps unsurprising that Cuba, uninfected as it is by neoliberalism, has responded so fervently to the present epidemic. With its system of free universal health care, the country has already racked up impressive medical achievements on the home front – why not take on the globe?
The Cuban government made a proposal as far back as 2002 to send 4,000 doctors to Africa in a special offensive to radically expand the Aids treatment programme in that continent and save millions of lives at risk. All they asked is that the rest of the world pay for the medicines and infrastructure needed. The idea was ignored.
Unknown to most of us in this part of the world, Cuba is also providing doctors and training locals in most of the Pacific Island states in a special medical school in Cuba, The Latin American School of Medicine. The Australian Development Policy Centre blog reported in February 2012:
One of the most prominent of the Cuban engagements now is in Timor-Leste where more than 300 Cuban health workers are spread around the country and which sent 700 young Timorese to study medicine in Cuba free of charge. Additionally, Cuba has worked with the government of Timor-Leste to set up a medical school in Dili initially with Cuban trainers.
Building on this regional engagement, over the past five years, the Cuban model has been extended to the countries of the Pacific through bilateral deals. In response to the dramatic shortages of the health workforce in countries such as Nauru, the Solomon Islands, Tonga and Kiribati, Cuba hosted the first Cuba-Pacific Islands ministerial meeting in 2008 where collaborations in medical education were hatched. Since then, more than 170 young Pacific Islanders (including 90 Solomon Islanders, 23 i-Kiribati, 17 ni-Vanuatu and 20 Tuvaluans) have commenced medical school in Cuba and more than 30 heavily-subsidised Cuban doctors have arrived in the Pacific to support the domestic workforce.
The increase in the number of trained doctors currently working in the Pacific and the future return of newly-trained health personnel has and will continue to improve health outcomes in the Pacific. Some reports have cited an 80% drop in infant mortality in one part of Kiribati and 53 lives being saved in Tuvalu.
Since that report was written, Papua New Guinea has begun sending students to study in Cuba and Fiji has 18 students in Cuba and has accepted nine Cuban doctors to work in Fiji.
The US government actively seeks to sabotage the medical aid that Cuba provides. Cuba is the only country in the world from which its residents have automatic residency rights the moment they step foot on US soil. That encourages risky and dangerous attempts to cross the sea between Cuba and the US. The US also has a special programme called the “Cuban Medical Professional Parole Program” designed to incite Cuban doctors and nurses to leave wherever they are working and go to the US with consular assistance. The New York Times estimated 2000 were in the US under this programme.
A programme designed to take doctors from working in some of the poorest places on earth is a particularly twisted aspect of the permanent economic war waged on Cuba for five decades. That war makes it illegal for US companies to trade with Cuba, including drugs and other medical supplies. A ship that docks in Cuba is banned from docking in the US for six months. The Cuban government estimates that the economic embargo has cost the country the equivalent of $1 trillion dollars since its inception 54 years ago.
The Howard government in Australia denounced Cuba’s medical cooperation as “destabilising” to the Pacific region but it was ignored by the Island states. I’m looking forward to the day when a Pacific medical conference decides its common language to be Spanish rather than English!
The new Australian government’s response to Ebola was to give a $20 million contract to a private company without a bidding process. Aspen, the company that got the contract, was formed in 2003 with lots of ex-civil servants and ex-politicians on the board of directors. It has been given $200 million in contracts from the Australian Department of Defence since 2007. Greens senator and public health expert Richard Di Natale says the contract “has a real stink about it. I’m at a loss. The only plausible explanation is that a government is so ideologically committed to advancing private interests, even when it’s counter-productive.” Di Natale also points out that “There aren’t any votes in black Africans dying. We’ve led the world in developing a vaccine for the Hendra virus which affects race horses, and yet when it comes to something like Ebola both in Australia and in the US we haven’t given it appropriate concern.”
A few days ago New Zealand finally announced that was joining the fight against Ebola. $2 million has been set aside to fund 24 doctors and nurses to go to Sierra Leone. Unfortunately the media report says it is with the “privatised” Australian aid mission.
Faced with the reality that no serious response is possible to Ebola without Cuban help, the US government has accepted the need to work together on this crisis. Some elements in the US establishment, such as The New York Times, have used the occasion to editorialise against continuing the embargo. The Times remains bitterly hostile to Cuba’s socialism but thinks “engagement” will be a more productive strategy to undermine the regime.
Working people worldwide need to take our own lessons from this crisis. Public health should be promoted and available to everyone on earth. Ebola is demonstrating that neglect of the Earth and its people anywhere will ultimately be a threat to human survival everywhere. Putting profits before people is a dead end, literally. The monopoly control over drug and other aspects of medical research by the drug companies needs to be broken. Finding an alternative way of running this world which puts people and the planet before profit also must involve defending Cuba and its revolutionary example.