Taming the international commercial surrogacy industry
By Sally Howard, freelance journalist, London, UK
With no worldwide regulatory framework, south Asian countries are struggling to legislate to protect children born through “fertility tourism”and the surrogates who carry them.
The recent case of surrogate baby Gammy, rejected by his commissioning parents after being born with Down’s syndrome and a congenital heart defect, provoked censorious press coverage worldwide. “Surrogate mom vows to take care of abandoned twin,” ran the typical headline when the story broke in August. Outrage grew when it emerged that the father had 22 child sex convictions.1
But behind its sensationalised aspectsthe cold transaction of cherrypicking one healthy child from twins and the questionable background of the Australian fatherthe case was more legally and ethically nuanced than it might have seemed.
Gammy’s gestational mother, 21 year old Thai food vendor Pattaramon Chanbua, told news agency Agence France Presse that she had found out that one of the twins had a chromosomal disorder four months into the pregnancy.1 The commissioning parents, David and Wendy Farnell, told Australia’s Channel Nine television (60 Minutes, 9 August) that they had then urged Chanbua to selectively abort the abnormal fetus.
Abortion is illegal in Thailand, except in cases of rape or incest or endangerment to the mother’s life or mental or physical health.2 It is unclear whether abortion for a birth defect was stipulated in the surrogacy contract between Chanbua and the Farnells. However, Chanbua claimed that she refused to abort the child because it was against her Buddhist faith. She also complained that she has been promised $9300 (£5800; €7300) to carry the children but had not been paid in full.3
Gammy remained in Thailand under the care of Chanbua who, under Thai law, was considered the child’s mother. After the case gained media attention, pressure grew to repatriate the 7 month old to Australia, where he was also offered citizenship and where he would be entitled to free healthcare for his complicated birth conditions.
“A bodge job or worse” The family law barrister Barbara Connolly QC says that the labyrinthine tangles of family, immigration, and contract law exposed by Gammy’s case are typical of international commercial surrogacy.
“When it comes to commercial surrogacy our laws are a bodge job or worse,” she told The BMJ. “Unlike international child abduction and adoption, there are no international conventions and agreements in this area. Legal issues relating to parentage and immigration vary so widely that the process can result in dramatic outcomes, such as a child born via surrogacy who is both legally orphaned and stateless.”
The legal status of commercial surrogacy varies from country to country. In some countries, including Georgia, Ukraine, and South Africa, all surrogacy agreements are legal and enforceable. Other nations, such as the United States and Australia, regulate or criminalise commercial surrogacy with a patchwork of common law and case legislation that is enforced at state level. France, Italy, and Switzerland ban all forms of surrogacy and will not recognise children born through commercial surrogacy abroad as legal citizens. In the United Kingdom and Denmark altruistic surrogacy (when the mother can receive only reasonable expenses) is permitted but agreements are unenforceable and commercial surrogacy is banned. However, when couples have sought commercial surrogacy abroad, the courts may retrospectively sanction payments that have already been made in the interests of the child.
Asia legislates The call for a unified legal framework around commercial surrogacy is loudest in the “fertility tourism” destinations of the global south. In Thailand, where the commercial surrogacy industry is worth $125m according to the Thai Department of Health Service Support, the military government responded trenchantly to the baby Gammy case by approving a draft law to criminalise commercial surrogacy. If the law is approved by Thailand’s National Legislative Assembly in early 2015, it will criminalise both commercial surrogacy agencies and commissioning parents, allowing only altruistic surrogacy for infertile, married Thai nationals.
Reverberations are being felt most keenly in India, the world’s largest destination for fertility tourism. (The Indian commercial industry, legalised in 2002, was valued at $449m in 2006.) Last month the Indian government introduced into parliament the 2010 Assisted Reproductive Technologies Regulation (ART) Bill, which has been grinding on to the statute book since 2008.4 The bill, in its current draft, includes a chapter that considers oocyte donors, gestational surrogates, and surrogate born children in altruistic and commercial surrogacy agreements. When the bill is enacted, surrogacy agreements will become legally enforceable, and the age and background of surrogate mothers will be restricted. All foreign surrogacy arrangements will require the appointment of a local guardian who is legally responsible for the surrogate mother throughout the pregnancy as well as the resulting child if the commissioning parents fail to claim him or her.
Indian wombs for hire This law change comes after the Indian Ministry of Home Affairs issued new guidelines on surrogacy in January 2013. These included a visa requirement for foreign nationals commissioning surrogacy in India, with such visas being restricted to married couples from countries where surrogacy is legal.5 N B Sarojini, founder of the non-profit making Delhi based women’s health advocacy and research organisation Sama, thinks that these regulations have done little to curb what the Indian press has derisively referred to as the trade in “Indian wombs for hire.” Sarojini, who has lobbied for amendments to the ART bill, hopes that the new legislation will check the untrammelled commercialisation of India’s assisted reproduction industry but fears that the bill will be “hugely lacking” in its reach.
“The ART bill has been led by the ART industrythat is, by commercial clinics and gynaecologists, largely for the purpose of validating this lucrative business,” she says. “It fails to regulate big players in the industry, such as surrogacy agents. And it provides little support, or legal recourse, for the gestational surrogate. It seems the free trade mandate brushes aside all ethical questions.”
Sarojini argues that, although the new bill imposes restrictions on the number of embryo transfers a surrogate can accept for a commissioning couple (three) and the number of children a surrogate can bear (five, including her own children), the bill makes no provision for the health of the surrogate beyond the bounds of the nine month gestational contract. In a climate where the public healthcare sector is under-resourced, says Sarojini, such omissions are unethical.
An early draft of the bill said that the health risks to the surrogate mother were small. But Deepa Venkatachalam, who also works for Sama, says the organisation’s research shows that surrogacy “can have grave effects on women’s health. The surrogate is subjected to repeated hormonal injections in preparation for implantation, putting her at risk of ovarian hyperstimulation syndrome, and most surrogates undergo non-indicated caesarean sections to time the birth for the commissioning parents’ convenience.” Human trafficking Anil Malhotra, a lawyer based in the north Indian city Chandigarh, is also a critic of the upcoming legislation. At a conference on surrogacy organised by the Centre for Social Research, a New Delhi non-governmental organisation, in September he raised concerns that the bill fails to consider the background and credentials of commissioning parents, a problem that emerged in the baby Gammy case.
