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The great ebola scare

It is being called the most severe health emergency of modern times. But are the fears of mass contagion in the west overblown?

It is, according to the World Health Organisation director general, Margaret Chan, the “most severe acute health emergency in modern times”, one that is “threatening the very survival of societies and governments in already very poor countries”. Almost 4,500 people have been killed by the ebola outbreak in West Africa. Although most of the deaths have occurred in just three countries – Liberia, Sierra Leone and Guinea – where infection rates are still rising exponentially, western governments are preparing themselves for the arrival of the virus on their shores. The US and Spain have confirmed cases, and in the UK Jeremy Hunt, the Health Secretary, expects ebola to be putting the National Health Service to the test by Christmas.

Amid the rising panic, a few calm voices are struggling to be heard. Sarah Wollaston, who chairs the House of Commons health select committee, has said that she expects the UK to get five cases in total, at the rate of roughly one a month. The NHS, she says, is perfectly ready and able to cope. Seth Berkley, chief executive of the Global Alliance for Vaccines and Immunisation, concurs: ebola is not a disease you have to fear when living in a wealthy country. “The likelihood of this causing a major epidemic in Europe or the US is very, very low,” he says.

The rapid transmission in West Africa is largely a result of broken civil structures and health-care systems. Sierra Leone and Liberia are recovering from decades of conflict that also sucked in neighbouring Guinea. The consequences are a dearth of medical resources and a mistrust of government: a perfect storm that leads the population to pay scant attention to advice from the state. Diagnosis of the disease has been slow and in some areas people have insisted on following local traditions, rather than best practice, when caring for – and disposing of – ebola-stricken relatives. This is what has cleared a path for the virus through the population of these countries. In the west, with highly responsive and respected health-care systems and no tradition of physical contact with the sick or dead, there should be little worry. The boring flu virus is more likely to get us, and yet we have let ebola, a somewhat self-defeating virus, become a major concern. It might be said that we are suffering from Ebola Panic Disorder.

Ebola is not an especially dangerous pathogen. It was first identified in 1976 but because it did not seem much of a threat a vaccine was never developed. Periodic outbreaks were fairly easily contained. A few hundred people died in Africa but no money or urgency was given to finding a cure. The US military paid ebola a bit of attention at first, in case it could be weaponised. That interest soon waned, however: bioterrorists would find it almost useless. It coexists happily with certain animal hosts – the current outbreak originated in fruit bats – but is so deadly to us that the virus is normally stopped in its tracks.

“It’s not airborne, and it kills its victims too quickly for them to pass it on efficiently: it just doesn’t spread fast enough,” says Melissa Leach, director of the Institute of Development Studies at the University of Sussex.

The virus is carried in body fluids and enters through cuts in the skin or through mucous membranes. Infection can occur through sexual intercourse, ingestion of breast milk and through physical contact if protective measures are not taken. Once ebola takes hold, it disables its host’s immune system. Survival depends on certain factors. One is simply the strain of the virus (some are deadlier than others). Another is early and copious use of rehydration solution, replacing the fluids that the disease will cause to leak from the body. In some cases, a transfusion of plasma from a recovered victim has also assisted recovery.


The first signs of infection are fever and malaise; a few days later come diarrhoea, nausea, vomiting and abdominal pain. Despite the frenzied reporting, bleeding from the eyes is not that common. However, the ebola virus halts the mechanism that clots blood, and gastrointestinal bleeding is a common symptom. Eventually, the mucous membranes (including those in the eyes) and any cuts or other wounds may ooze blood continuously. If you are going to die of the disease, you will usually know by about day six after the first symptoms show – the point at which most surviving patients’ condition has improved. The last stages of the disease are painful and horrific. The average time to death in West Africa, mostly through septic shock and multiple organ failure, has been just over a week.

It is what happens next that presents the greatest problem. Traditional funerals in the affected countries often require relatives to wash the corpse, in some cases multiple times over a few days. This provides an opportunity for the virus in the dead person’s leaking body fluids to make the leap into a new host. Disposing of the body while following strict protocols – using disinfectant while wearing full-cover protective clothing – cuts the risk of transmission to near zero.

