Ebola and the failure of the market

Oct 24, 2014

By Anil Netto
When Thomas Duncan first showed up at a Texas hospital complaining of a fever and stomach pains after a visit to his native Liberia, he was prescribed antibiotics and sent home.

He did not have medical insurance. He returned to the hospital three days later and eventually died there.

The hospital denied that his ability to pay, or his nationality were factors; instead, it said, there was a miscommunication about his visit to Liberia between the nurse and the doctor attending to him.

But Duncan’s nephew Josephus Weeks, reportedly said that his uncle’s death was needless. “He was a man of colour with no health insurance and no means to pay for treatment, so within hours, he was released.”

Beyond the question of ability to pay for treatment (a concern also among many Malaysians who cannot afford medical insurance), market forces may have failed in containing the Ebola outbreak in other ways. What’s more, these forces may have even worsened the situation.

Science writer Leigh Phillips, writing in the online magazine portal Jacobin, outlined several ways the failure of the market may have contributed to the spread.

Ebola is an unprofitable disease to treat, he noted. The target population affected by the disease is relatively small and if there is a readily available vaccine, chances are the patient only needs to receive it for a limited time. It is not something that a patient needs to take over a lifetime or over a prolonged period, such as in diabetes and cancer medication (which makes such drugs more profitable). Big Pharma is more interested in more profitable drugs that give them more bang (profits) for their buck (heavy investment in developing a vaccine or cure).

Even though potential treatments are already under development by scientists; Big Pharma firms have not shown much enthusiasm for them as they are seen as unprofitable.

Writing in the Independent, Dr John Ashton, the president of the UK Faculty of Public Health, urged: “We must ... tackle the scandal of the unwillingness of the pharmaceutical industry to invest in research to produce treatments and vaccines, something they refuse to do because the numbers involved are, in their terms, so small and don’t justify the investment.”

He lamented, “This is the moral bankruptcy of capitalism acting in the absence of an ethical and social framework.”

It is no coincidence that Ebola has struck hardest in three of the poorest countries in the world — Guinea, Liberia, and Sierra Leone. These nations are ranked 178th, 174th, and 177th out of 187 countries in the UN’s Human Development Index, notes Leigh, who observes that neoliberal policies and structural adjustment programmes (SAPs) promoted by international financial organisations have exacerbated the crisis.

Several of these West African nations, like countries elsewhere, have promoted agrobusiness (cash crop plantations) and mining. Land has been grabbed/privatised and opened up for foreign investors. The transition was made from subsistence agriculture to cash crops/agrobusiness. This then resulted in food shortages while wages remained low, forcing many people to forage deeper in the forest for basic food items. Now Ebola, is a ‘zoonotic’ disease i.e. it spreads via contact between animals and humans. So, closer contact between affected animals and humans is a factor in the degree of spread.

Meanwhile, under these SAPs, government spending (including health care spending) was curtailed and health care infrastructure has struggled to cope with the disease.

And not only in West Africa. In Madrid, when a 75-year-old Spanish priest who contracted Ebola in Liberia was flown in for specialist treatment, a problem emerged. The infectious disease centre in Madrid had been shut down. The government had privatised some hospitals and closed a couple of others, including the infectious disease centre.

Cost-cutting measures in education and health care were introduced in Spain by the conservative government in 2012, to slash public debt after a construction boom ended. That year, Spain was forced to seek financial assistance from Europe for its crisis-hit financial sector, which obligated it to introduce ‘austerity measures,’ including spending cuts in its public sector.

What this Ebola outbreak should tell us is that we cannot rely on market forces and neoliberal programmes (which tend to curb public spending in health care) to contain infectious diseases or other health care emergencies. These privatisation and cost-cutting measures are short-sighted measures as they tend to result in overstretched and underfunded public hospitals, overworked health care personnel and a brain drain to the private sector.

There is no substitute for protecting the common good, a key tenet of Catholic Social Teaching, through a universal health care system. Such a government-funded universal system would adequately fund proper facilities and dedicated medical personnel who are committed to serve the sick, regardless of the patients’ ability to pay. In fact, many developed nations strengthened their public health care system in the post-War decades but this was gradually undermined by the wave of privatisation and neo-liberal measures favouring Big Business from the 1980s onwards.

In the midst of this crisis, the heroic work of medical personnel, both African and foreign, working and volunteering in West Africa should not go unrecognised — even if foreign governments have been slow to intervene with humanitarian aid.

At a time when many are disillusioned with segments of the medical profession in its quest for profits over public service, the unsung sacrifices of these doctors and nurses working with Ebola patients, sometimes at the cost of their own lives, is inspiring and reminds us of Jesus words: 12 “This is my commandment: love one another, as I have loved you. 13 No one can have greater love than to lay down his life for his friends” (John 15).