“As the bill stands, there is no requirement to verify the background of commissioning parents,” Malhotra told The BMJ. “At the minimum, the home study reports mandated under CARA [India’s Central Adoption Resource Authority] guidelines on inter-country adoptions should be applied, under the bill, to cross-border surrogacy arrangements.” 6
Malhotra also noted the absence of a clause pertaining to human trafficking for surrogacy. In 2009 the United Nations Development Programme warned that trafficking of women for commercial surrogacy would eventually develop.7 Just two years later, 13 Vietnamese women, seven of whom were pregnant, were rescued from a surrogate “baby breeding ring” in Bangkok.8
“You cannot just close your eyes and hope that baby breeding cartels won’t develop,” Malhotra said. “With such financial incentives involved, it’s a false hope.”
Malhotra argued that India is losing its opportunity to set a legislative standard for surrogate source nations: “To have any hope of keeping pace with socioeconomic conditions and technological advancements, we need a one-stop-shop piece of surrogacy legislation that covers both domestic and international surrogacy arrangements,” he said. “Scattered pieces of legislation won’t do.”
China’s ban China is one of the few Asian nations to have taken a firm stance on commercial surrogacy from the outset. In 1994, as gestational surrogacy was emerging, the Chinese government banned commercial surrogacy on the grounds of its implications for defining true parenthood. However, by the early 2000s an unregulated market was flourishing. In 2009 the Chinese government strengthened the criminal enforcement of the surrogacy ban, and reports emerged of surrogates having forced abortions.
Health and human rights campaigners say there is a pressing need for an international legal framework to regulate the commercial surrogacy industry. But such agreements will be a long time coming. The Hague Conference on Private International Law convened to consider international surrogacy arrangements in March 2012 and April 2014. It will reconvene in early 2015. To Connolly, the conferences’ preliminary reports make for sober reading.9 10
“The reports highlighted the huge problems in these cross border arrangements,” she said. “But they also pointed to the real obstacles in the way of reaching any kind of international consensus, let alone a convention, on the issue. As an indication of how long these conventions can take, Japan only signed up to the Hague Convention on International Adoption, which was drafted in 1993, earlier this year.”
Meanwhile there is pressure for affluent nations to legalise the commercial surrogacy market within their own borders. Connolly agrees that the argument is attractive. “But you have to be realistic about market forces,” she said.
“If you liberalise commercial surrogacy in the UK you won’t prevent UK nationals from seeking a cheaper surrogate abroad. For example, as India and Thailand impose restrictions there are signs that an unregulated commercial surrogacy industry is emerging in Mexico.”
For baby Gammy the future is bright. He will soon live with his surrogate mother in a new three bedroom apartment paid for with funds from the reported $AU240 000 (£130 000; €165 000; $210 000) donated to a charitable endowment established for his long term care.11 For the industry that brought Gammy into being, the future is less certain.
Modern surrogacy: the birth of an industry
In 1980, two years after the birth of the first baby conceived in vitro, Louise Brown, the US lawyer Noel Keane wrote the first legally binding surrogacy contract through his own infertility centre, a business that sought to connect couples to willing surrogates.
In 1986 Keane wrote the contract pertaining to Baby M, a controversial case in which surrogate Mary Beth Whitehead refused to cede custody of the resultant child, Melissa, to the couple with whom she made the surrogacy agreement. The case led many US states to ban commercial surrogacy arrangements.
In traditional surrogacy the egg of the surrogate mother and the sperm of either the intended father or a sperm donor are used. From the 1990s advances in in vitro and implantation methods enabled gestational surrogacy, in which the surrogate carries a child she is not genetically related to, created from eggs and sperm of the intended parents or donors.
The arrival of gestational surrogacy led to a boom in commercial surrogacy worldwide. The global industry is now estimated to be worth $6bn12
Footnotes Competing interests: I have read and understood BMJ policy on declaration of interests and have no interests to declare. Provenance and peer review: Commissioned; not externally peer reviewed.
The time has come to demand immediate and effective action to significantly reduce carbon emissions.
View the Monster Petition Website and download a copy for a pen to paper signature HERE
What Is The Monster Climate Petition?
A petition by Australians to the House of Representatives demanding immediate and effective action to significantly reduce carbon emissions. Original, pen on paper signatures will be collected in time for the G20 in Brisbane 14-15 November. These signatures will demonstrate to the world that many Australians want effective action on reducing carbon emissions.
The Monster Petition will then be presented to our national Parliament in late November 2014.
We need a truly MONSTER petition, with hundreds of thousands of signatures. The need for action is urgent.
If you have any trouble downloading the Petition, please email
or call (03) 9642 0422.
Please join us. Let’s make our voices heard. Download the petition now. Ready to act?
The petition is available HEREin 7 other language versions, Turkish, Vietnamese, Arabic, Italian, Greek, Mandarin, Spanish
If you are using a Mac computer and are having trouble downloading the Petition, please right click on the ‘Download’ button and select ‘Save linked file as...’ Save the Petition to a location on your Mac, and open it from there.
General information sheet to accompany petition collection such as leaving in a cafe or bookshop etc.
The Petition Says The Following:
To The Honourable The Speaker and Members of the House of Representatives
This petition of Australia’s daughters and sons, parents, grandparents, godparents, aunts and uncles, draws to the attention of the House the damage to the earth’s climate and its oceans from humanity’s continuing and increasing carbon emissions and the consequent severe risks to the future health, safety and well-being of our children and our children’s children and future generations. We remind the House that it is the fundamental duty of parliament, including this House, to protect Australia’s people, land and seas.
We therefore ask the House to respect the science and build a safe climate future for our children and grandchildren and generations to come by enacting immediate and deep reductions to Australia’s carbon emissions. We also ask the House to commit to and actively promote and support global strategies for immediate and deep reductions to global emissions at every relevant international forum.
If you are using a Mac computer and are having trouble downloading the Petition, please right click on the ‘Download’ button and select ‘Save linked file as...’ Save the Petition to a location on your Mac, and open it from there.
Who Can Sign The Petition?
Everyone of us can sign our names. There are no formal eligibility requirements. Signatories do not have to be on the electoral roll. Addresses are optional, but they add legitimacy. The only people who can’t sign are current members of the House of Representatives. While the Monster Climate Petition is organized and led by women, it is for all Australians to sign, men and women, boys and girls. Climate change is affecting us all.
State parliamentarians and senators can sign. Ex-parliamentarians can sign.
Why Should You Sign?
• In a 2014 Lowy Institute Poll, 63% of Australians said they wanted the government to take a leadership role in reducing emissions.
• To let our politicians know that huge numbers of ordinary Australians want urgent action to reduce carbon emissions.
• To make climate change a bi-partisan national priority rather than a political football.
• To let world leaders in Brisbane for the G20 know that ordinary Australians desperately want their national government to step up and act on climate change.
• To stand up and be counted for the sake of Australia’s children and the land and seas we love.
• To do something that will make a constructive difference rather than languish in despair or cynicism.
it’s 3:23 in the morning and I’m awake because my great great grandchildren won’t let me sleep my great great grandchildren ask me in dreams what did you do while the planet was plundered? what did you do when the earth was unraveling?
