Thursday 4 September 2014

Ebola: 3069, West African Governments: 0


The best way to test Government promises is to count dead bodies. Governments in West Africa (perhaps in talking of governments I am being too generous) have not covered themselves in glory when purporting to look after their citizens. They neglect to provide their health workers with adequate facilities, and often don’t pay their salaries, and are better at public bombast than local practicalities. In the years before this outbreak they have not put in the health infrastructure that even a poor country like Cuba was able to do five decades ago, though Cuba was better off to begin with, and has risen since. They have not managed their economies with sufficient foresight to have plans in place for a disease which has been known since 1976 and which has mutated very little over that period. They don’t appear to have been able to teach their citizens about disease control. Black citizens in Cuba are doing better than black citizens in West Africa, even though several of those countries have had black leadership since 1792 and full independence since 1961. These governments do not appear to behave intelligently and altruistically. The leaders may simply be dull.

A new paper by Rindermann, Kodila-Tedika, and Christainsen shows the relationship between governance and intelligence:

Good governance is a critical factor for the wealth of nations insofar as it shapes political and economic institutions and affects overall economic performance. The quality of governance, in turn, depends on the attributes of the people involved. In an analysis based on international data, government effectiveness was related to the cognitive human capital of the society as a whole, of the intellectual class, and of leading politicians. The importance of cognitive capital was reflected in the rate of innovation, the degree of economic freedom, and country competitiveness, all of which were found to have an impact on the level of productivity (GDP per capita) and wealth (per adult). Correlation, regression, and path analyses involving N=98 to 201 countries showed that government effectiveness had a very strong impact on productivity and wealth (total standardized effects of beta=.56-.68). The intellectual class’s cognitive competence, seen as background factor and indicated by scores for the top 5 percent of the population on PISA, TIMSS and PIRLS, also had a strong impact (beta=.50-.54). Cross-lagged panel designs were used to establish causal directions, including backward effects from economic freedom and wealth on governance. The use of further controls showed no independent impacts on per capita wealth coming from geographical variables or natural resource rents.

The citizens of West Africa may be right to doubt every word their Governments say, but in doubting the means of transmission of Ebola they are not behaving intelligently themselves. Currently, West Africa is behaving in line with the predictions of those much maligned measures, intelligence tests. Governments and populace alike are making a mess of their response to an infectious disease, a threat which usually tests the ability and morality of a society:

Prof Peter Piot, who found the virus in 1976 said on 29 August: "We have a situation where Ebola finds an enormously fertile ground in very poor countries with very dysfunctional health systems."

Dr. Tom Frieden, director of the US Centers for Disease Control and Prevention, gave a lengthy press conference immediately after returning to the US (2nd September) from a visit to the Ebola zone. The whole transcript is on this page, and it is worth a read, but here are some highlights:

“Despite tremendous efforts from the U.S.  Government, from CDC, from within countries, the number of cases continues to increase and is now increasing rapidly. I’m afraid over the next few weeks those numbers are likely to increase further and significantly.  There is a window of opportunity to tamp this down, but that window is closing. We need action now to scale up the response. We know how to stop Ebola. The challenge is to scale it up to the massive levels needed to stop this outbreak.”

“The number of cases is increasing so quickly that for every day’s delay, it becomes that much harder to stop it. There are three key things that we need. The first is more resources.  This is going to take a lot to confront. The second are technical experts in health care and management to help in country. And the third is a global coordinated unified approach because this is not just a program for … West Africa, it’s not just a problem for Africa, it’s a problem for the world and the world needs to respond.”

“In some ways the most upsetting thing I saw is what I didn’t see.  I didn’t see enough beds for treatment.  So in one facility which had just opened with 35 beds, there were 63 patients, many of them lying on the ground.  I didn’t see data coming in from large parts of the country where Ebola might be spreading.  I didn’t see the kind of rapid response team that’s needed to stop a single cluster from becoming a large outbreak.  I didn’t see the kind of efficient management systems and support and transport and jeeps that are essential for a rapid and effective response.”

