Abstract
Denial and lack of information about ebola caused hundreds of avoidable deaths in west Africa. From Spanish flu to Aids to Sars, cover-ups and misinformation have fuelled epidemics.
In July 2014, Médecins Sans Frontières, the NGO fighting desperately to keep a lid on the spread in Guinea and its next-door neighbours Sierra Leone and Liberia, openly criticised Guinean ministers for deliberately downplaying the extent of the outbreak. “They are very much annoyed by ebola, because of the investors,” said one MSF official. “The government’s first concern was not to scare outsiders. They wanted to minimise the cases.”
Despite the repeated pleas from NGOs on the ground, and top experts such as Professor Peter Piot, director of the London School of Hygiene and Tropical Medicine, who co-discovered the ebola virus in 1976 following an outbreak in what is now the Democratic Republic of the Congo, the World Health Organization and the international community were woefully slow to respond on anything like the scale needed. He told The Guardian in December: “It reminds me of the beginning of Aids. The same attitude prevailed. Just – no, it is not us, it does not exist. Precious time was wasted.” Professor Piot added: “WHO was silent. Governments denied it. All that meant [was]that it got out of control.”
Ebola and Aids are not the only examples of infectious diseases that have spread because the authorities denied how serious the outbreaks were. By far the most notorious and most devastating in terms of lives lost was the great Spanish flu pandemic of 1918, which killed at least 50 million people worldwide. In its early stages all news and information on the disease was censored by belligerent governments – a policy that greatly hindered attempts to prevent its spread and undoubtedly contributed to many thousands of avoidable deaths.
But Piot’s comparison of the spread of ebola and Aids is chillingly apt. Acquired Immune Deficiency Syndrome first came to world attention in 1981 as cases of a strange and lethal form of pneumonia appeared among gay men in New York and San Francisco, and subsequently among intravenous drug users, people receiving blood transfusions and heterosexual couples. Soon it was found to be widespread across the world, and especially prevalent in sub-Saharan Africa.
A health worker escorts nine-year-old Maraila, a suspected ebola victim, to an ambulance in Sierra Leone, December 2014
Credit: Baz Ratner / Reuters
In 1983 a virus was identified that was considered by international experts to be the causative agent for Aids and was dubbed Human Immunodeficiency Virus (HIV). Yet, despite this strong consensus, a sizeable and remarkably influential anti-HIV lobby emerged, largely from within the gay community in the USA, denying that the virus had any part to play in the disease.
Spearheaded by the renowned US molecular biologist Peter Duesberg, who asserted that HIV was simply a harmless “passenger” virus, the deniers did much to fuel the notion that Aids was likely to be caused by some unknown environmental factor rather than unsafe sex. This belief was to have disastrous consequences for human health – particularly in South Africa where Aids was raging out of control.
There was a shroud of secrecy imposed by the Chinese government in the early stages of the Sars epidemic
In 2000, the South African government of President Thabo Mbeki enthusiastically embraced the idea that HIV was not to blame, that proven anti-retroviral therapy was ineffective, and that Aids was mainly linked to poverty. His then health minister, Manto Tshabalala-Msimang, focused on promoting good nutrition, particularly beetroot, garlic, potatoes, olive oil and lemon juice, as the best way to fend off the disease.
For years the South African government continued to drag its feet in rolling out a programme of anti-retroviral drug therapy for patients with advanced Aids and for HIV-positive pregnant women. This failing was described by British ex-Cabinet minister Peter, now Lord, Mandelson as “genocide by sloth”. In 2006 the United Nations special envoy for Aids in Africa, Stephen Lewis, accused ministers of promoting a “lunatic fringe” approach to HIV/Aids. He said the South African government had been “obtuse, dilatory, and negligent about rolling out treatment”.
As the current ebola crisis has made all too clear, secrecy and denial serve only to fuel potential catastrophe
Finally in 2008, President Mbeki was ousted, together with his health minister. The incoming minister, Barbara Hogan, announced that “the era of denialism is over completely in South Africa”. Tragically, this conversion came too late for the more than 330,000 Aids sufferers in South Africa who, according to researchers at Harvard University, died between 2000 and 2005. These people, the researchers say, might have been saved by timely anti-retroviral treatment.
While this shamefully misguided public health policy was playing out with disastrous consequences in South Africa, a different kind of “denialism” was occurring in southern China, which also threatened to endanger the entire world.
In late 2002 a farmer in Guangdong province fell ill with a high fever and sudden severe shortness of breath. He failed to respond to treatment with antibiotics and soon died of fulminating pneumonia and multiple organ failure, but not before further cases occurred among his family and other contacts. A doctor who had treated these patients checked in at the Metropole Hotel, Hong Kong, and fell suddenly ill himself, infecting several other hotel guests. Within a few weeks the outbreak of the deadly Sudden Acute Respiratory Syndrome (Sars) became a full-scale global health scare.
According to international agreements, an outbreak of this nature should immediately have been reported to the WHO, but for reasons unknown the Chinese authorities failed to do so until February 2003. By this time the epidemic was claiming dozens of lives every day and had started spreading to several other countries, notably Canada. The shroud of secrecy imposed by the Chinese government in the early stages of the epidemic undoubtedly hampered the international response and rendered other countries more vulnerable. Ultimately Sars infected over 8,000 people worldwide and killed a total of 774 before it was suppressed.
So, what lessons can be learned from these worrying examples of disease denial? Ten years after Sars, Margaret Chan, the director-general of WHO, insisted that important changes had been incorporated into international health regulations. Countries are now required to follow set procedures in preparing for, reporting on and responding to potential cross-border health threats, including complete openness in the provision of information.
“Because of the impetus coming from the Sars outbreak,”Chan told The Canadian Press in 2013, “… all these requirements actually paved the way for countries to build their capacity and also understand the need for transparency.”
But has greater transparency truly come about? Are countries, regions and cities around the world displaying the degree of openness needed to allow a timely and robust response to every potential international health threat?
The emergence of a new deadly Sars-like virus in Jeddah, Saudi Arabia, three years ago might suggest otherwise. Initially dubbed “camel flu”, but afterwards officially named Middle East Respiratory Syndrome, the disease can cause sudden severe pneumonia with a 30 per cent fatality rate and has so far led to hundreds of cases throughout the Middle East and beyond. In Saudi Arabia alone more than 800 people have caught the disease. Many of those infected in the Arabian peninsula have had close contact with camels or camel products, but the virus can also pass from person to person through close contact of the sort experienced by family members and healthcare workers.
The Saudi government is currently working closely with WHO to monitor developments and find out more about the new virus, but this was not always so. In the early stages, according to news reports, international experts accused the health ministry of covertness and foot-dragging. Only since April 2014, when King Abdullah sacked the incumbent health minister, has reporting to the WHO, and the Saudi public at large, been more open.
We live in an increasingly globalised world. Every country depends on every other country for its health security. Viruses are constantly mutating and evolving. New infectious diseases can emerge anytime, anywhere. A single individual case can spark a global health emergency. As Anne Schuchat, director of the US National Center for Immunization and Respiratory Diseases, said in a press conference last May: the next pandemic is “just a plane’s ride away”.
The ease with which pandemics can spread is the reason health systems around the world must be ready, willing and able to stamp out viral threats at the earliest opportunity. This means people at all levels must be informed, empowered and motivated to act promptly and decisively. As the current ebola crisis has made all too clear, secrecy and denial – whether by a village chief, health official or president – serve only to fuel potential catastrophe.
Has the vital importance of openness and transparency reached the people it needs to reach? Or will history repeat itself yet again? Let’s hope the next pandemic doesn’t prove to be one cover-up too many.