Breaking the Fever

With Ophelia Dahl just back from Liberia and Sierra Leone, Jeffrey Sachs, the economist and poverty guru, and Dr. Jim Cunningham, the virus detective, we’re reckoning with Ebola, still the world’s biggest story. We’re looking for long-term cures that will outlast this feverish moment in American media.

We’re curious about the prehistory of this disease, first manifest in 1976. This time, it spread from a child in the Guinean countryside a year ago to the gates of West Africa’s biggest cities. Where will it go, or not go, next?

Richard Preston in The New Yorker tells of the death of Dr. Sheik Umar Khan, on the frontlines in Liberia heroically treating hemorrhagic fevers and then succumbing to one, and about the race to beat the disease: with a drug, or a vaccine. (But it’s Preston, of course, who introduced the world to Ebola as an almost biblical plague in The Hot Zone, and its film adaptation, Outbreak.)

What have we learned? That countries like Liberia are still dealing with massive shortfalls in health infrastructure, but that countries like Nigeria can contain Ebola. That even with our behemoth medical establishment, we can still get the chills when a tropical disease lands on our shores. That we could close the borders, but that we certainly shouldn’t. And that, to quote Dylan Matthews at Vox, we can politicize anything.

The question: what does the Ebola outbreak, and American worries about it, say about the global age? And what’s to be done?

Guest List
Ophelia Dahl
co-founder and president of Partners in Health.
Jeffrey Sachs
American economist, director of the Earth Institute at Columbia University, and author of The End of Poverty: Economic Possibilities for Our Time.  
Jim Cunningham
virologist specializing in Ebola at Brigham & Women's Hospital, and at Harvard University's Virology Lab.

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  • Cambridge Forecast

    EPIDEMICS AND POWERLESSNESS OIN A GLOBAL SCALE

    Professor Sachs made the passing comment during the excellent ROS Ebola discussion, that AIDS may have originated in West Africa in 1920.
    If you think of World War I as a kind of upside-down globalization by death and disease, one can profitably link this Ebola show with the ROS WWI series.

    As mental preparation, think back to the opening scenes of the 1950’s hit movie “The African Queen” with Bogart playing Charlie Allnutt and Hepburn doing Rose Sayer. How does the movie begin?
    It’s August/September 1914 and WWI comes to Africa and not just Europe,
    and In the very first minutes, German troops are burning African villages in German East Africa and Charlie Allnut (Bogart) realizes the Germans plan to depopulate and eradicate villages so the Africans natives have nowhere to go but into military slave labor under the German soldier-overlords. Robert Morley (playing Rose’s brother) protests to the German soldiers and dies from his beating. This “launches” the movie.

    Scholars like Paice who have studied the effects of these brutalizations in and of Africa tell us:
    By 1917 the conscription of c. 1,000,000 Africans as carriers, had depopulated many districts and c. 95,000 porters had died, among them 20% of the British Carrier Corps in East Africa.. A Colonial Office official wrote that the East African campaign had not become a scandal only “…. because the people who suffered most were the carriers – and after all, who cares about native carriers?”

    In the German colonies, no records of the number of people conscripted or casualties were kept but in the German Official History, Ludwig Boell (1951) wrote
    …. of the loss of levies, carriers and boys [sic] [we could] make no overall count due to the absence of detailed sickness records.2.

    This scholar Paice refers to a 1989 estimate of 350,000 casualties and a death rate of 1:7 people. Carriers impressed by the Germans were rarely paid and food and cattle were stolen from civilians; a famine caused by the consequent food shortage and poor rains in 1917, led to another 300,000
    civilian deaths in Ruanda, Urundi and German East Africa.3.
    The impressment of farm labor in British East Africa, the failure of the rains
    at the end of 1917 and early 1918 led to famine and in September Spanish
    flu reached sub-Saharan Africa. In British East Africa 160,000–200,000 people died, in South Africa there were 250,000–350,000 deaths and in German East Africa 10–20 % of the population died of famine and disease; in sub-Saharan Africa, c.1,500,000–2,000,000 people died in the epidemic.4.

    2. Paice 2007, p. 393.
    3. Paice 2007, p. 398.
    4. Paice 2007, pp. 393–398.

    Paice, E. (2007). Tip and Run: The Untold Tragedy of the Great War in Africa
    (Phoenix 2009 ed.). London: Weidenfeld & Nicholson. ISBN 978-0-7538-2349-1.
    One might speculate that the WWI-related Spanish flu might have had multiple causal links to the subsequent emergence of the AIDS phenomenon mentioned by Prof. Sachs.
    In other words, the whole history of Western conquest of indigenous peoples
    worldwide and conquistador behavior in subjugating and despoiling and looting
    them has fed into native deaths in the many millions. (whether smallpox in the Americas, or Spanish flu/AIDS in Africa.).

