Pandemic Politics: Ebola, COVID-19, and Lessons for the West
COVID-19 continues to disrupt every aspect of life, striking particularly hard within wealthy, Western countries. However, epidemics are nothing new in Africa, given the developing world bears most of the infectious disease burden. As Mauss (Mauss, 1916; Burawoy, 1992; Klinenberg, 2005) note, institutions tend to reveal themselves during times of crisis. Ebola, like COVID-19, uncovered everyday micro and macro processes and brought them to the surface due to the exigency of a global health crisis. The 2013-2016 West Africa Ebola Epidemic ended less than five years ago, and bears striking similarities to our current experience in the West, despite occurring in a different context. In mid-February 2021, Ebola surfaced once again in the same region it emerged in 2013. While Western expertise is frequently exported to the developing world, what can the West learn from the recent West Africa Ebola Epidemic, not only in terms of pandemic politics, but also in terms of local management of crisis?
The 2013-2016 West Africa Ebola Epidemic ended the lives of more than 11,000 West Africans (CDC, 2016), and set the entire world into panic. Even in New York City, residents avoided the typically crowded subway line 7 because it went towards United Nations Headquarters. Neoliberal economic policy, promoted by the International Monetary Fund (IMF) and the World Bank, created a tsunami of enabling conditions contributing to the spread of Ebola, notably, the retraction of the social sector at the expense of health and education infrastructure. While Chinese authorities reprimanded novel coronavirus whistle-blower Dr. Li Wenliang as early as December 2019 (NPR, 2021), similarly, the governments of Guinea, Liberia, and Sierra Leone were reluctant to acknowledge the existence of the epidemic, particularly due to fears about a flight of foreign direct investment. In turn, as at present, governments lacked the capacity to control the epidemic. Ebola was also an early warning that Western countries, too, would lack the capacity to control a similar epidemic, for example Rull, Kickbusch, and Lauer (2015) argued that even the United States would lack capacity for a similar epidemic.
Structural adjustment and neoliberal economic policy arguably contributed to the structural conditions that made West Africa vulnerable to Ebola. Relatedly, numerous health researchers and social scientists note that the COVID-19 pandemic as well exposes the deleterious effects of neoliberalism on public services, notably the education and health sectors. Moreover, Ebola was our recent glimpse into border and school closures, as well as quarantine, pre-COVID-19, and the burden of care, again, fell on women. The racialization of the epidemic contributed to its politicization, which in turn led to denial of the epidemic’s existence and massive social resistance to response efforts. In the vacuum left by neoliberalism and in a context of underdevelopment, local organisations and volunteers, which, in most crises, are the first responders, became all the more important. Local organisations brokered scientific norms against pervasive rumours and myths about Ebola, and taking into account the needs of the population to take care of the sick and dying in a dignified way (Reddy, 2021).
Urbanization and Global Mobility Catalysed an Unprecedented Epidemic
The epidemic started in Guéckédou, Guinea, in late 2013, in a region known as Guinée Forestière, part of the wider Mano River Union subregion including border areas of Guinea, Liberia, and Sierra Leone. An eighteen-month-old boy in Guéckédou, Guinea, was argued to be “Patient 0” – the first Ebola case of the West African epidemic (Sáez, Kelly, and Brown, 2014). Given Ebola’s similarity to Lassa Fever, however, the epidemic may have started earlier (Doucleff, 2014). Ebola was first identified in 1976 in Central Africa. While fruit bats are hypothesised to be the natural reservoir of Ebola, the virus is transmissible to humans. The World Health Organisation hypothesises that deforestation due to foreign mining and timber extraction displaced infected animals, bringing them into more contact with human settlements (WHO, 2015). Critics of the emphasis on human-bat transmission, and bushmeat as the original source, argue that the exoticization of transmission obscures the social, environmental, and political conditions leading to a massive epidemic (Lachenal, 2015, McGovern, 2014). The virus usually remained within the rainforest, however, with urbanisation in West Africa and global mobility, it moved faster than expected. Ebola followed colonial trade routes, travelling from interior, remote villages to capital cities. Rapid urbanization of Conakry, Freetown, and Monrovia began with refugee and IDP (internally displaced persons) flows during the regional civil wars from 1989-2002, and coupled with underdevelopment, catapulted the epidemic. Ebola spread to the capitals and then back out into other regions the interior, and ended in a remote province of Guinea.