This has been proven time and again in previous ebola outbreaks. The protective protocols are so straightforward, in fact, that rural communities in parts of Africa have been successfully implementing them for decades without outside help. Some of the flare-ups in the Democratic Republic of Congo have been staunched rapidly without ever coming to prominence in the western media. Two other West African countries have had cases in the recent outbreak, but contained them by implementing stringent public health measures. In Nigeria, which has a population of 170 million and where roughly 15 million live in Lagos alone, eight people have died (of 20 confirmed cases) and there are now no residual infections. In Senegal, just one person has died.

So while we should be doing all we can to help West African countries deal with the disease, there is little reason for us to panic in the west – especially as a vaccine is in development. Two vaccine candidates have proved promising in animal trials, and human safety tests run by the University of Oxford began last month. If the vaccines perform as well as expected, and mass-production techniques are developed in time, 2015 might bring a huge effort to eradicate susceptibility to animal-borne ebola.

Seen in this light, both the tragedy playing out in West Africa and the panic besetting the developed world are actually a result of ebola’s lack of virulence. As Berkley points out, a vaccine is finally being developed, not because of the disease ravaging Africa, but because of a sudden realisation that, as a result of poor decision-making early in the current outbreak, the disease is not necessarily going to stay in Africa this time. “It’s more about fear of the disease taking hold in the west than it is about the disease in the south,” he says.


The threat has arisen because no one in charge realised that it would be so tough to implement even straightforward protection protocols in the broken health-care systems of Liberia and Sierra Leone in particular. The index case (that is, the first one) in the present outbreak was reported in December last year and attracted no response. “Then, very late, the international community started to get interested,” Melissa Leach says. “And the focus was on how we contain and control this.”

Leach sits on the Scientific Advisory Group for Emergencies, which informs the government about risks and recommends strategies. The discourse has at last evolved, she says: the decision to scale up aid was well motivated, and the entire discussion about how we help stop the disease killing people in West Africa, rather than how to prevent it coming here. Nonetheless, motivating politicians to do the right thing did require some discourse about the threat to the UK, channelled through the media. And that’s when the silliness started.

There is a stark contrast between the calm, low-profile checks on NHS preparedness for ebola and the pointless but highly visible implementation of screening programmes at UK airports. The latter is only to allay public fears; it is close to impossible to spot ebola-carrying travellers. Yet in some senses the panic is predictably human, according to Wandi Bruine de Bruin, professor of behavioural decision-making at Leeds University Business School. One reason we are failing to assess the risk sensibly, she says, is that we hear stories of things such as people bleeding from their eyes; it is an upsetting mental image, and one that hampers our cognitive processing. “People use the emotions they feel about an event as a ‘mental short cut’ for assessing risk,” she says. “Horrific images of ebola are likely to evoke strong negative emotions, potentially leading to higher perceptions of risk.”

Another issue highlighted by de Bruin’s research is the human need for control. The two biggest threats in the developed world are stroke and heart disease. The problem is, stroke, heart disease – and cancer – are slow and steady killers. These are familiar, comfortable threats; it doesn’t feel as if they’re out of control. Ebola is different.

No matter how few deaths have occurred compared to other diseases, or what the likelihood of coming into contact with an ebola-infected person might be, if many people are being afflicted at once, in an unfamiliar environment, with a disease that evokes horror and has no cure – that is a frightening scenario, and our control-hungry minds are disturbed by it.

It’s easy to see this playing out in the US and Europe but it is also at work in West Africa, says Heidi Larson, an anthropologist who researches interactions with health-care systems at the London School of Hygiene and Tropical Medicine. “They are freaked out,” she says. “Look at the levels of panic and anxiety after one case in a western country: imagine how the people of West Africa feel.” It is almost certainly a desperate desire for control that is keeping people away from health centres, she argues. “Who would want to go to a hospital if you didn’t have to right now?” The same desire compels people to maintain customary burial practices, keeping infection rates high.