“Everything I’ve seen suggests over the next few weeks it’s likely to get worse.  We’re likely to see significant increases in cases.  Already we have widespread transmission in Liberia.  In Sierra Leone, we are seeing strong signs that that will happen in the near future.”

“There’s a real risk to the stability and security of societies as governments are increasingly challenged to not only control Ebola but provide basic health services, security services, and keep the government running, the stability of these countries, of their economies, of their neighbors and of others is increasingly at risk.”

“There is a theoretical risk that may be very low: we simply don’t know that Ebola could become easier to spread through genetic mutation.  That risk may be very low, but it’s probably not zero.  The longer it spreads, the higher the risk.”

“In theory it’s not hard to stop Ebola.  We know what to do.  Find patients quickly.  Isolate them effectively and promptly.  Treat them.  Make sure their contacts are traced and tracked for 21 days, if they develop fever, do the same thing and make sure they’re tested and treated.  Make sure health care is safe and that burial practices are safe.  The challenge is not those efforts, it’s doing them consistently at the scale that we need.”

“One of the most experienced Ebola experts in the world was there on one of my site visits, his comment to me summed up my visit.  What has worked to stop every Ebola outbreak until now will work here if we can get it to scale.”

“The window of opportunity really is closing. I could not possibly overstate the need for an urgent response.”

To make the most of the window of opportunity the governments of West Africa should be giving all of their citizens the following advice:

1 Wash your hands with soap and water as often as possible;

2 Air dry your hands rather than use a towel;

3 Don’t shake hands;

4 Don’t touch someone suspected of having Ebola, not even a family member;

5 Get medical help for suspected Ebola patients and afterwards burn their clothes, sheets and mattresses;

6 Do not touch the body of someone who has died of Ebola, not even as part of a respectful burial ritual; bury the body deep in the ground.

7 Above all, no bushmeat: don’t eat or even touch bats, monkeys and chimpanzees.

None of this is very complicated, and getting these things right should help with the control of all infectious diseases.

How do we deal with governments? If you know someone with contacts in West African governments, see if you can get them to take in and implement the following requirements:

1 Find patients quickly. 

2 Isolate them effectively and promptly. 

3 Treat them. 

4 Make sure their contacts are traced and tracked for 21 days.

5 If those contacts develop fever, do steps 2 and 3 with them. 

6 Make sure health care is safe and that burial practices are safe. 

Finally, a note about heroic doctors and nurses who have died of Ebola. Dead doctors help no patients. Medecins Sans Frontiers has not lost any doctors. There is absolutely no point sending doctors or nurses to work in circumstances where they are exhausted, under-staffed, and under-resourced. There is no point in extremely altruistic medical volunteers going to work in settings where they will eventually fail to follow barrier protocols and become ill themselves. They are not helping, particularly when they have to be specially air lifted back to the West to be treated. Catching something you don’t have to catch if you take basic precautions is not heroic. It is not intelligent either.


  1. Your advice on what should be done seems harsh to me.

    It seems to me that you are saying that we should send posters listing your 6 steps and let them deal with it.

    And if they don't have the human capital to deal with the situation then so what.

    Seems really harsh.

    Especially since I think you and I know that it is likely that the "governments" will
    be ineffective in implementing the 6 steps.

  2. Not intended to be harsh. I am frustrated by their lack of care for their citizens. Giving them advice does not preclude also giving them help in other ways. As to human capital, governments have had since 1961 at the very least, to build it up, and should be held to account, just like governments everywhere.

  3. Never mind Cuba or Costa Rica, a lot of West African countries would be better off if they could achieve the levels of public health, public services, and efficiency of Haiti, and I'm not kidding.

  4. Nigeria Government has to take necessary steps for Ebola .
    ebola in West Africa