Drew Delinger Extract from Hieroglyphic Stairway
Download all the forms you need and start collecting signatures from your family, friends, clubs, businesses and community.
Importantly, please mail all petition forms by 8 November to the Victorian Women’s Trust Level 9/313 Latrobe Street Melbourne Vic 3000
The Monster Climate Petition is an independent initiative without any party political affiliation.
LD Comprehensive public education about Ebola is required, including its possible links to biological warfare research in the West. As for the response to the present outbreak in West Africa, the AU and ECOWAS have horribly failed the people of that region and Africa.
INTRODUCTION As the Ebola outbreak rages, and there are projections of more than 1.4 million persons infected in the next few months, the African Union and the regional bloc ECOWAS have taken a back seat as the international media uses this virus to stigmatize Africa and Africans. Pious statements have been made by the World Health Organization (WHO) as the World Bank warns that could Ebola could have “catastrophic” economic costs on the region of Western Africa. This same World Bank has not yet accepted any reasonability for its role in promoting neo-liberal politics that degraded the health care facilities of Africa. This degradation will be called in this article economic warfare. Bioeconomic warfare is the combination of economic warfare and biological warfare. In the midst of this tragedy, Britain, France and the United States use the deaths of thousands to remilitarize West Africa. Characteristically, this militaristic intervention with the division of the three societies between USA (Liberia) France (Guinea) and the United Kingdom (Sierra Leone) ensures that the media attention is placed on the military deployments of the western states and not on measures for public education.
The kind of international response that will be needed for countering bioeconomic warfare requires a different kind of public education and mobilization than what the AUand ECOWAS have so far called for. Liberia, Sierra Leona and Guinea are the societies that are at the epicenter of the outbreak of the Ebola hemorrhagic fever (EHF) that some writers have said has spun out of control.  These three territories are members of the Economic Community for West Africa (ECOWAS). ECOWAS is one of the five regional organizations that make up the AU. Six months after it was clear that this epidemic was widespread, in August 2014, there was a meeting of ECOWAS held in Ghana to address the outbreak. At this meeting, it was stressed that the best approach to curbing the spread of Ebola and bringing the disease under control remained effective quarantine, isolation and public education. There is no indication that either the AU or ECOWAS is working at their maximum effort to bring this disease under control. In the same month of August, the Director General of the World Health Organization stated that, the outbreak is “the largest and most severe and most complex that we’ve ever seen in the nearly 40-year history of this disease."
One of the priorities of public education is for citizens to have a fuller understanding of the source or sources of Ebola and the kind of responses that can bring this pandemic under control. Citizens need to understand everywhere that Ebola is not particularly contagious. There should be the clarification that there is no cure for Ebola. All of the therapies and vaccines being used so far are experimental. The simple requirements of control are robust public health infrastructures, clean water facilities with sanitation and a clean environment. In short, Ebola can only be contained with robust health facilities. The very same institutions and organizations that have been at the forefront of bioeconomic warfare in Africa cannot lead the mobilization against Ebola. This mobilization requires nonmilitary, civilian medical leadership. Ebola presents one more challenge for a new kind of leadership in Africa that can value the lives of the producers. EBOLA: WHERE DID IT COME FROM? From the varying press reports this current strain of Ebola broke out in Guinea at the end of 2013 and was brought to international attention by the time it had spread across West Africa by March 2013. The symptoms of Ebola haemorrhagic fever begin 4 to 16 days after infection. Persons develop fever, chills, headaches, muscle aches, and loss of appetite. As the disease progresses, vomiting, diarrhea, abdominal pain, sore throat and chest pain can occur. The blood clots and the patient may bleed from injection sites as well as into the gastrointestinal tract, skin and internal organs. The mortality rate is usually very high. This virus is not spread through the air via coughs or sneezes like the common cold. It is spread through frequent contact with bodily fluids and can be spread only by someone who is showing the symptoms.
It should be stated from the outset that Ebola is not one of those illnesses known to the majority of healers and doctors in Africa. Scientific journals of all continents attest to the profound ignorance about this virus. Fifteen years ago the internationally respected International Journal of Infectious Diseases stated that “Filoviridae is the only known virus family about which we have such profound ignorance.”  What accounts for this profound ignorance on the part of the top researchers in the West?
Inside Africa, the most experienced, the traditional healers have no experience in dealing with this illness. The reports in the mainstream media place the first outbreak of Ebola in Africa in 1976. This virus was named for a river in then Zaire, where Ebola was allegedly first detected. Then, according to information released by the Center for Disease Control (CDC) in Atlanta," Ebola is a member of a family of RNA viruses known as filoviruses. When magnified several thousand times by electron microscope, these viruses have the appearance of long filaments of threads. Although the CDC places the first outbreak of Ebola in Zaire in 1976, the leading scientific journals such the Lancet and the New England Journal of Medicine placed the first outbreak in Marburg, Germany.
One of the most profound requirements of public education is to diminish the racialization of Ebola to clarify that the first recognized outbreak took place not in Africa, but in Marburg Germany, hence the name given to Ebola as Marburg Virus. In 1967 an outbreak of haemorrhagic fever occurred simultaneously in laboratories in Marburg and Frankfurt, Germany.
Thirty-one people became ill, initially laboratory workers followed by several medical personnel and family members who had cared for them. Seven deaths were reported. THE EVOLUTION OF EBOLA According to the CDC, the first Outbreak of Ebola was in 1976 in Zaire. In their website, the CDC stated the first Outbreak of Ebola “occurred in Yambuku and surrounding area. Disease was spread by close personal contact and by use of contaminated needles and syringes in hospitals/clinics. This outbreak was the first recognition of the disease”.  Why is it necessary for the CDC to place the evolution of disease in Africa?  The website of the CDC differs from the Journal of Infectious Diseases that stated, “Biomedical science first encountered the virus family Filoviridae when Marburg virus appeared in 1967.”
The reporting on the number of deaths in the Zaire outbreak differs according to differing sources. One fact is indisputable. This was the largest number of deaths at that time in 1976. There were 550 cases and 340 deaths.
In the third outbreak in 1979, in Sudan, there were 34 cases and 22 fatalities.
RESTON-EBOLA The fourth outbreak of Ebola was in the United States. The strain of Ebola Reston is so called because of an outbreak which occurred in Reston, Virginia, in late 1989. Very few following the present outbreak of Ebola know that there was an outbreak of Ebola in the Washington Suburb of Reston, less than 20 miles from the United States Capitol. There were two other small incidents of the Reston outbreak after 1989. THE KITWIT OUTBREAK Six years after the first Reston outbreak there was a major outbreak of Ebola at Kitwit, again in Zaire. There were over 200 fatalities. Up to then, the Kitwit Ebola outbreak had been the deadliest. The outbreaks were usually controlled when appropriate medical supplies and equipment were made available and quarantine procedures used.