A health officer checking the temperature before people enter church during the COVID-19 pandemic. Photo copyright: Kwame Amo for Shutterstock
Politicization and Racialization of the Epidemic
The epicentre of Ebola– the historically marginalised Manu River Union subregion, one of the poorest areas of the world above ground and one of the wealthiest in terms of diamond and mineral wealth underground, was also the epicentre of the previous civil wars. The initial denial of Ebola was rooted in historic racism of ethnic groups living in the Forestière Region, as it was viewed as a virus belonging to the people who lived in the “forest.” Decades of crumbling infrastructure and under-allocation of funds to this politically marginalised area made the response all the more challenging, especially given longstanding distrust of the state and ethnic rivalries culminating in political power struggles. Just as the Trump administration complained of the “Chinese virus”, Ebola, too, was blamed on the Forestiers, who were also stigmatised for their practice of indigenous religions and secret societies. The cultural practices of secret societies and rituals were actually part of an existing contentious relationship between Guineans in the Forestière region and the central government. In contrast, the same rituals and secret societies were tolerated across the border in Sierra Leone and Liberia (McGovern, 2017). While Sierra Leone’s local chiefs had significant legitimacy and power (a remnant of indirect colonial rule), in contrast, in Guinea civil servants, selected by the party in power, come from other regions (Wilkinson and Fairhead, 2017). As a result, Ebola was more easily contained in Sierra Leone and Liberia once international responders worked with locally respected interlocutors such as village chiefs.
Governments were reluctant to acknowledge the Ebola outbreak, particularly due to concerns about foreign direct investment flows, and lacked resources to respond (Rull et al., 2015; International Crisis Group, 2015). When they communicated, the messages were inadequate and, in many cases, led to social resistance to response efforts, including the hiding of victims (Tokpa, Kaufmann, and Zanker, 2015, Calnan, Gadsby, et al., 2018). Especially given a history of conflict and political distrust, communities were hesitant to believe that Ebola was real, particularly when the messages came from other ethnic groups in power or from foreigners. There was a tension in the politics of knowledge– with rational, scientific approaches to epidemic control on the one hand, and traditional ways of explaining phenomena and caring for the sick and dying, on the other (Reddy, 2021). Consequently, Ebola spread rapidly in vulnerable communities, where the death rate was higher when it co-occurred with food insecurity (Kelly, Richardson, et al, 2018).
At first, government messages were inadequate, such as “Ebola kills and there is no cure”, catalysing distrust and lack of cooperation with response measures. Rumours and conspiracy theories, for example, that Ebola was constructed in an American lab and released onto the population as a test, proliferated in an environment of distrust, between ethnic groups and also of outsiders. Distrust was also fuelled by misuse of Ebola funds, and the belief that the massive inflows of foreign aid served to enrich expatriate workers while local Ebola workers were paid low wages for ha leading locals to call it “the Ebola business.” Approximately 9.8 million USD earmarked for the Ebola response in Sierra Leone disappeared (O’Carroll, 2015), leading to popular belief that the funds had gone to construct houses for those in power in Freetown and to fund the upcoming election. The All People’s Party (APP) was voted out after eleven years in power. Kono, a district at the epicentre of the epidemic voted for the opposition due to their belief that the Ebola response was mishandled. The COVID-19 pandemic may have similar effects on elections. While in the US, COVID-19 has not yet been shown to have directly impacted the 2020 election, there is a correlation between economic growth – impacted by COVID-19– and Trump’s vote share, that is to say, Trump did better in states that bounced back. In Liberia, for example, the government allocated more Ebola aid to swing states – which in turn ensured votes in the following election (Maffioli, 2018). Moreover, Ebola impacted the state-civil society relationship, especially in terms of trust in the state.