    War, conquest, epidemic disease are interlinked and this backdrop to the fun movie ‘The African Queen” might well be pondered to get a deeper understanding of what the movie tells you beyond the drolleries and presentation of colorful personalities.
    See also:

    World War I casualties

    http://en.wikipedia.org/wiki/African_theatre_of_World_War_I

    Richard Melson

  • Cambridge Forecast

    AFRICAN MICROBIAL ECOLOGY AS A BACKDROP TO EBOLA

    Is there something we can say about Africa as some kind of ecological
    incubator of Ebola and AIDS-type phenomena? Does this have to do with
    mosquitoes and tsetse flies?

    Before trying to say something about this, utilize the movie “Out of Africa” as a fun way to
    prepare:
    In the movie we have at least three life-threatening illnesses:

    1, “Karen” (Meryl Streep) contracts syphilis from her husband Bror and has to voyage back to Denmark for Salvarsan therapy, Paul Ehrlich’s arsenic-based treatment. The year is circa
    1915. One wonders: if Salvarsan is available in Denmark, is it not available in Africa in British East where Karen is diagnosed?

    2. the African boy who becomes her cook has some severe leg sore and she (“Karen”) bandages him up and gets him to the hospital and he recovers.

    3. “Barkley Cole” (the safari business partner of “Dennis Finch Hatton” (Robert Redford) dies of blackwater fever, a mainly subsaharan African variant or sequel of malaria.

    (This malady is mentioned in several Hemingway Africa stories.)

    (I don’t remember if “Karen” ever losses any of her coffee crop to plant diseases.)

    The great University of Chicago historian,William H. McNeill wrote a masterful survey and interpretation of illnesses in his classic work, “Plagues and Peoples”.

    McNeill writes:

    “The interactions that produced and sustained such fluctuating (ecological–RM) balances were and remain extremely complex. Despite several generations of scientific
    observation, the interrelationships of disease, food supply, human densities,
    habit patterns, not to mention insect vectors of disease and the number and
    distribution of alternate hosts for disease-causing organisms, are not fully
    understood in Africa….Morever, conditions in contemporary Africa do not exactly
    match the patterns of infection and infestation that must have existed when all
    men were hunters and before agriculture intruded upon older natural balances.
    (“Plagues and People”, Anchor Books paperback, 1975, page 22).

    “ Yet the multiplicity of life forms in tropical Africa is an undeniable fact…the extraordinary variety
    of human parasites that exist in Africa suggests that Africa was the principal
    cradle for humankind, for nowhere else did the adjustment between human and
    nonhuman forms of life achieve anything like the same biological elaboration.”
    (book page 23)

    “Many of the parasitic worms and protozoa that abound in Africa do not
    provoke immune reactions ie the formation of antibodies in the bloodstream.

    This allows a sensate and quite automatic ecological balance to assert itself…” (book page 21)

    One wonders if Ebola, malaria, AIDS, blackwater fever have something to do not only with zoonosis (man animal interaction) but also with McNeill’s depiction of these African
    “biological elaborations.”

    Lastly: The Fred Zinneman movie masterpiece “The Nun’s Story” (1959?) with Audrey Hepburn concerns illnesses in the Belgian Congo on the eve of WWII and the microscopy concerning them.

    Richard Melson

  • Cambridge Forecast

    CAN THE EBOLA VIRUS SPEAK?

    Think of the very savvy ROS side-comment for this show: “What does the Ebola outbreak say about the state of the world”? Also from the ROS setup essay:
    “The question: what does the Ebola outbreak, and American worries about it, say about the global age? And what’s to be done?”

    In this comment, in the same spirit as those two shrewd ROS questions above, I’d like to “zoom out” and look at a phenomenon like Ebola from a completely unexpected and even initially strange-sounding vantage point, far from virology and pharmaceutical research by themselves.

    First, an info detail: Professor Roger Owen the Harvard Middle East economic historian interviewed by Radio Open Source in 2012 has a very heterodox book title on his course syllabus:
    Rule of Experts: Egypt, Techno-Politics, Modernity
    Timothy Mitchell (Author) (Professor Columbia University)
    Paperback, 429 pages
    The first chapter of this book carries the title: “Can the Mosquito Speak”?

    This is a variant of a famous 1988 essay “Can the Subaltern Speak”? (a subaltern is a colonized “nobody” in world history, someone who doesn’t make history but suffers or undergoes
    history as a nonentity).

    See:
    http://www.amazon.com/Critique-Postcolonial-Reason-History-Vanishing/dp/0674177649/ref=pd_bxgy_b_text_y

    The author tries to link Egypt’s history in a way that everything reacts with everything else: Mosquito invasions with WWII army invasions, the government, water policy, agriculture, diseases, all influencing each other in a total picture.