Since those days there have been periodic outbreaks in Uganda, Angola, Gabon, Côte d'Ivoire (Ivory Coast) and other parts of Africa, but nothing compared to the scale and depth of the present pandemic in West Africa.
In the most popular book on this virus published over 20 years ago by Richard Preston, The Hot Zone: The Terrifying True Story of the Origins of the Ebola Virus  readers are exposed to the twenty years of research by the United States Army Medical Research Institute of Infectious Diseases (USAMRID) on a family of viruses that are lethal. This book came out before the Kitwit outbreak but we know from press reports that the USAMRID, the CDC, the National Institutes of Health (NIH) and other international research organizations used the Kitwit outbreak to study this virus. The book concentrated on the three ways which the scientific community attempts to deal with a virus: vaccines, drugs and bio containment. This book by Preston came out in a moment when the tabloid press was making great claims about the airborne possibilities of Ebola and was whipping up anti-African hysteria.
It was in the same period when Robert Kaplan had written his celebrated article, “The Coming Anarchy. “ It was this sensationalism that set the tone about the so-called failed and fragile states in Africa. Robert Kaplan wrote extensively on how scarcity, crime, overpopulation, tribalism, and disease were rapidly destroying the social fabric of our African societies.  Kaplan’s work was part of the psychological warfare against Africa and Africans at the moment when the peoples of world were celebrating the victory over apartheid.
USAMRID -THE US MILITARY AND BIOLOGICAL WARFARE RESEARCH- ONE ARM OF BIOECONOMIC WARFARE The U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) at Fort Detrick, Maryland, is supposed to be the frontline research institution for the USA in its bioshield preparations, which is the preparedness of the US government to fight against biological threats. President Richard Nixon had ended the offensive biological warfare program of the USA with his “Statement on Chemical and Biological Defense Policies and Programs" on November 25, 1969 in a speech from Fort Detrick. The statement was supposed to put an end, unconditionally, to all U.S. offensive biological weapons programs. The United Nations Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction was signed in 1972. Even after the signing of this international convention a number of countries, including the USA, continued research on designer viruses.
Despite the UN convention, the explosion of scientific research on genetically modified organisms gave a boost to the research being carried out by both military and civilian agencies that were chasing profits from developing dual use pathogens. Biological agents that were being experimented with as bioweapons accelerated and the one bioweapon from this school of dual use pathogens that has come to light has been the experimentation on anthrax.
Characteristically, the use of anthrax on civilians by the military was in the case of the racist Rhodesian military who unleashed anthrax spores in feed cakes for animals killing over 80 Africans in what was then Rhodesia. Years later Timothy Stamps, the Minister of Health in Zimbabwe, drew a connection between the anthrax outbreak in Rhodesia, the Ebola outbreaks and the experimentation that had been carried out under South Africa's Chemical and Biological Warfare (CBW) program.
This South African apartheid CBW program has now received international notoriety through Project Coast where the apartheid regime was experimenting with biological agents that could be specifically targeted at Africans. The government of the United States has gone to great lengths to distance itself from the experimentation of Project Coast even though at the Truth and Reconciliation Commission (TRC of South Africa), Dr. Wouter Basson testified how he was warmly embraced by US intelligence elements. The full implication of the work of Wouter Basson and Daan Goosen is still to come to light. 
The attractiveness of the weaponization of biological agents increased in the era of genetically modified organisms. Because Africa was the space of the most diverse genetic materials, scientists and bio anthropologists from the West traversed the rural countryside in Africa looking for plants with unique characteristics. In the era of massive research in the life sciences, many universities became involved in dual use research. DUAL USE RESEARCH Dual use research (DURC) is life sciences research that, based on current understanding, can be reasonably anticipated to provide knowledge, information, products, or technologies that could be directly misused to pose a significant threat with broad consequences to public health and safety, agricultural crops and other plants, animals, the environment, or national security. In short, dual use research was research that could be used to assist in advancing human health and security or at the same time be used for biological warfare.
We have learnt from research carried out by UNESCO that “military interest, in harnessing genetic engineering and DNA recombinant technology for updating and devising effective lethal bioweapons is spurred on by the easy availability of funding, even in times of economic regression, for contractual research leading to the development of bioweapons.” 
This is the research environment within which to grasp the present outbreak of Ebola in West Africa.
On the day before President Barack Obama spoke to the world on the Ebola pandemic, the White House on Wednesday September 24, 2014 issued new guidelines intended to strengthen the oversight of federally funded biology research that could inadvertently produce bioweapons. According to the report in the New York Times carried on Thursday September 25, “The new policy shifts the burden of finding and disclosing the dangerous aspects of research from the funding agency -- usually the National Institutes of Health -- to the scientists who receive the grants and the universities or other institutions where they work.” On the same day, the National Public Radio (NPR) was more specific that the ruling related to dual use pathogens and research being carried in government funded laboratories. This report came three years after the controversies about bird flu research that was being carried out for bioterror purposes. In 2011, there had been a fierce debate in the media about the use of biological research for terror, in short bioterrorism. Then as NPR reported, “Scientists and security specialists are in the midst of a fierce debate over recent experiments on a strain of bird flu virus that made it more contagious weapons. In September of 2011 at a scientific conference in Malta, one scientist made a stunning announcement at a flu conference “he'd done a lab experiment that resulted in bird flu virus becoming highly contagious between ferrets the animal model used to study human flu infection. It seemed that just five mutations did the trick.” This report on NPR in November 2011 did not reappear but in the same broadcast one noted bioterrorism expert and director of the Center for Biosecurity at a national university stated that,
"It's just a bad idea for scientists to turn a lethal virus into a lethal and highly contagious virus. And it's a second bad idea for them to publish how they did it so others can copy it.” So far no expert or whistle-blower has come forward to speak openly about experimentation with viral haemorrhagic fevers, which are now lumped under the name of Ebola. Today as a vital component of prevention and public education there is the need for scientists and researchers to speak out about the laboratories in the West or elsewhere that have been experimenting with dual use pathogens. It is also necessary for the international community to know whether any of these research teams or university personnel associated with dual use pathogens has been active in the countries of Liberia, Sierra Leone, Guinea or Nigeria before the present outbreak of Ebola. At the minimum, ECOWAS and the AU should pressure the UN Ebola Fund to focus not only on fund raising but to also make Freedom of Information Act (FOIA) requests to fully develop the measures to properly organize against outbreaks of the current type.
