Poverty Is Ebola's Deadliest Vector

Health care follows money.

Aug 11 2014, 2:25pm

Image: European Commission DG ECHO

Ebola isn't necessarily the daunting super-disease your social media feed wants you to think. Its symptoms are brutal, but it's not too much of a stretch to say that you are going to die brutally yourself, because a whole lot of dying is brutal. Look up liver failure, to start, or end-stage respiratory disease. You, in particular, have a reasonable chance of going out via either route, and it will be terrible and have nothing to do with any hot zone. 

I don't say this to minimize the abject misery of contracting Ebola, but to point out that we have a particular lens with regards to the virus, and others of the sort that happen there and not here, and which help keep the average life expectancy in sub-Saharan Africa at about half that of what can be expected in America

A real super-disease is HIV, which had 15 odd years of free reign before a real and lasting treatment was developed. Or, rather, it had 15 odd years of free reign in the developed world, while, in Africa, it still more or less does as it damn well pleases, at least compared to the US and other developed nations. In 2012, HIV/AIDS killed around one million people in Africa, which shouldered about 70 percent of the disease's total mortality for the year. 

Talk about a bad way to die: an undefended human body, at the mercy of everything from leukemia to thrush. Leukemia is leukemia, but thrush is a fungus that normally just chills around the body's mucous membranes under the watchful eye of a healthy immune system, occasionally erupting as a yeast infection. But as HIV progresses to AIDS (which, thanks to antiretroviral therapy, it doesn't have to) and that immune system falls into a downward spiral, thrush (Candida, properly) might just take over everywhere from the oesophagus to the farthest corners of the lungs. And that's death.

Those 15 years were far too many and it's easy enough to speculate as to how different that number would be if HIV attacked predominantly straight couples, just as it's easy to speculate that if Ebola's ground zero were anywhere in the developed world (New York, London, wherever), it would be easily treatable and a vaccine would be on-hand just in case, like so many other illnesses crushed by the focused efforts of an elaborate and well-funded medical establishment.

Just in the past week, that establishment has been able to toss out two (so far) promising anti-Ebola candidates and it's worth speculating where we'd be if those candidates had been rushed into testing a month or year ago. Ebola, after all, didn't just materialize this summer. Meanwhile, a vaccine looks to be on the way as well.

Again, that's not just good timing. Ebola could easily be a treatable disease with a low mortality rate, which is largely my point. Even without new specialized treatments, if Ebola managed to spread throughout the US you would find it rather quickly become a much less scary disease. Consider that Ebola mortality rate, some very large part of what makes the virus as spooky as it is. That rate is based on Ebola mostly being contracted in Africa and being treated in Africa. A big part of treating something is supportive care, helping the body deal with its invader while not necessarily going after the invader directly, and good supportive care is dependent on access to a good hospital armed with adequate tools.

As for why these potential new treatments are just now making their way into the world, that's easy. Health care follows money. The things people die (young) of in the developing world—cholera, hepatitis, and malaria—are mostly all easy to treat if not eradicate, or they should be. Money on the other hand stays put, and so we get drug companies churning out chemical mirrors of old drugs designed not to treat something new or treat something better, but to reestablish a patent, so that said drug can remain expensive for patients and profitable for the drug company. 

Malaria kills millions every year, with a particular preference for young children.   

Like Ebola, Malaria could have been wiped off the surface of the planet by now. Maybe Ebola and its very public brutality and dark mythos will be a wake-up call of sorts that we're doing something very wrong in allowing this connection between money and not dying in horrible and unnecessary ways to persist. The evidence suggests otherwise, and more likely, the disease will continue on in the popular imagination as some wonder of virulence soon to be eradicated by the quick efforts of benevolent drug companies, rather than a comparatively "dumb" virus that's been allowed to persist because of those companies' disinterest.