One consequence is that it’s not just ebola that is running rampant in West Africa. Now that the hospitals are no longer seen as places where you take control of a disease, malaria, pregnancy complications, pneumonia and dysentery will kill even more people than usual. Not that there would be resources to deal with these afflictions even if people did present themselves at clinics and hospitals. Health-care workers are consumed, sometimes literally, by ebola: there is no slack in the system.

Those who do seek care when ebola symptoms manifest are thrust into an environment that creates even more fear and loss of control. Generally in the west, we have little contact with the sick; we leave them in the care of professionals. In many West African hospitals, doctors and nurses are for diagnosis and treatment; everything else is the family’s responsibility. If your child or your partner is hospitalised, you take them food, give them fluids, wash them and meet all their basic needs. You touch them, hold their hand, reassure them it’s going to be all right. But not with ebola.

“They see a family member getting sick; they’re not supposed to touch them; they’re told that they are to be taken away to a place where they can’t be accessed, and that they may never see them again,” Larson says. The prospect is too much for many to cope with; hence the suspicion that Guinea, Liberia and Sierra Leone are harbouring many unreported cases. “The panicked relatives are the real risk.”

These fears can be allayed. Health-care workers in previous outbreaks in the DRC became so concerned by the disengagement of families that they changed disposal routines. Bodies would be disinfected and bagged in front of relatives, who were given protective clothing. The bagged corpse was physically handed to the family, and family members put it into a grave. These rituals, performed 30 times a day at the peak of one outbreak, seemed at first to be a waste of precious resources. However, in the longer term, increasing relatives’ engagement with the health-care system helped stem the tide of new infections.

Implementing such measures requires trust in the authorities and donor agencies – a rare currency in West Africa now. Many developing countries have lost confidence in western programmes, says Didier Raoult, a disease researcher at Aix-Marseilles University. Several high-profile failures are to blame, he notes. In what he calls the “Haiti mess”, international aid workers imported cholera into the country following the 2010 earthquake and killed more than twice as many people as have died in the present ebola outbreak.

The CIA’s covert use of a vaccination programme in Pakistan to try to identify Osama Bin Laden’s children was, in effect, a subversion of essential aid programmes to protect a few westerners from the possibility of death in terror attacks. “That undermined our credibility,” Raoult says. It led to a long-standing boycott of vaccination drives and attacks on health workers, causing enormous setbacks to the effort to eradicate diseases such as polio.

Mistrust is also a problem in the UK, where the panicked reaction to ebola can be correlated with the public mood. Unpopular political leaders and a loss of confidence in the NHS are potent stimulants to overreaction. “People underestimate the amount that underlying political or social issues affect the public’s reaction to an event,” Larson says. “Think about the MMR [jab] scare. The panic around that was because it came hot on the heels of the poorly managed and frightening BSE saga.” The result was a severely reduced uptake of vaccines and an ensuing series of measles outbreaks. The west’s reaction to ebola, given our current economic and political gloom, will be similarly exaggerated, she suggests.

It is vital that we stem the panic, otherwise our reaction will be short-sighted and short-lived. During an outbreak of plague in India a few years ago, health-care workers went to the world’s premier plague labs for help and found none; the researchers had retired and hadn’t been replaced. “There was no capability almost anywhere to work on this disease,” Berkley says. “Because we don’t see these diseases commonly, we get hysterical, and then when it’s over we tend to move completely away from it.”

Stringent budget cuts at WHO and other agencies and a lack of political attention to global health challenges between outbreaks have exacerbated the crisis in West Africa, and heightened the wider panic, Berkley reckons. Contrast that with our preparedness for nuclear war. “The likelihood of that is pretty low but the UK has nuclear submarines going round the world, always available in case a nuclear attack occurs.

“Everybody accepts it’s OK to spend the money on armed forces and nuclear submarines, but when you say, ‘Let’s keep disease labs up to date, let’s keep a fast response team, let’s do the training necessary to prepare for an outbreak,’ people don’t respond. There’s no perspective.” 

