Paul Farmer on Ebola: “This isn’t a natural disaster, this is the terrorism of poverty”

The Washington Post
By Joel Achenbach
October 06, 2014

(Click here to view the original article.)

Africa’s Ebola problem is now America’s Ebola problem. The best way for the United States to free itself of the terror of this virus is to ensure that it is wiped out at the source, where the epidemic is currently out of control. That will happen only through a coordinated effort to provide the kind of basic, front-line health care that we take for granted in the developed world but which is tragically scarce in impoverished countries.

[Exclusive: How the world failed to stop the Ebola epidemic]

“This isn’t a natural disaster. This is the terrorism of poverty,” Paul Farmer, the Harvard professor and co-founder of Partners in Health, told The Washington Post after a recent trip to Liberia.

Americans unnerved by Ebola are concerned, naturally, about travelers from West Africa bringing the virus here. But long-term, the only practical (and humane) solution is to stop it there. That’s what Tom Frieden, the director of the CDC, has been saying in recent days as the national news has focused on the Ebola case in Dallas and fears of Ebola breaking out elsewhere in the U.S.

Look at Frieden’s Twitter feed:

"CDC’s #1 priority: protecting Americans from health threats. #Ebola anywhere is a threat everywhere."

"To protect America’s health security, we must continue the hard work of stopping #Ebola at its source in W. Africa."

"Imposing quarantine on entire nations would backfire and fuel the #Ebola epidemic. #CDCchat"

"Impt to remember, as 1st US #Ebola case grabs headlines: We must be relentless in stopping spread in W. Africa."

Frieden is one of the major characters in the 6,000-word story we published on Sunday that showed how the world’s health organizations failed to keep pace with the exploding epidemic.

"The virus easily outran the plodding response. The WHO, an arm of the United Nations, is responsible for coordinating international action in a crisis like this, but it has suffered budget cuts, has lost many of its brightest minds and was slow to sound a global alarm on Ebola. Not until Aug. 8, 4 1 ⁄ 2 months into the epidemic, did the organization declare a global emergency. Its Africa office, which oversees the region, initially did not welcome a robust role by the CDC in the response to the outbreak."

"Previous Ebola outbreaks had been quickly throttled, but that experience proved misleading and officials did not grasp the potential scale of the disaster. Their imaginations were unequal to the virulence of the pathogen."

Now, however, there’s an action plan that has a chance to bring the epidemic under control. Thousands of U.S. military personnel will play a key role. In the coming weeks we’ll see if this more muscular response has come soon enough.

Paul Farmer last month went to Liberia and, with a number of colleagues, flew deep into the bush to visit a provincial hospital. The hospital had only a handful patients. People were afraid of the Ebola virus and had retreated to their homes. Farmer and his colleagues visited a pharmacy where there was virtually nothing on the shelves.

Farmer argues that the only way to solve these epidemics is to focus on the four S’s — stuff, staff, space, and systems.

“All over the world there are warehouses of guidelines and policies and protocols, but you’ve got to have stuff, stuff, space and systems in the places where you need them most. You can’t work magic out of nothing,” Farmer said.

He said if it were a purely “natural” disaster, the case fatality rate would be the same everywhere. But it’s not.

“There’s a reason the case fatality rate is 80 percent in rural Africa and 0 percent in Americans and Europeans who get out in time and get proper medical care,” Farmer said.

He said the world needs to bridge the “know-do gap,” the disconnect between what gets planned in conferences among elite global health leaders and what actually is happening on the front lines of medical care.

In West Africa they need personal protective gear, starting with gloves. They need oral rehydration fluid. They need medicine. Much of Liberia is off the grid, and hospitals need diesel fuel and generators. They need the basics, in other words.

The response to Ebola, Farmer said, “has to be linked to the broader effort to strengthen health systems. We need health workers, clinics and hospitals, too. Re-opening the primary health system in order to take on problems like malaria is part of the Ebola response too.”

In our Sunday story on Ebola we reported a similar observation from a top World Health Organization official, Keiji Fukuda:

"…after six trips to Africa during the epidemic, [Fukuda] has seen a more profound truth: Global organizations can provide epidemiologists and laboratory help, but what these resource-poor countries really need are front-line doctors and nurses, and basic resources. In Africa, patients told him, 'We don’t have enough food.'"

Fighting Ebola isn’t that complicated: The virus isn’t terribly contagious and by isolating patients it is possible to bend the “epi curve” in the right direction. But the basic resources have to be deployed at the front lines. Here’s another key passage from out story:

"The epidemic has exposed a disconnect between the aspirations of global health officials and the reality of infectious disease control. Officials hold faraway strategy sessions about fighting emerging diseases and bioterrorism even as front-line doctors and nurses don’t have enough latex gloves, protective gowns, rehydrating fluid or workers to carry bodies to the morgue. “We cannot wait for those high-level meetings to convene and discuss over cocktails and petits fours what they’re going to do,” exclaimed Joanne Liu, international head of Doctors Without Borders, when she heard about another U.N. initiative."

Farmer, for one, is optimistic that the epidemic will be contained with the more muscular response finally being put into action.

“It will work,” he said. “It will be brought under control even as we apply these basic interventions.”

He doesn’t blame any person or organization in particular for the failure to contain the epidemic before it expanded into historic proportions. The failure was collective, Farmer said.

”I wish we’d responded earlier and more publically as a collective. That’s a regret. Between early June until [mid-September], when we left for Liberia, I think a number of us were invaded by a persistent anxiety that we’re not doing enough. Because we’re not doing enough.”