From the reports coming in on the numbers of people who have been left to die without attention or a decent burial, the figures on the number of deaths in West Africa from WHO have been a clear undercount to minimize the extent of the devastation by Ebola. In contrast to the numbers being broadcast by WHO, the Center for Disease Control and Prevention in Atlanta reported on Tuesday September 23 that “Ebola cases could increase to between 550,000 and 1.4 million in four months, based on several factors including how many people are infected by Ebola carriers. The report questioned whether the official number of deaths recorded by WHO, 2,800 out of at least 5,800 Ebola cases, has been underreported. CDC has said it is likely that 2.5 times as many cases, or nearly 20,000, have occurred so far.”  On the same Tuesday that the CDC issued its dire warning of the prospect of 1.4 million persons dying, the New England Journal of Medicine also weighed in and stated that “if the disease isn’t adequately contained, it could become endemic among the populations in countries hardest hit by the outbreak Guinea, Sierra Leone and Liberia. …. “Without drastic improvements in control measures,” researchers say, “the numbers and cases and deaths from [Ebola] are expected to continue increasing from hundreds to thousands per week in coming months.”
According to the WHO, “Extensive, immediate actions - such as those already started - can bring the epidemic to... a rapid decline in cases.” BEYOND THE MILITARIZATION OF THE RESPONSE TO EBOLA The extensive and immediate action referred to by WHO concerns the deployment of military forces by the United States, Britain and France to the countries most affected. The US has deployed over 4,000 military personnel to West Africa to assist in the fight against Ebola. The fight against Ebola cannot be a military effort. It must be an effort that is based on seeking to bring back the health and safety of the peoples whose communities have been destroyed with hundreds of families losing loved ones. The US plans to quickly increase its presence in Liberia, where military personnel are deploying to help the people halt the advance of the worst Ebola epidemic on record but we also need to know what the private security contractors have been doing in Liberia over the past ten years. President Obama has stated that the military is required to set up the medical and transportation infrastructure needed to deploy health workers. Why could this infrastructure work not be carried out by civilian agencies?
From India, Sreeram Chaulia noted correctly in an article entitled ‘Foreign Pulse: Viral Politics’, that “As the Ebola epidemic ravages West Africa, a familiar act with troublesome connotations is playing out. The international response to the conjoined public health crises in Liberia, Sierra Leone and Guinea is following imperial patterns of tutelage and patronage, wherein each of these three countries has been exclusively taken over by its respective former master from America and Europe through targeted humanitarian aid…….An erstwhile colony established by American citizens freed from slavery, Liberia is back to being literally a ward of the US, which faces no competition from any other Western donor there. Washington is deploying up to 4,000 military personnel to set up hospitals, medical laboratories and treatment centres on a war footing. This mission, codenamed “Operation United Assistance”, is being overseen by the controversial US Africa Command (AFRICOM).”
In a context where the international news media is dominated by the western news agencies, ECOWAS has also called for military mobilization to respond to Ebola. In the opinion of this author, ECOWAS and the AU have dropped the ball because the militarization of the international response will make it difficult for countries such as China, Cuba, India, South Korea and other societies to properly harmonize the medical response to this Ebola outbreak. The AU and ECOWAS need a new kind of medical diplomacy which is rooted in the valuation of black bodies. Chaulia noted that “if the US, UK and France were driven by humanitarian motives, why did they not contribute to the multilateral UN Ebola response fund that would have distributed the funds more equitably among the three worst-hit West African countries? Thus far, only India and Australia have made sizeable donations of $10 million each to the UN Ebola fund that is woefully undersubscribed.”
PROJECT 112 In North America, the Fox news organization and its affiliates have been at the forefront of the racialization of the present outbreak of Ebola. When the Liberian national was hospitalized and later succumbed to Ebola, the conservative media whipped up an unprecedented hysteria about the possibilities of an Ebola outbreak in the United States. (This patient, Thomas Eric Duncan, has since passed away). Within this hysteria, there are questions in the media whether this virus could go airborne. Some readers will remember that the possibility of the airborne transmission of Ebola was the theme of the film Outbreak that was produced by Hollywood. What has not been in the public domain is the fact that it was the US government that from 1962 to 1973 carried out a biological and chemical weapon experimentation project called Project 112.
This was specifically conducted so that those who were being experimented with did not know that they were guinea pigs. In 2000 when US television network CBS made known the existence of this biological warfare program, it was also revealed that apart from testing on individuals in the USA there were tests carried out in countries where “The US Department of Defense (DoD) conducted testing of agents in other countries that were considered too unethical to perform within the continental United States.”
PROJECT BIOSHIELD We are yet to know which African societies were considered ripe for the testing of toxins by the US Department of Defense. After the anthrax scare in the USA in 2001 and the war against the people of Iraq in 2003, the US Congress passed the Project Bioshield Act in 2004 calling for U.S. $5 billion for purchasing vaccines that would be used in the event of a bioterrorist attack. There has been a ten-year program to put money into the same forces that were experimenting with dual use pathogens. In the words of the Congress, Project Bioshield was a ten-year program to acquire medical countermeasures to biological, chemical, radiological, and nuclear agents for civilian use. The US government has been working on countermeasures against biological warfare. Is it by accident that the top three threats that the Bioshield program is meant to defend the citizens of the US from are Anthrax, Ebola and Bird Flu?
AFRICA AND BIOTERRORISM Africans have faced bioterrorism from the time of colonialism and apartheid and this is well documented in the book Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. Author Harriet Washington went into great details about the bioterrorism against black people. The Tuskegee experiment is now the most well-known case of using black bodies as guinea pigs for medical experimentation. The book on Hela Cells (Henrietta Lacks) is another devastating account of the use of black bodies. 
Harriet Washington placed chemical and biological warfare under the larger category of “bioterrorism,” which “employs chemical or biological agents such as microbes and poisons in the service of terrorism…weapons often consist of disease-causing organisms, usually microorganisms such as bacteria, viruses, fungi, or derivatives from humans, animals or plants”  Another important aspect of biological warfare that Harriet Washington brings forth is the fact that it can be both direct and indirect when used against populations. In other words, chemical agents can be used to kill people directly by physically harming them with something such as nerve gas, or biological warfare can be used to pollute the environment in which someone lives in order to cut off their source of food (plants, livestock), water, or both.
Cuba is one society outside of Africa that has been forced to develop the medical and biosafety capabilities after the outbreak of Dengue fever in 1977. We now know from the new book, Back Channel to Cuba, that Henry Kissinger had organized a plan to ‘smash’ Cuba.  This was because Kissinger was angry about the Cuban intervention in Angola in 1975-1976 to beat back the racist South African incursion. Kissinger who had overseen the authorship of the National Security Memorandum 39 of 1969 which predicted that whites were destined to stay and rule in Southern Africa was upset that a small island committed to an alternative mode of economic organization could ruin his plans for Africa. It was reported in the recent New York Times article that in the discussions between Kissinger (then Secretary of State) and President Gerald Ford, Kissinger used “language about doing harm to Cuba that is pretty quintessentially aggressive.” 