Michael Brooks is the New Statesman’s science correspondent. His latest book is “At the Edge of Uncertainty: 11 Discoveries Taking Science By Surprise” (Profile, £12.99)

Michael Brooks holds a PhD in quantum physics. He writes a weekly science column for the New Statesman, and his most recent book is At the Edge of Uncertainty: 11 Discoveries Taking Science by Surprise.

This article first appeared in the 15 October 2014 issue of the New Statesman, Isis can be beaten

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Why did the Tunisian National Dialogue Quartet win this year's Nobel Peace Prize?

Thanks to Tunisia, it is no longer possible to argue that the Middle East and North Africa are inherently undemocratic or prone to violence.

It is a fitting that in a tumultuous year for global peacemaking, the Nobel Peace Prize has been awarded to the little-known Tunisian National Dialogue Quartet, a coalition made up of the union federation UGTT, the employers’ institute, the Tunisian human rights league and the order of lawyers . Over the past few years, the Quartet has been quietly shepherded in democracy to the country that lit the fuse of the Arab Spring. In part thanks to the efforts of this broad cross-section of civil society, Tunisia has stayed the course in transitioning from an authoritarian past to a democratic future, even in the face of terrorist violence and as other revolutions in the region have faltered.

The award comes at a time of escalating sectarian conflicts in Syria, Libya and Yemen. Islamic State’s campaign of terror has uprooted Iraqis and Syrians alike, driving desperate refugees into small boats to battle the waves of the Mediterranean. They join others fleeing to Europe from political and economic crises in Africa and Asia, forming a stream of humanity symbolising failures in leadership in three continents.

Among all this, it is not hard to identify why the Norwegian Nobel Committee awarded the world’s most coveted peace prize to the Tunisian Quartet.

First,Tunisia deserves to be celebrated for its momentous achievements in consolidating democracy. Unlike other countries in the region, it has trodden a path that is slow but solid, adopting a comprehensive and consensus-building approach to decision-making.

In this it provides a rare and extremely important example, not only for the region but also for the world. Thanks to Tunisia, it is no longer possible to argue that the Middle East and North Africa are inherently undemocratic or prone to violence.

Civil society steps up

Second, the role of civil society is fundamental for bringing about sustainable peace. Political leadership is important, but the scale of the challenge in transitional societies means that we cannot simply leave things to political leaders to sort out.

At local level especially, peace feels a lot more real when it comes with tangible improvements to quality of life. Citizens want to see the economy motoring again and to have confidence in the state’s institutions. They want to know that they can sleep soundly and safely, without fear of violence, persecution or poverty. Governments often lack the capacity and credibility to deliver these dividends alone. Civil society must step up to the plate – particularly the associations of trade, justice and human rights of which the Quartet is formed.

And third, the Quartet’s work relies heavily on forming constructive relationships across the political spectrum – from secularists to fundamentalists. It has walked a fine line, keeping disparate groups with diverging interests invested in an inclusive national process of dialogue. It has, in the words of the Norwegian Nobel Committee, laid the “groundwork for a national fraternity”.

Politicians are often the most cynical of creatures, yet the Quartet has managed to build a sense of collective endeavour among them. It has encouraged them to put the country’s best interest ahead of personal or sectarian interests, making this the guiding principle for decision-making.

Other bright spots

The transition in Tunisia is a work in progress and there will be more setbacks and successes. The country was left reeling from two terrorist attacks earlier this year, when 22 people were killed at the Bardo Museum in Tunis, and another 39 people died during an attack on a tourist resort in Sousse. But the message today is clear – Tunisia has made remarkable progress since 2010, despite the odds. This is in large part due to a credible and engaged civil society, a remarkable achievement in a new democracy. The country has forged a path of inclusive national dialogue from which many lessons can be learned.

Elsewhere this year, Myanmar goes to the polls in November – the country’s first free national ballot since 1990. Colombia is closer to lasting peace than ever, ending half a century of war that has taken 220,00 lives and uprooted six million people.