Neoliberalism and the Social Sector: A Turn Towards Organisations and the Challenges of Multilateralism
Neoliberal economic policy, aiming to reduce the size of the central state, paved the way for the Ebola epidemic. Structural adjustment programs imposed by the International Monetary Fund (IMF) and the World Bank in the 1980s reduced state capacity to deliver social services such as education and health and resulted in political turmoil ultimately leading to conflict in Guinea, Liberia, and Sierra Leone. The subsequent United Nations intervention during the civil wars in Sierra Leone and Liberia (1989-2003) arguably entrenched neoliberalism through expanding development aid especially through international and non-governmental organisations (NGOs) as well as promoting privatisation. The state had limited ability to intervene in economic policy, and mostly through public private partnerships (Abdullah and Rashid, 2018), and as a consequence, health infrastructure remained increasingly limited by the time Ebola arrived, a decade after the end of the civil wars.
On the road between Faranah and Conakry, Guinea. Photo by Michelle Reddy
As a result of the lack of government capacity to respond, and fears of the epidemic spreading to the West, international organisations intervened. International organisations, most notably the World Health Organisation (WHO), took significant time to respond to the epidemic, and to contain the epidemic, despite extensive expenditures. Though the outbreak began in late 2013, the WHO did not declare Ebola an international health emergency until August 8, 2014 (Kelland, 2014). The International Crisis Group (ICG) warned that the spread of the virus and the domestic military response threatened regional stability, leading to the international response in the form of a U.N. peacekeeping mission and foreign military intervention (International Crisis Group, 2014, in Nyei, 2016).
Social Resistance and Conspiracy Theories
Social resistance to international as well as local responders was pervasive. The border regions at the epicentre of the epidemic were all home to marginalised ethnic groups. Since the epidemic originated in this marginalised region, this led to stereotypes about Ebola and initial indifference at the national level. Rumours about Ebola proliferated due to the failure of governments to effectively communicate about Ebola (Lahai, 2017), and fuelled social resistance across the three countries. For instance, in Sierra Leone, university-educated professionals I interviewed admitted to believing that Ebola was leaked from an American laboratory in Kenema. There was also a pervasive rumour that foreigners spread Ebola, including the Ebola responders themselves. Most people were fearful to seek treatment for anything, as Ebola contamination occurred in the hospital as well, for example, individuals were infected while being kept as suspect cases in Ebola Treatment Centres (ETCs). Though epidemiologists cited low literacy rates as reasons for the proliferation of rumours, since individuals are more likely to seek out second-hand information from others, we can see even in the developed West the spread of conspiracy theories. Social resistance included riots, threats to burn down Ebola treatment centres, massacres, and general violence against Ebola responders. Other forms of social resistance included refusal to allow family members to be taken to Ebola treatment centres, stoning of ambulances and burial teams, resistance to quarantine, and ‘secret’ burials of Ebola victims in non-compliant ways. Fears of Ebola treatments, tests, and vaccination led many communities to coin the term “blood business”, reflecting the belief that international responders were profiting from the epidemic, much like the “big Pharma” rumours at present. The contrast between medical treatments and more traditional methods of healing catalysed rumours and social resistance, especially with the marginalisation of traditional healers, who had authority in many communities, at a time when hospitals and health centres were closed for months. Houses of worship closed, galvanizing resistance among some but in many instances important cooperation occurred once imams, priests, and ministers were included as part of the response and public outreach.
Challenges of International Response to an Epidemic
In light of government failure to properly communicate and address the epidemic, international organisations intervened. Initially international organisations were reticent to work with local organisations. However, they faced significant challenges in educating communities, in a context with low educational attainment and literacy, alongside different cultural approaches to epidemic control and caring for the sick and dying. Ebola particularly thrived on the most vulnerable and marginalised communities, which suffered from decades of structural inequality and political marginalisation. While at first response efforts were top-down, eventually international organisations worked with local organisations to counter social resistance fuelled by misinformation. Once met with social resistance, the international response worked more with local organisations, to harness local knowledge alongside scientific responses to epidemic control. As a result of international-local cooperation, the response succeeded.
