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Ebola – The Blame Game: W.H.O. Chastized For Failing To Respond: Criticism of I.M.F. Structural Adjustment Policies Deflected

January 13, 2015
Ebola Trends: Death Toll Rises While U.S. Interest Wanes

Ebola Trends: Death Toll Rises While U.S. Interest Wanes


(Note: This also appears at Foreign Policy In Focus)

Ebola is back in the news in Colorado and shortly hereafter I would speculate nationally.

A Denverite recently returned from West Africa countries affected by the ebola outbreak is being tested for the virus at the Denver Medical Center, one of the country’s 29 public health laboratories authorized to do ebola testing by the Center for Disease Control. The patient whose identity is being withheld, is considered low risk but is being held in a designated in patient unit any way as a precaution. Dr. Connie Price, the hospital’s chief of infectious diseases noted that “infection with the virus has not been confirmed.” Ebola symptoms may appear anytime between 2 and 21 days after initial infection. They include muscle pain, fever, diarrhea,vomiting, weakness, lack of appetite and abdominal pain.

Given the fact that the patient shows no symptoms as of yet, isolated in a medical ward monitoring his/her condition repeatedly there is a good chance that should the person actually be infected that the virus will be stopped in its tracks through early intervention. Early intervention appears to be one of the key elements in reversing ebola’s deadly course.

Before the recent mid-term November elections here in the United States, ebola was news both its reality in West Africa, its threat here in the USA and elsewhere. But since the election results were in, it has all but disappeared from the news, despite the fact that ebola continues to infect more people and take its growing share of victims in Guinea, Liberia and Sierra Leone. It is only at such times, when the specter of the ebola outbreak touches lives of people here in the United States, that the issue is re-ignited in the media here. Otherwise, the infection working its way through West Africa’s population – a terribly painful if not horrible way to die – hardly makes it into the media despite its cruel consequences .

To devote so much attention to ebola’s course in one place, and so little in another part of the world smacks of a pattern of discrimination. If that isn’t racism, then what is?

The Grim Reaper Continues To Harvest Death…

As the U.S. media lurches from one international crisis to another in network stampedes to break stories before their competitors, something gets lost along the way. The way that the ebola crisis was first covered, magnified and the dropped out of sight is a case in point. The graph above, first published at CBS News on January 8, is telling: while the cases of ebola continue to spike in West Africa, concern about the condition here in the United States is plummeting. As the cases in the United States shrank, “Google searches” collapsed accordingly.

At the same time the number of infections and deaths in West Africa – Guinea, Liberia and Sierra Leone – continued to rise. These days one can hardly find articles on the subject in the news, this despite the fact that the latest figures put the death totals as above 8300 and the number of infections at more than 21000 – that is to say even higher than this graph indicates. The World Health Organization (WHO) admits that the actual figure is higher due to difficulties in collecting data.  As a BBC report (1-09-2015) notes: WHO officials this week discovered scores of bodies in a remote diamond-mining area of Sierra Leone, raising fears that the scale of the Ebola outbreak may have been under-reported.

WHO officials this week discovered scores of bodies in a remote diamond-mining area of Sierra Leone, raising fears that the scale of the Ebola outbreak may have been under-reported.

Also left out of this picture is that among those victimized are 800 West Africa healthcare workers, of whom 500 have died, leaving the healthcare support system – fragile to nonexistent prior to the outbreak – virtually shattered, and necessitating urgent ongoing international intervention. So the grim reaper continues to take his toll on peoples of West Africa. More international aid – not less – is needed as a result to reverse the situation. And it is coming. The United States and Great Britain are mostly engaged in building more hospital space, useful needless to say but what is much more needed is actual medical personnel on the ground. Kenya is in the process of sending 300 medical workers. The Kenyans join Cuban teams of some 165 medical personnel that have been in Sierra Leone since late September consisting of 100 nurses, 50 doctors, 3 epidemiologists, 3 intensive care specialists, 3 infection control specialists and five social mobilization officers. Soon thereafter, a further 296 Cuban medical professionals were sent to Liberia and Guinea. West Africa is well-known territory for the Cuban medical teams that have served in the affected countries for the past fifteen years. Even The Washington Post had to admit that “in the medical response to ebola, Cuba is punching far above its weight.” Several of these Cubans medical staff contracted ebola as a result of their work. This kind of medical aid is not new to Cuba. It has more than 50,000 medical workers in more than 60 countries, many in nations like Brazil that pay hundreds of millions a year for their services. Others are on humanitarian missions that generate good will abroad.

West Africa Ebola Distribution Map

West Africa Ebola Distribution Map

World Health Organization comes in for increasing criticism deflecting responsibility from International Monetary Fund Structural Adjustment Programs. 