The US restored diplomatic relationships with Cuba, and also struck a landmark agreement with Iran over its nuclear programmes. And the UN has adopted the sustainable development goals, explicitly recognising peaceful and inclusive societies as a development priority for the first time. Behind every step forward there is an individual or institution worthy of the Nobel Peace Prize, but only one can win and the Tunisian National Dialogue Quartet is a worthy laureate.

Laura Payne is a Research Fellow and Director of RISING Global Peace Forum, Coventry University

This article was originally published on The Conversation. Read the original article.


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What Jeremy Corbyn can learn from Orwell

Corbyn’s ideas may echo George Orwell’s – but they’d need Orwell’s Britain to work. It’s time Corbyn accepted the British as they are today.

All Labour Party leaderships since 1900 have offered themselves as “new”, but Tony Blair’s succession in 1994 triggered a break with the past so ruthless that the Labour leadership virtually declared war on the party. Now it is party members’ turn and they, for now at any rate, think that real Labour is Jeremy.

To Keir Hardie, real Labour had been a trade union lobby expounding Fellowship. To the Webbs, real Labour was “common ownership” by the best means available. Sidney’s Clause Four (adopted 1918) left open what that might be. In the 1920s, the Christian Socialist R H Tawney stitched Equality into the banner, but during the Depression young intellectuals such as Evan Durbin and Hugh Gaitskell designated Planning as Labour’s modern mission. After the Second World War, Clement Attlee followed the miners (and the London Passenger Transport Board) into Nationalisation. Harold Wilson tried to inject Science and Technology into the mix but everything after that was an attempt to move Labour away from state-regulated markets and in the direction of market-regulated states.

What made the recent leadership contest so alarming was how broken was the intellectual tradition. None of the candidates made anything of a long history of thinking about the relationship between socialism and what the people want. Yvette Cooper wanted to go over the numbers; only they were the wrong numbers. Andy Burnham twisted and turned. Liz Kendall based her bid on two words: “Have me.” Only Jeremy Corbyn seemed to have any kind of Labour narrative to tell and, of course, ever the ­rebel, he was not responsible for any of it. His conference address in Brighton was little more than the notes of a street-corner campaigner to a small crowd.

Given the paucity of thinking, and this being an English party for now, it is only a matter of time before George Orwell is brought in to see how Jeremy measures up. In fact, it’s happened already. Rafael Behr in the Guardian and Nick Cohen in the Spectator both see him as the kind of hard-left intellectual Orwell dreaded, while Charles Cooke in the National Review and Jason Cowley in the New Statesman joined unlikely fashion forces to take a side-look at Jeremy’s dreadful dress sense – to Orwell, a sure sign of a socialist. Cooke thought he looked like a “burned-out geography teacher at a third-rate comprehensive”. Cowley thought he looked like a red-brick university sociology lecturer circa 1978. Fair enough. He does. But there is more. Being a middle-class teetotal vegetarian bicycling socialistic feministic atheistic metropolitan anti-racist republican nice guy, with allotment and “squashily pacifist” leanings to match, clearly puts him in the land of the cranks as described by Orwell in The Road to Wigan Pier (1937) – one of “that dreary tribe of high-minded women and sandal-wearers and bearded fruit-juice drinkers who come flocking towards the smell of ‘progress’ like bluebottles to a dead cat”. And though Corbyn, as “a fully fledged, fully bearded, unabashed socialist” (Huffington Post), might make all true Orwellians twitch, he really made their day when he refused to sing the National Anthem. Orwell cited precisely that (see “The Lion and the Unicorn”, 1941) as an example of the distance between left-wing intellectuals and the people. It seemed that, by standing there, mouth shut, Comrade Corbyn didn’t just cut his wrists, he lay down full length in the coffin and pulled the lid shut.


Trouble is, this line of attack not only misrepresents the Labour leader, it misrepresents Orwell. For the great man was not as unflinchingly straight and true as some people think. It is impossible, for instance, to think of Orwell singing “God Save the King”, because he, too, was one of that “dreary tribe” of London lefties, and even when he joined Labour he remained ever the rebel. As for Corbyn, for a start, he is not badly dressed. He just doesn’t look like Chuka or Tristram. He may look like a threadbare schoolteacher, but Orwell was one twice over. Orwell was never a vegetarian or a teetotaller, but, like Corbyn, neither was he interested in fancy food (or drink), he kept an allotment, drove a motorbike, bicycled, cared about the poor, cared about the environment, loathed the empire, came close to pacifism at one point, and opposed war with Germany well past the time when it was reasonable to do so.

