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October 27, 2014 6:16 pm

Ebola and Public Health Versus the ‘Bottom Line’

avatar by Bernard Starr

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An Ebola virus virion. Photo: CDC/Cynthia Goldsmith.

In 1347 CE the Black Death — known as the Black Plague — struck Europe. It swept across the continent, eventually killing more than 20 million people — one-third of the population. The Plague was terrifyingly virulent as described by the poet Giovanni Boccaccio: “People who were perfectly healthy when they went to bed at night could be dead by morning.”

As gloom and doom spread, and the death rate soared, a rumor erupted that Jews were responsible for the disease. This accusation was not far removed from other bizarre accusations, including the charge that Jews performed ritual killings of Christians. In the case of the Black Plague, “what else,” the accusers argued, could explain why Jews were not contracting the disease proportionate to the incidence among Christians? “They must be poisoning the wells,” the rumor mongers concluded.

The accusation traveled almost as fast as the Plague, resulting in widespread violence against Jews:

“Christians everywhere in Europe went on a murderous rampage against Jews, burning them alive wherever they found them. In August 1349, the Jewish communities of Mainz and Cologne were exterminated. In February of that same year, the citizens of Strasbourg murdered 2,000 Jews. By 1351, 60 major and 150 smaller Jewish communities had been destroyed.”

If European societies had not been blinded by anti-Semitism, and had asked a different question, millions of lives might have been saved: “What do the Jews know that we don’t know?” — or, better yet, “What are Jews doing right that we are not doing?” In searching for answers to these questions with an open mind, they might have discovered that Jews were practicing public health measures (and had been since the time of Moses), measures that Western societies would not embrace for another 500 years.

The kosher laws, spelled out in the Book of Deuteronomy in the Torah, ensured cleanliness and freshness in food preparation. And the Jewish ritual of washing hands before eating imposed a degree of protection against the spread of the Black Plague, as did other prescribed hand washings throughout the day: on awakening, before prayers and study, and before candle lightings and blessings. Other rituals of washing of hands and feet are prescribed in the Book of Exodus (30:18-21). Ironically, the fact that Jews were confined to ghettos in Europe served as virtual isolation wards, shielding them from Plague-infected Christians.

The value of simple Jewish public health measures was illustrated in another disease outbreak in the 18th century. A group of 42 Portuguese Jews escaping the Inquisition in Europe arrived in the American Colony of Savannah Georgia in 1733. The colony was in the throes of a yellow fever epidemic. Many people, including the colony’s only doctor, had died from the disease. Dr. Samuel Nunes, the leader of the Portuguese Jewish group, immediately imposed cleanliness procedures. According to one report, none who followed Dr. Nunes’s procedures died from the disease.

Today we are faced with a devastating outbreak of Ebola, with fears of the disease becoming a pandemic, since there is no sure cure or vaccine. Yet despite our otherwise rational thinking about infectious diseases and advanced scientific knowledge about them, we are impeded by a doctrinaire economic ideology: leave the cure to the market. Yes, government and foundations may contribute incentives to companies and institutions for research and development. But that approach has proven to be ineffective in addressing dire threats, especially when the profit motive can’t be sparked. The Ebola crisis is a case in point.

According to the Centers for Disease Control and Prevention (CDC), Ebola has been around since 1976, when 388 people in Zaire (Democratic Republic of the Congo) contracted the disease. Since then there have been small incidences of Ebola, mostly in East Africa, with yearly cases ranging from one in Zaire in 1977 to 425 cases in Uganda in 2001-2002. In 2014, the incidence exploded to more than 9,000 cases in multiple countries, most in West Africa. The death rate has generally been higher than 50 percent.

Scientists can’t fully explain why Ebola suddenly disappeared in previous outbreaks, despite the lack of effective treatments. But they have warned that if the disease became readily transmittable by air, which is possible through mutations that routinely occur in viruses, Ebola could lead to a disaster similar to the Black Death. Why, then, wasn’t a crash international program initiated along the lines of the Manhattan Project, which created the atomic bomb during World War II? It’s a proven model for speedy results. Knowing little about atomic fusion, the most brilliant scientists were assembled in locations where they worked cooperatively to beat Germany to the atomic bomb — and they succeeded in six years at a cost of $2 billion ($26 billion in today’s dollars).

In 1976, when Ebola was confined to a small number of cases in Africa, there was no incentive for businesses to make an investment in research. If Ebola continued as confined outbreaks for a limited time, a patent for a drug to treat it, or a vaccine to prevent it, might not feed the corporate bottom line. So we have waited for a desperate crisis when a cure might bring enough profit to light up the bottom line. But how many lives will be sacrificed for the worship of that ideology?

The irrationality and immorality of our dedication to the competition model of “leave it to the market” for disease control and prevention is exposed in the startling revelation reported in The New York Times on Oct. 23, 2014. Ten years ago, we are told, scientists created an Ebola vaccine that was “one hundred percent effective in protecting monkeys against the Ebola virus.” The scientists speculated that if research had proceeded, a vaccine effective for humans could have been ready as early as 2010. Why didn’t that happen? University of Texas Ebola expert Thomas W. Geisbert explained to the Times: “There’s never been a big market for Ebola vaccines…. So big pharma, who are they going to sell it to?” Dr. James E. Crowe Jr., of Vanderbilt University, described the bottom-line obstacle more starkly: “Academic researchers who developed a prototype drug or vaccine that worked in animals often encountered a ‘biotech valley of death’ in which no drug company would help them cross the finish line.”

Perhaps we will get lucky this time and dodge the Ebola bullet. But luck is not a reliable or wise business plan, particularly in matters of life and death. Isn’t it time for us to wake up and establish an infrastructure for a cooperative international response to global disease threats? A setting like the Los Alamos Manhattan Project worked once and can work again. It’s the best answer to the question of how to most effectively address global pandemic threats. Think back to the Black Plague. The right question with the right answer could be life-saving.

Bernard Starr, PhD is a psychologist and professor emeritus at the City University of New York, Brooklyn College. He is also the main United Nations representative for the Institute of Global Education (IGE) that founded Radio For Peace International and the Mucherla Global School in Mucherla, India.

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