The Cubans have exposed that the Dengue fever which broke out in Cuba in 1977 was linked to biological warfare by the US government. This has been corroborated by press reports from the United States. At that time the US government blocked efforts by the Cuban government to purchase fumigators and chemicals to control the Dengue spread. As a small island, Cuba has been able to develop quarantine measures but more importantly develop the scientific capacity to research the root of outbreaks such as Dengue.
AU AND ECOWAS MUST TAKE THE LEAD TO RESPOND TO THIS LETHAL VIRUS In August the President of the US called the first US-Africa Summit in Washington. Although the Ebola pandemic was already killing more persons than the four episodes discussed in the website of the CDC, White House was not focused on the devastation that was being wrought on West Africa. In Africa, Ebola has exposed the porousness of the so-called borders. The AU has so far failed to take the lead in mobilizing to fight this pandemic. Does the African Union have in place any kind of bioshield preparation? At the time of the outbreak of the HIV AIDS pandemic it was significant that western pharmaceuticals placed their profits before human lives. It took the massive organizing of a grassroots movement such as the Treatment Action Campaign (TAC) of South Africa to pressure the pharmaceuticals to allow for the production of generic drugs to treat AIDS patients in Africa. This TAC campaign influenced the cooperation between India, Brazil and South Africa which later merged into BRICS.
A similar grassroots mobilization is now needed in West Africa to break the slow and lackadaisical response of ECOWAS and the AU. ECOWAS has been able in the past to intervene in Liberia and Sierra Leone to bring peace. Collectively, ECOWAS and the AU possess the technical and medical capabilities to be more vigorous in response to Ebola. There is the mistaken perception abroad that Africa does not have the medical personnel to fight this epidemic. However, the ability to mobilize the resources in Africa for a more robust response depends on political will. Nigeria alone has over 40,000 doctors with thousands having experience in infectious diseases. In the economic warfare against Africa the medical profession of Africa was assaulted and there was a massive brain drain of African medical personnel to Europe and North America. African governments have been very clear about their objections to the wholesale migration of their physicians to rich countries. Despite these objections there are more than 10,000 international medical graduates from Africa in the USA and Western Europe. The US received more than 7,000 doctors from three countries: Ghana, Nigeria and South Africa. Progressive Africans will have to mobilize for a change of course so that the AU and the United Nations can demilitarize the response to Ebola.
Already it has been demonstrated in Liberia that the pandemic can be contained. Nigeria and Senegal have been able to contain the virus. The western media has drawn attention the fact that Firestone Company in Liberia was able to contain and control the virus on its rubber plantation.  This author is no fan of Firestone. At the recent Empowered Africa Dialogue in Washington during August, workers at Firestone spoke of the low wage and exploitative working conditions on the rubber plantation. Thus this company cannot be held up as an example, but the important point is that Ebola can be controlled and there is no need for the pandemic to spin out of control. The Firestone story also demonstrates that the military is not needed to organize the medical and transport infrastructure to contain the escalation of the deaths.
This author has been critical of saviours from outside but this Ebola pandemic provides an opportunity for the true humanitarian doctors to separate themselves from the militarized response to the Ebola outbreak. The African Union must take the lead so that those medical responders can find a non-military infrastructure to work with. There is the need for full-scale mobilization in all of the countries where health workers, traditional doctors, scientists, civilian agencies and the military will be crucial in the fight against bio-economic warfare. Global health experts have declared the Ebola epidemic ravaging West Africa an international health emergency that requires a coordinated global approach.
Although the media has racialized the Ebola pandemic, there is an urgent need for the international community to come together for this coordinated global approach. The Ebola virus presented a real challenge to Africa and the deployment of scientists, community health workers, volunteers and health brigades to combat this virus is one of the most important tasks of reconstruction in Africa. * Horace Campbell is Professor of African American Studies and Political Science at Syracuse University. He is the author of Global NATO and the Catastrophic Failure in Libya: Lessons for Africa in the Forging of African Unity, Monthly Review Press, New York, 2013.
 Evan Horowitz, “How the Ebola Virus Spun Out of Control,” Boston Globe, October 8, 2014. http://tinyurl.com/n7azj76  C. J. Peters, J. W. LeDuc, “An Introduction to Ebola: The Virus and the Disease,” The Journal of Infectious Diseases, Vol. 179, Supplement 1. Ebola: The Virus and the Disease (Feb., 1999), pp. ix-xvi  Outbreaks Chronology: Ebola Virus Disease, CDC, Known Cases and Outbreaks of Ebola Virus Disease, in Chronological Order: http://tinyurl.com/nrzolre  See Centers for Disease Control, “Known Cases and Outbreaks of Ebola Virus Disease, in Chronological Order:” http://tinyurl.com/nrzolre  Richard Preston, The HotZone: The Terrifying True Story of the Origins of the Ebola Virus,” Anchor books, 1995.  Robert Kaplan, “The Coming Anarchy,” The Atlantic, February, 1994 http://tinyurl.com/lyx89cd  Helen E. Pruitt, Stephen F. Burgess: South Africa’s Weapons of Mass Destruction. Indiana University Press, Bloomington 2005  Edgar J. DaSilva,” Biological warfare, bioterrorism, biodefence and the biological and toxin weapons convention,” Electronic Journal of Biotechnology,Volume 2, No 3, December 1999. See also Wright, S. (1985). “The military and the new biology. Bulletin of the Atomic Scientists 41:10-16.  “Estimating the Future Number of Cases in the Ebola EpidemicLiberia and Sierra Leone, 2014–2015,” http://tinyurl.com/puh8tev  Sreeram Chaulia, “Viral Politics, Foreign Pulse, October 8, 2014.” http://tinyurl.com/nrarcl2  Rebecca Skloot, The Immortal Life of Henrietta Lacks, Broadway Books, New York 2011  Harriet Washington, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, Anchor Books, New York 2008 page 365  William M. Leo Grande and Peter Kornbluh, Back Channel to Cuba, University of North Carolina Press Chapel Hill, North Carolina, 2014.  Frances Robles, “Kissinger Drew Up Plans to Attack Cuba, Records Show,” New York Times, September 30, 2014 http://tinyurl.com/pzurfx7  National Public Radio, “Firestone Did What Governments Have Not: Stopped Ebola In Its Tracks.” http://tinyurl.com/m8vqcov
By Yabome Gilpin-Jackson | Twitter: @supportdevelop
“What can be worse than watching your child wasting away from the Ebola virus, and not being able to comfort her with a touch, or care for her directly?”
