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Public health expert Allyson Pollock explains how poverty, sanitation and infrastructure contribute to Ebola’s death toll in West Africa

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SHARMINI PERIES, EXEC. PRODUCER, TRNN: Welcome to The Real News Network. I’m Sharmini Peries, coming to you from Baltimore.

The Ebola virus is taking hold of West African nations, and news of Ebola continues to be one of the most heavily covered stories in the world. Until now, much of the news focused on concerns of screening, containment, and vaccines. Little attention is paid to addressing the root causes of the problem, says our next guest. She says that the social determinants and the role of poverty and political economy of these countries have had very little attention in the media.

Allyson Pollock is professor of public health, research, and policy at Queen Mary University of London. Allyson is joining us today from London.

Thanks a lot for joining us, Allyson.


PERIES: Allyson, what is great about the virus today is that if you contract this virus, you have a 55 percent chance that you will die from it. What is happening to the other 45? Why are they surviving? Is it conditions or is it the virus?

POLLOCK: Well, I don’t know if that’s quite the right question to ask. I suppose we should be asking why are so many people dying of the virus in Sierra Leone, Guinea, and Liberia, where the disease is taking hold. And the real issue is that the high case fatality rate is due largely because this is a disease of extraordinary poverty. So there’s malnutrition, poor sanitation, poor nutrition. So that creates poor housing. That creates the economic climate for the spread of the disease.

But on top of that, these three countries, it’s no coincidence that these three countries are among the very poorest in the world. And over the last few decades, the little public health care infrastructure they did have has been gradually hollowed out. The problem is not that people are falling sick so much as when they fall sick there hasn’t been the means to both contain the disease and to nurse them back to proper health. And so [incompr.] low immune systems and poor social conditions, it means their immunity’s reduced and they’re more vulnerable to infection and, of course, disease spreads more easily.

But the real issue, of course, is that it should be managed very easily by isolation and quarantine, and also by barrier nursing. But the problem is that it spreads because the infrastructure, the health care systems, cannot support the sick and the needy at the moment.

PERIES: Allyson, Liberia, Sierra Leone, Guinea, they have lots of natural resources. Why are they not able to afford the basic health services required to deal with this problem? What has happened?

POLLOCK: Well, it’s quite a complicated picture, but it really boils down to two or three factors. The first is, of course, some of these countries have had decades of civil war. So money has been spent on fighting, and /ɪtsˈlɛtən/ wars always are disastrous for countries. They always result in the decay and collapse of economies, and it takes a long time to recover. And, of course, wars also result in displaced people, so you have a lot of migration, you have a lot of refugees moving across the border, and that also creates conditions for the propagation of disease. So that’s the first thing, economic collapse on the back of major civil wars and mass migration.

The second thing, of course, is, as you rightly say, these countries are very rich. They’ve got mines, mineral rights, forests, agriculture, palm oil, rubber, coffee, cocoa. So really they’ve got a lot of natural resources. But we’ve got a second problem going on, which is, increasingly, foreign direct investors and Western governments have been coming in and using public-private partnerships. There’s been sequestration of land and mineral rights and the mines, so that increasingly the people in these countries are being used as employees and as cheap labor. But very little of the resources that are within the country are contained within the country. They’re actually flowing out. And they’re flowing out through very expensive public-private partnerships and deals where you’ve seen the undermining and loss of land. You see this especially, for example, in Sierra Leone. And then [incompr.] collapse of the economy, and you’ve got the foreign direct [snip] coming in. You’ve also got corruption of governments and government officials. So you’ve got a whole undermining of the democratic base of countries and their ability to determine their future.

And really this is what we should be looking at is the issue of self-determination. How do these countries, which are among the poorest in the world, which also are very resource-rich, how do they actually recover?

And Western governments play a big role in the determination of their future. The West has benefited hugely, over centuries, actually, in the scramble for Africa, as it’s called, undermining the resources and the agriculture and the rights. And the West must now begin to put back even a tiny bit of what it’s actually taken away.

PERIES: Allyson, in your interview with Tariq Ali, you indicated that a lot of the health and the infrastructure and social services have been eroded. What has been eroded? What was there before?

POLLOCK: Well, all these countries have had public health care systems, many modeled on the [sort of (?)] U.K. systems of public administration or European systems of public administration. But what’s happened is, of course, the doctors and nurses, even if they are being trained in these countries, are either leaving these countries to go and seek employment elsewhere, so you’ve got a brain drain, or wealthy people are encouraging their children–the wealthy elite–to go and have their education elsewhere, and then they stay away. So it’s really critical. I mean, Liberia, which has a population of about 5 or 6 million, has fewer than 100 doctors, fewer than 1,000 nurses. Now, the equivalent in the West would be tens of thousands of doctors and tens of thousands of nurses. So what we’ve seen is almost no capacity there, a complete either–there’s no capacity for training and infrastructure, and then there are no incentives to keep doctors and nurses and health care workers in place.

And this is further compounded in some countries in Africa by the entry of public-private partnerships such as those funded by the Bill and Melinda Gates fund and others, where we have the entry of vertical disease programs. So what you have is a parachuting in of workers to tackle single diseases like TB or malaria or AIDS. But what happens, in turn, when you bring in a lot of foreign money and foreign direct investment is that you actually undermine the local economies, because, of course, that then attracts the few remaining doctors, nurses, and workers to these vertical disease programs and actually accelerates the hollowing out of the public health care infrastructure and also results in a major problem. You’ve got loss of capacity, both at the primary care level, but also in terms of the whole system. You don’t have the integrated health care systems anymore.

PERIES: Right. So has there been any dialog with the Melinda and Bill Gates Foundation about addressing, say, Ebola and having a more comprehensive approach to the way in which they provide funds and direct services?

POLLOCK: I mean, there’s been a lot of discussion about vertical disease programs and critiques. One of the problems is that these funds are very, very powerful. And then when they’re put in conjunction with Western government funding, they drive the new design of health systems, and even of the research. So you’ve seen the targeting of TB, malaria, AIDS, HIV, for example, we’ve got these vertical disease programs come in, but they’re not integrated anywhere, they’re not holistic, and above all, they don’t represent /oʊmɑːtə/, in that they’re not about health for all and starting with primary care and community health services as the building blocks–together with data and information, as the building blocks of a health system.

And this is one of the–this is not a new problem. This is a really chronic problem is that health care systems are increasingly–the public health care systems which were integrated, which were built up from primary care–very simple, basic measures–are increasingly being verticalized in order to deliver new interventions and technologies, some of which actually [may not be appropriate (?)] for the poorest countries in the world, and some of which are actually distorting and undermining the public health care systems, for example, of Africa. And we’ve got good illustrations of that, with new interventions around diagnostics and treatments which may not be the essential medicines and essential treatments that governments need.

PERIES: If you wouldn’t mind joining me for a second segment so that we can continue this discussion on what an appropriate response at this time might be, I’d appreciate that.

POLLOCK: Yes. Pleased to do so.

PERIES: Thank you for joining us on The Real News Network.

POLLOCK: Thank you very much. Thank you.

PERIES: And thank you for joining us on The Real News Network.


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Allyson Pollock is professor of public health research and policy at Queen Mary University of London. She was previously director of the Centre for International Public Health Policy at the University of Edinburgh and prior to that was head of the Public Health Policy Unit at University College London and director of research and development at University College London Hospitals NHS Foundation Trust. She is known for her research into, and opposition to, part privatisation of the UK National Health Service (NHS) via the Private Finance Initiative (PFI) and other mechanisms.