When asked to explain the causes of the ebola outbreak, world health experts have pointed to a number of factors: its transfer from certain mammals (primates and bats top the list), the possibility that this new outbreak is the result of a newly mutated more virulent strain, human carriers, etc and the lack of adequate healthcare infrastructure and facilities to stem the epidemic’s spread. Another reason given is the sluggish failure of WHO to respond to the crisis despite repeated warnings. It was this last theme that was picked up last week by the New York Times in a (January 6, 2015) page 1 story. The article notes how the WHO had received repeated warnings that the ebola crisis was growing from when it was first reported in March 2014, but that it failed to act until months later when the infection had spread to the three most affected countries, all of which were appealing for immediate international aid. It went on to accuse the WHO’s chief executive officer, Dr. Margaret Chen of Hong Kong China of “poor leadership.”

There is probably some truth to the charges but in many ways they are little more than cheap shots, meant to deflect attention away from what has been a growing perception: that World Bank and I.M.F. structural adjustment policies – the conditions for badly needed loans to poor countries – undermined government funding for health infrastructure in all three countries. As the media began to seriously explore this charge – and the I.M.F. began to strenuously deny its validity, suddenly the focus of the reporting shifted to the foibles of WHO The New York Times was a part of this deflection. Much that is stated in the article is true enough. The WHO is, like the United Nations, something of an unwieldy global bureaucracy riddled with careerists, and some corruption. Its leadership – regardless of whom is in charge – lacks executive decision-making abilities to give the organization a military-like focus to deal with epidemic outbreaks. Its decentralized process of decision-making – which places the main decisions for health emergencies in the hands of the local WHO administrators, themselves connected by near-umbilical chords to the ruling circles – is thus highly politicized, not just in West Africa, but everywhere.

The structural difficulties to act facing the WHO provide a perfect scapegoat in times of crisis as well. First create an imperfect, moderately dysfunctional global organization in the first place and then lay the blame  for not responding to the ebola (and other) health crisis at its door steps. A pretty effective way to shift the blame!

Yet, for all its shortcomings, the WHO provides a vital global function and when it finally directs its energies to a problem – as it has begun to seriously do in the case of the West African ebola outbreak, it quickly becomes a vital player. When finally given the green light, the WHO. is proving to be highly effective.  If the world’s richer, more powerful nations wanted a more effective global response to health emergencies, they would have structured and funded the organization differently than they have. But similarly to the way that the United Nations General Assembly is “the voice” of the world’s people, but a voice void of much executive power, the WHO with its unwieldy, politicized and decentralized decision-making process has difficulty in transforming its knowledge of crises into action and can only do so when (finally) prodded to act by the world’s more powerful nations, either in concert (the G-8, G-20) or through pressure from Washington, Peking or whatever. Then something happens.

Curiously, in the week or two prior to the wave of global criticism of WHO for its sluggish response,  mounting criticism had focused on another institution’s role in preparing the groundwork for the epidemic’s spread: the International Monetary Fund. It came after a short but pithy article appeared just before Christmas in Lancet, a prestigious British medical journal. On December 22, 2014, Lancet published a commentary entitled The International Monetary Fund and the Ebola Outbreak”  by Alexander Kentikelenis, Lawrence King, Martin McKee and David Stuckler. In it the authors raised the question:

“…could it be that the IMF had contributed to the circumstances that enabled the crisis to arise in the first place? A major reason why the outbreak spread so rapidly was the weakness of health systems in the region. There were many reasons for this, including the legacy of conflict and state failure. Since 1990, the IMF has provided support to Guinea, Liberia, and Sierra Leone, for 21, 7, and 19 years, respectively, and at the time that Ebola emerged, all three countries were under IMF programmes. However, IMF lending comes with strings attached—so-called “conditionalities”—that require recipient governments to adopt policies that have been criticised for prioritising short-term economic objectives over investment in health and education. Indeed, it is not even clear that they have strengthened economic performance.”

Kentilkelenis et. al’s piece goes on to note that while IMF structural adjustment programs for the three West Africa countries include “poverty-reduction programs to include health spending, these conditions were often not met.  What gave the commentary legitimacy is the fact that these comments are based on studies of the actual structural adjustment programs implemented in Guinea, Liberia and Sierra Leone, the precise contracts of which have been difficult to unearth.

No great surprise that the IMF immediately rejected the allegation of its responsibility and noted that it has responded to the crisis by providing much-needed emergency funding to the countries involved as well as a temporary easing of loan obligations to help them deal with the crisis. True enough. But the suspicions remain – now strengthened by growing documentation – that IMF structural adjustment policies bear some responsibility for the collapse of West African health care systems and as such contributed no small amount to the failure to stem the spread of ebola.

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