In Orwell’s thinking about socialism, for too long his main reference point was the London Marxist left. Not only did he make speeches in favour of revolutions, he took part in one with a gun in his hand. Orwell was far more interested, as Corbyn has been far more interested, in speaking truth to power than in holding office. His loyalty was to the movement, or at least the idea of the movement, not to MPs or the front bench, which he rarely mentioned. There is nothing in Corbyn’s position that would have shocked Orwell and, should they have met, there’d have been much to talk about: belief in public ownership and non-economic values, confidence in the state’s ability to make life better, progressive taxation, national health, state education, social care, anti-socially useless banking, anti-colonialism and a whole lot of other anti-isms besides. It’s hard to be sure what Orwell’s position would have been on Trident and immigration. Not Corbyn’s, I suspect. He was not as alert to feminism as he might have been but equally, few men try to write novels from a woman’s point of view and all Orwellians recognise that Julia is the dark hero of Nineteen Eighty-Four. In truth they are both austere types, not in it for themselves and not on anyone else’s expense account either. Corbyn won the leadership because this shone through from the very beginning. He came across as unaffected and straightforward – much as Orwell tried to be in his writing.

Except, as powerfully expressed in these pages by John Gray, Corbyn’s politics were made for another world. What sort of world would he need? First off, he’d need a regulated labour market: regulated by the state in partnership with a labour movement sensitive to what people wanted and experienced in trying to provide it. He would also need capital controls, a manufacturing base capable of building the new investment with Keynesian payback, an efficient and motivated Inland Revenue, a widespread public-service ethos that sees the country as an asset, not a market, and an overwhelming democratic mandate to get things done. In other words, Corbyn needs Orwell’s Britain – not this one – and at the very least, if he can’t have that, he needs the freedom to act that the European Commission forbids.

There’s another problem. Orwell did not trust left-wing intellectuals and spent half his life trying to work out their motivations as a class who spoke for the people, went in search of the people, and praised the people, but did not know them or believe in them. True, Corbyn says he wants to be open and inclusive, but we know he can’t possibly mean it when he says it will be the party, not him or the PLP, that will decide policy, just as we knew it couldn’t possibly be true when he said he’d turn PMQs into the People’s Question Time. Jeremy hasn’t changed his mind in forty years, appears to have great difficulty (unlike Tony Benn) in fusing socialism to national identity or experience (Hardie, Ben Okri and Maya Angelou were bolted on to his Brighton speech) and seems to think that not being happy with what you are given somehow captures the historic essence of socialism (rather than its opposite).

Granted, not thinking outside the ­circle is an inherent fault of the sectarian left but some of our most prominent left-wing journalists have it, too. Working-class support for nationalisation? Good. Right answer! Working-class opposition to benefit scroungers and further mass immigration? Bad. Wrong answer! Would you like to try again? In his essay “In Defence of Comrade Zilliacus” (1947) Orwell reckoned that left-wing intellectuals saw only what they wanted to see. For all their talk of representing the people, they hated the masses. “What they are frightened of is the prevailing opinion within their own group . . . there is always an orthodoxy, a parrot-cry . . .”

The game is hard and he may go down in a welter of knives, yet Corbyn still has time. He may go on making the same speech – on the benefits of apple pie to apple growers – but at some point he will have to drop the wish-list and get on the side of the British people as they are, and live with that, and build into it. Only the nation state can even begin to do the things he wants to do. The quicker he gets that, the quicker we can see if the latest incarnation of new Labour has a future.

Robert Colls is the author of “George Orwell: English Rebel” (Oxford University Press)

This article first appeared in the 08 October 2015 issue of the New Statesman, Putin vs Isis