    The book writeup reads:

    “Rule of Experts examines
    these questions through a series of interrelated essays focused on Egypt in the
    twentieth century. These explore the way malaria, sugar cane, war, and
    nationalism interacted to produce the techno-politics of the modern Egyptian
    state; the forms of debt, discipline, and violence that founded the institution
    of private property; the methods of measurement, circulation, and exchange that
    produced the novel idea of a national “economy,” yet made its
    accurate representation impossible; the stereotypes and plagiarisms that
    created the scholarly image of the Egyptian peasant; and the interaction of
    social logics, horticultural imperatives, powers of desire, and political forces
    that turned programs of economic reform in unanticipated directions.”

    ISBN: 9780520232624 November 2002

    See:
    http://www.ucpress.edu/book.php?isbn=9780520232624

    His main argument is that conceptualised modernity is flawed, and that consequently any development project pursued within this framework is unlikely to achieve its proclaimed ends. “We have entered the twenty-first century,” Mitchell writes, still divided by a way of
    thinking inherited from the nineteenth …
    The book is divided into an introduction, followed by three subsections of three chapters each that deal with themes of history and globalizing forces, peasant studies, and economic reform. It is within these chapters that Mitchell challenges accepted notions of “logic or
    rationality attributed to modernity, the market, law, science, technology,
    [and] capitalism” (p. 14). He does so in a unique and highly successful way.”

    “Rule of Experts” is advertised as falling within politics, Middle Eastern studies, and anthropology. This is accurate, but the book also deals with economics, sociology, peasant studies, and history.
    The first chapter, “Can the Mosquito Speak?” offers a glimpse of Mitchell’s overall vision. Human agency, in the form of war and colonialism, is portrayed as the central factor that mired Egypt in
    stagnation.

    Mitchell agrees to an extent but then proceeds to explain that in addition to the effects of the Second World War, Egypt had experienced another, more devastating, invader that is seldom mentioned in its development narrative. Anopheles gambiae, a mosquito native to
    sub-Saharan Africa and never found in Egypt prior to the summer of 1942, invaded Upper Egypt. This non-human agent was far more ruinous than the German invasion. The
    mosquitoes bore a virulent, malignant strand of malaria called Plasmodium
    falciparum. While the war was responsible for between 50,000 and 70,000
    deaths, it was a secondary factor compared to the 100,000 to 200,000 deaths
    caused by the mosquitoes. Why, then, is Mitchell’s one of the first in-depth
    accounts of these mosquitoes and the death they brought? Surely the infection
    of three-quarters of a million people negatively affected Egyptian development
    in terms of human resources and capital? Mitchell argues that the mosquitoes
    have been omitted from Egypt’s development narrative because they are not human actors. Social scientists prefer to focus on humans as the sole agents and causes of change.

    Yet Mitchell is not so simplistic as to maintain that non-human agents were the sole reason for Egypt’s hindered development. He explains that the interconnectedness of human and non‑human agency over decades provided amenable conditions for the mosquitoes’ invasion. For example, he notes that the first Aswan Dam, completed in 1933, changed the sediment that
    reached Upper Egypt, creating fertile breeding grounds for mosquitoes. Again, the British colonial military, because of the German presence in the north, altered shipping routes in such a way that mosquitoes were transported to Egypt aboard vessels from Sudan.
    And although the United States possessed a remedy for this malarial strain, its help was not sought because the British feared increased US involvement in Egypt.”

    Domestic Cairene politics also obstructed counter-measures as “expert” political technocrats debated the most efficient way to handle the mosquito invasion. A key factor contributing to the
    mosquitoes’ domination of Upper Egyptian villages was the residents’ high sugar
    consumption. Traditionally, because the regional cash crop is sugar cane, Upper
    Egyptians consume disproportionate amounts of sugar. This made their blood
    particularly attractive to the mosquitoes. Indeed, Mitchell notes that in the
    biggest sugar-cane plantation near Luxor, malaria is said to have affected 80 to 90 per cent of the people. Doctors in the nearby town of Armant claimed there were eighty to ninety deaths a day (p. 21).

    This retelling of Mitchell’s account scarcely does justice to its richness. He successfully weaves together a complexity of factors and influences, and his argument that human agency alone is
    insufficient to explain the historical course of Egyptian development is an
    important contribution. As Mitchell puts it, “Individuals may at times secure
    control of certain elements, and they may even claim to represent those
    elements in the social world. But no individual masters them, or submits the
    world to their intentions” (p. 34). Mitchell’s revisionist history combines
    several layers, showing how war, political manoeuvring, colonial ambitions,
    nature, and domestic consumption united to produce the devastating mosquito
    plague of 1942. It calls for a rethinking of how social scientists practise
    their trade and for more consideration to be given to non-human agents as
    contributory variables in a country’s development narrative.”

    Now imagine that one could begin to look at West Africa, Sierra Leone and Liberia and Guinea and the Ebola “hot spot” epicenters in the originary villages in this type of panoramic or “holographic” way.

    Perhaps one might call this holistic quest, “Can the Ebola Virus Speak”? modelled on Mitchell’s question, “Can the Mosquito Speak.”?

    Richard Melson