This question haunts me.
Unimaginable pain, unbelievable heartache, unspeakable torture. It’s the plight of parents in the West African countries of Guinea, Sierra Leone, Liberia and Nigeria, at this very moment. Since the official start of the Ebola outbreak in Guinea in March, there are now 6,500+ confirmed cases and over 3,000 deaths. Each death represents someone’s beautiful baby boy or girl. I cannot retreat from the despair rising in me.
Ebola is much too close to home. I was born to Sierra Leonean parents while they were working in Germany and I lived in the West African coastal country between the ages of 5 and 20. I am also a naturalized Canadian having immigrated here because of another crisis in Sierra Leone–the civil war of the 1990s and early 2000s–and because our family has a Canadian history. My parents lived and had three children in Edmonton while my father was a graduate student at the University of Alberta. So I consider myself a global citizen, and predominantly a Sierra Leonean-Canadian. I am deeply connected to all things Sierra Leone and consider the development of the African continent part of my life’s purpose.
When I see photos in the paper of children, like two-year old Bintu whose parents have both been diagnosed with Ebola, I see my own two-year old son. My heart sinks to the bottom of my ribcage and seems to keep dropping.
I am a professional serving in the Canadian healthcare system. So, when I see the photo of the beautiful 25-year-old nurse Justina, who died after treating the first Ebola patient in Nigeria, the fog around me thickens. I think about the countless resources required every “winter surge,” our healthcare label for the flu season in Canada. Yet every year, there are still flu cases and fatalities. Then I imagine what it must be like in the West African nations currently battling Ebola, nations that are year after year named within the world’s poorest economically, with struggling health systems and some of the worst global health outcomes.
Their relative poverty (another cause for an exasperated, incomprehensible, rhetorical question!) is, for example, why over 60% of deaths in Sierra Leone result from preventable communicable diseases. Like Ebola. There are not enough resources to take the measures needed to quarantine and eradicate the virus, so it keeps spreading. It’s been at least 180 days and counting. There needs to be 42 days without a new case of Ebola for the outbreak to be declared over. And Nigeria and Senegal where there have been 21 cases as a result of someone with Ebola travelling there, are close to seeing the end of those days.
The ongoing impacts of the Ebola outbreak, like food shortages and threats of violence and civil rights violations, is why my Facebook status one day was simply “My heart aches.”
My brother-in-law, living in Freetown, Sierra Leone, tells us how Ebola is visibly changing life is Freetown. People go about their daily business wearing masks. Public gatherings are all but non-existent. A community that thrives in handshakes, touching and being in each other’s spaces are learning that for the moment at least, they must invent “Ebola greetings” that entail none of the above.
And for children, normalcy is suspended. Schools are closed indefinitely. There have been no birthday parties, no playdates. Some are being uprooted, if their families can afford it, to go elsewhere for school. And those with parents and communities who are facing the reality of Ebola are teaching their children a confusing and contradictory message–“don’t touch people.” Because Ebola spreads on contact with the bodily fluids of those it has touched, this unwelcome virus is risking the very core of our humanity–human touch and connection.
This unwelcome virus is risking the very core of our humanity–-human touch and connection. Not A Single Story My heart aches, because the poverty numbers and the Ebola stories, tell nothing of the people with a rich socio-economic history and culture. It says nothing of the beautiful tourist destination where I grew up with some of the most beautiful beaches. Very few know the time in the 1980s when my father came home rejoicing because of his role in economic policy reforms that resulted in our currency hitting par with the US dollar and UK pound. The current Ebola news dominates other important numbers of hope. Like the fact that the West African region of 300,000,000 people, is also the largest economic block on the continent, making it a potential economic goldmine for the region and globally. And in regard to Ebola, the fact that MSF reports at least 650 people have recovered in their care. That includes the 22-month-old girl, Isata, who according to history and statistics had zero chance of surviving the virus. All 650, someone’s beautiful baby boy or girl. Precious, miraculously healed lives.
So, in spite of my sinking heart, and in spite of the fog, this is not a sob story. This is a call to action–because Sierra Leoneans, Liberians, Guineans and Nigerians need hope, not pity and more than sympathetic bystanders. They need reassurance that the world cares about theirs and our collective health.
So, I am trading despair for a focus on hope and action. Hope that we will get to 42 days Ebola-free. And I am joining the action. Will you consider joining me? Donate to efforts to STOP EBOLA NOW! Here are my favorite picks: Doctors without Borders (MSF), because they are most experienced at working with and treating the Ebola virus and are asking for help. Sierra Leone Action, because they are taking an evidence-based and progressive approach to pioneer treatment for Ebola using convalescent serum therapy (survivors’ blood serum and whole blood transfusions). HOPE Academy for Girls, because they are taking on a public and community health approach (hand-washing stations) to curb the spread of the virus. Self-organize by: Hosting a fundraiser with your friends and family, Raising awareness by sharing information about what is happening to any and all. That always sparks new ideas and ways to help!
In the words of Margaret Mead: “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it’s the only thing that ever has.”
That’s my hope.
About Yabome: ?My name means woman … I love the obvious simplicity and profound impact of carrying that name. It’s a name ascribed to the wisdom of an older woman, an elder, and was my grandmother’s. On top of that, my mom meant to also name me Satia, meaning satiated, full to abundance. It is her favorite cousin’s name, infused with the double entendre of a woman overflowing with the joy and blessing of having had me, her 7th biological child. So what can I say about me? I am a woman, seeking after wisdom, determined to live life to the fullest and help, in whatever way I can, others in the world to do so also. I believe in and love God. I am also a wife, mother of 3, academic, working professional, consultant and budding author. I love learning, new experiences…and fashion. I, Yabome (Satia) Gilpin-Jackson am who I was born to be…and I am (re)discovering that daily.
The Making of a Tragedy: Inequality, Mistrust, Environmental Change Drive Ebola Epidemic
By Laurie Mazur
In August, armed men stormed an Ebola clinic in Monrovia, Liberia, releasing infected patients and stealing contaminated bedding. The following month, eight health workers were attacked and killed in a Guinean village as they tried to educate residents about the deadly disease; their bodies were found in a village latrine. Days later, Red Cross workers in western Guinea were assaulted as they tried to collect and bury Ebola victims.
Why? Gripped by fear and rage, the attackers either denied the presence of Ebola, or blamed health workers for intentionally spreading the disease.
These incidents underscore the extraordinary challenge of containing the Ebola epidemic, a metastasizing global health tragedy that could afflict up to 1.4 million people in West Africa by January. The emergence and spread of the virus raises warnings that must be heard worldwide.