Importance of Local Organisations and Voluntarism in Crisis Response
Ebola illustrated the importance of local civil society organisations and voluntarism in crisis response. In the context of weak state capacity to respond to the epidemic, as well as massive social resistance, local community-based organisations mediated tensions in the politics of knowledge. Despite significant investment in civil society organisations by international donors since the end of the regional civil wars, when Ebola struck, the international response largely neglected local organisations. Although humanitarian aid to local organisations is arguably cheaper, faster, and more efficient, international organisations typically allocate only 1.6 percent of their budget to local organisations (IFRC, 2015). Once met with massive social resistance, however, international organisations began to work more with local civil society organisations and domestic NGOs, and set up consortiums where one local organisation took the lead in coordinating smaller organisations and managed funds. Local organisations had pre-existing relationships with communities and local chiefs due to their sensitization activities– essentially, community-based educational activities not only around literacy and health but also human rights, development, and democratization. Due to the peacebuilding process, Sierra Leone and Liberia had deeper levels of international cooperation before, and during Ebola. As a result, international organisations were better able to leverage relationships with local organisations. My research shows that pre-Ebola participation in voluntary associations, especially when individuals engaged in raising issues, correlated with reduced Ebola duration at the district level. In addition, local organisations were able to fill important gaps in service provision, for example, providing instruction to children via community radio programs when schools were closed for nine months during the Ebola epidemic. Overall, while neoliberal economic policy favoured aid distribution through bypass channels such as NGOs, rather than funding central ministries, the organisations typically receiving funding during a humanitarian crisis are large international NGOs rather than local organisations.
Health Alert Executive Director- Victor Lansana Koroma and the Health Alert team help with dignified burials of Ebola victims in Hastings, Sierra Leone. Photo courtesy of Health Alert Sierra Leone
Local organisations have thus far been important in providing information during COVID-19, even in the developed world. Local organisations could play an important role in responding to COVID-19 vaccine reticence, particularly within vulnerable and historically marginalised communities. Civil society organisations in Sierra Leone and Guinea maintain that they have already helped mitigated the spread of COVID-19 in Africa, especially given their prior role in social mobilization during the Ebola epidemic. The role of local organisations was largely voluntary only a handful of 100 organisations I interviewed received international funding during Ebola. One approach was to form consortium, where a larger organisation received funding and then managed relationships with smaller local organisations as well as larger NGOs. If funding during health crises becomes more localised, civil society organisations have the potential to have more impact. As a consequence, funding these organisations is key to ending the COVID-19 pandemic, not only in terms of preventing the transmission of COVID-19 but in order to achieve buy-in of vaccination campaigns.
What is the Impact of COVID-19 in Africa?
When COVID-19 struck the world, observers of Africa braced themselves for catastrophe, given levels of development, health infrastructure, and especially the difficulty of social isolation and quarantine in subsistence economies. However, the impact of COVID-19 in Africa, at first glance, appears to be minimal as compared to the West, though the lack of testing, and ineffective surveillance systems present severe data limitations. Recently case counts have been increasing (Mwah, 2021) especially due to the South African variant. As of January 27, 2021, there were approximately 3.5 million cases and 87,042 deaths related to COVID-19 on the African continent (including North Africa) (Johns Hopkins University, national public health agencies, in Mwah, 2021). South Africa accounts for nearly 1.5 million out of the 3.5 million reported cases, though this estimate is biased given there is far more testing in South Africa than elsewhere. Aside from data limitations, several explanations exist for why there have been limited COVID-19 deaths on the world’s poorest continent. First, Africa has an extremely young population, for example, 75 percent of the population was under the age of 35 in 2015 (United Nations, 2015). Second, some hypothesise that the rapid closure of borders and early lockdowns helped contain the epidemic (Africa Report, 2021). However, border closure has not yet been proven as an effective measure in slowing viral transmission, since the virus usually has already spread to the country by the time of implementation. Geography and mobility are also potential factors, for instance, Africa has a warmer climate, lower rates of mobility, especially global mobility, and more outdoor living. At the same time, COVID-19 has thrived in places with a warm climate as well, for example, Brazil has one of the highest caseloads. The experience of prior epidemics, whether in terms of response and cross-immunity from other coronaviruses, might also be a contributing factor. As a result, there is a need for further research regarding COVID-19 levels in Africa.