It speaks powerfully of the risks posed by poverty, environmental degradation, and weak health systems, and of the need to bolster our collective resilience to epidemics and other disasters. And it illustrates the crucial role of trust in public institutions – government, health care systems, multilateral organizations.
Indeed, trust is an intangible social good that is perhaps best appreciated in its absence. It is especially elusive in times of crisis, when it is unfortunately needed most.
New Vectors Months before the Ebola epidemic spiraled out of control, there was Patient Zero, a not-quite-two-year-old girl in Guinea. She likely contracted the virus from an infected bat, in an impoverished village where bushmeat is a dietary staple. Because Ebola so often afflicts caregivers, the child’s pregnant mother was soon infected, then other family members, then the midwife who nursed the mother through a miscarriage. Within months, the virus had arrived in the capital, Conakry, and seeded even larger epidemics in neighboring Liberia and Sierra Leone.
But the origins of the epidemic reach back further still. The virus may have been flushed out of the forest by multinational timber and mining operations that have clear-cut the (now misnamed) Guinea Forest Region, where the child was from. And population growth, partly driven by refugees from the brutal civil wars in Liberia and Sierra Leone, has driven settlements deeper into the remaining bush.
“As the forests disappeared,” writes Jeffrey Stern in Vanity Fair, “so too did the buffer separating humans from animals – and from the pathogens that animals harbor.” Zoonotic diseases like Ebola are on the rise worldwide, as habitat loss accelerates.
Climate change may have also played a role. A 2002 study found that abrupt shifts from dry to wet conditions are associated with Ebola outbreaks in Africa – and climate change is making those shifts more likely. West Africa is already reeling from climate impacts: Sierra Leone, for example, is coping with “seasonal droughts, strong winds, thunderstorms, landslides, heat waves, floods, and changed rainfall patterns,” according to the International Food Policy Research Institute.
1 Nation, 200 Doctors Environmental change may have contributed to the emergence of the disease, but poverty and social dysfunction made it an epidemic.
“Large hemorrhagic fever virus outbreaks almost invariably occur in areas in which the economy and public health system have been decimated from years of civil conflict or failed development,” write Daniel G. Bausch and Lara Schwarz in the PLOS Neglected Tropical Disease s journal.
This is sadly true of the affected countries in West Africa. Liberia and Sierra Leone are still struggling to repair societies and economies devastated by war. Guinea, hobbled by decades of corrupt, authoritarian government, ranks 179 out of 187 countries on the UNDP Human Development Index, just behind Liberia (175) and above Sierra Leone (183).
In these impoverished nations, health care systems were completely inadequate before the Ebola outbreak. Liberia – a nation of four million – had fewer than 200 doctors. As the epidemic took off, health systems were quickly overwhelmed, turning away patients to be cared for by family and friends, who frequently became infected.
Hospitals in the region lack basic infection-control essentials like running water and protective gowns and gloves, so doctors and nurses catch the virus from their patients and pass it on.
As World Bank President Jim Yong Kim declared in early October, “[the Ebola epidemic] shows the deadly cost of unequal access to basic services and the consequences of our failure to fix this problem.”
Crowded Cities, Suspect Authorities Urbanization has also shaped the trajectory of the epidemic.
Previous Ebola outbreaks took place in remote villages, where quarantines effectively contained the disease. But the last two decades have seen unprecedented migration to cities in Africa. As a result, the current epidemic is unspooling in urban slums with inadequate sanitation – ideal conditions for the transmission of disease.
As Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota told NPR earlier this month, “the virus hasn’t changed, Africa has changed. We now have this virus in an urbanized population among people who travel far and wide.”
Still, the epidemic might have been contained in its early stages, if not for widespread distrust in public institutions. The proven tools of disease control (case reporting, quarantine, contact tracing) rely heavily on the trust and cooperation of affected communities. Without trust, even the best-intentioned, well-resourced public health efforts will falter.
The roots of distrust run deep, and they can be difficult to untangle. Research shows that recent traumatic experiences and a history of oppression – perhaps not surprisingly – erode trust. Inequality also profoundly weakens the bonds of reciprocity that hold societies together. And, in times of crisis, societies predictably cleave along religious and ethnic lines.
All of these dynamics are at play in the West African Ebola epidemic, where the trauma of recent conflict remains fresh and the legacy of oppression – from slavery, colonialism, and other forms of exploitation – is inescapable. The divide-and-conquer tactics of colonial powers ignited ethnic conflicts that still simmer today.
Against that backdrop, it is easier to understand the response to those working to stem the epidemic in West Africa. Terrified of moon-suited health workers, wary of dysfunctional hospitals, families hid their sick and their dead. As Stern observes, again in Vanity Fair:
It’s very likely we would not be where we are today had there not been large population pockets that were not cooperating with authorities, and in some cases violently resisting them. Infected people hiding allowed the virus to spread unseen. Lessons on Resilience The West African Ebola epidemic is a singular tragedy, a perfect storm of environmental and social factors that converged to ignite the largest outbreak yet of one of the world’s most deadly viruses.
But the conditions that aided Ebola’s emergence and spread – poverty, environmental degradation, weak health systems, mistrust in public institutions – are certainly not confined to West Africa.
There are lessons here for the development community, and for those seeking to build resilience in a turbulent world. Ebola illuminates the devastating toll of poverty and stalled development. It underscores the importance of intact ecosystems and the need to mitigate climate change. It demands immediate attention to the infrastructure of public health, including sanitation and primary care. It calls for new efforts to repair broken trust – by redressing historic injustices, by healing ethnic tensions, and by promoting broad-based development that reduces inequality.
The question of trust – how it is built, why it fails – is of urgent relevance everywhere disasters occur, from Monrovia to the Lower Ninth Ward. It is a question that deserves more attention as we seek to cultivate resilience to the shocks and surprises of the future. But this much is clear: trust is essential, and it can’t be compelled. It must be earned. ~~~~~~~~~~~~~~ Laurie Mazur is a consultant on population and the environment for the Wilson Center’s Environmental Change and Security Program and a writer and consultant to non-profit organizations. She is the editor, most recently, of A Pivotal Moment: Population, Justice, and the Environmental Challenge.
Sources: African Development Bank Group, American Society for Photogrammetry and Remote Sensing, Associated Press, Beyond Intractability, Biosecurity and Bioterrorism, CBS News, Foreign Policy, International Food Policy Research Institute, NPR, National Bureau of Economic Research, The New York Times, PLOS Neglected Tropical Diseases, Reuters, Stiglitz (2013), U.S. Centers for Disease Control and Prevention, UN Development Program, Vanity Fair, The Washington Post.
Photo Credit: Morgana Wingard/USAID; Ebola virus particles, courtesy of the National Institute of Allergy and Infectious Diseases.