However, even if the continent has not yet felt the viral impact of COVID-19 in the same way as much of the rest of the world, Africa will likely be heavily impacted by the global recession resulting from the pandemic. In comparison, Guinea, Liberia, and Sierra Leone experienced an approximately 2.8 billion USD loss as a result of Ebola, particularly impacting private sector growth, agricultural production, and cross-border trade (World Bank, 2016; CDC, 2014). A first immediate effect has been a drastic reduction in remittances, sent from African migrants in Europe to their families at home. The World Bank estimates that remittance flows will decrease by 14 percent between 2019 and 2021 (World Bank, 2021). The pandemic may also have important ramifications for not only humanitarian aid, but also development aid. For the first time in history, numerous African countries closed their borders to foreigners, and international aid workers returned home once COVID-19 struck the world. COVID-19 might arguably accelerate calls for the localisation of aid. Donor countries and organisations are in financial crisis, and several large organisations, for example, Oxfam, closed their offices beginning in March 2020 and brought home their international staff. Will we witness the localisation of development and humanitarian aid to recipient countries?
In addition to the economic impact of COVID-19 in Sub-Saharan Africa, the pandemic has also had a notable political impact, as numerous authoritarian-leaning leaders reinforce authoritarian measures based on the pandemic response, for example, the justification of oppressive security forces. Numerous observers believe the true cost of COVID-19 on the continent was an erosion of human rights and democracy (Africa Report, 2021). For instance, in Kenya, South Africa, and Rwanda, security forces implementing curfews and quarantine have been accused of violating human right. Allegedly authoritarian and authoritarian-leaning leaders in Guinea, Uganda, Zambia, and Zimbabwe, as well as elsewhere, capitalise on social distancing measures to stamp out protests and strikes, as well as postpone elections (Africa Report, 2021). Particularly in the West African subregion, where authoritarianism was on the rise pre-COVID, authoritarian-leaning leaders justify these measures on the basis of national health security.
As part of the COVID-19 response, Sierra Leone Autistic Society provides donations of food and supplies to families in Freetown and Makeni, Sierra Leone.Photo courtesy of Sierra Leone Autistic Society.
Though COVID-19 cases are relatively low on the African continent as compared with elsewhere, the pandemic is expected to last the longest because of limited vaccine coverage, just as the Ebola epidemic ended in the most isolated, hard-to-reach, part of Guinea. The ring vaccination method worked effectively in Lower Guinea in 2015, and again when it flared up in Koropara in 2016 (WHO, 2019). “Vaccine hoarding” in wealthy countries likely means that Africa will not have vaccine coverage, enabling the “return to normal”, until the end of 2023, if at all (WHO, 2021). The pandemic may not have yet touched the continent the same way it has in the developed world, however, Africa is likely to be the last place COVID-19 ends. Just as there has been global solidarity among scientists in finding a vaccine, the same global solidarity will be needed to distribute it, especially in terms of sharing the burden of vaccine costs. Most importantly, Ebola showed the importance of local organisations in epidemic response, and these organisations will be especially important in ending the COVID-19 pandemic globally.
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Acknowledgements: The author would like to acknowledge feedback from Emmanuelle Roth at the University of Cambridge.
Author Bio: Michelle Reddy is a Postdoctoral Scholar at the CERI, Sciences Po. She draws on comparative politics and organizational sociology to examine local organizations during crisis response, including Ebola, COVID-19, and the migration crisis. From 2017-2018 Michelle was a Fulbright Scholar in Sierra Leone and Guinea. In addition, she studies the framing of crises, and the emergence and evolution of education, health, and civil society organisations. Michelle received her PhD from Stanford University and is a lecturer at the Paris School of International Affairs. She has worked as a consultant for numerous international organisations, including the United Nations Office for West Africa and UNESCO.
Michelle Reddy is a member of the The Politics of Migration and Asylum Crisis in Europe (PACE) project.