The Ebola outbreak was political — just like every disease outbreak

On February 22nd, 1845 the HMS Eclair, a British naval steamer tasked with interrupting the slave trade along the western coast of Africa, made port in Freetown, Sierra Leone. Though the crew left England with a clean bill of health, by the time the Eclair made it home in late September 1845, more than two-thirds of the original crew of 146 had died of yellow fever. While mortality rates onboard naval vessels of the 19th century were known to exceed 50 percent, the story of the Eclair rocked the British papers and embroiled the international medical and political classes.

In fact, this early incident may help explain some of the political conversation around the Ebola outbreak, the low point of a notably depressing election cycle. Last week, Politifact crowned the spread of misinformation concerning Ebola its "Lie of the Year;" in October, The Verge reported on the spread of dicey information online by spammers. And there was Louisiana, which implemented new rules on travel that prevented a meeting of Ebola experts.

Politicians exploited the difference between scientific and political language. Scientists deal with different degrees and expressions of certainty than politicians, which can lead to confusion even in the best of circumstances. This was not one of those circumstances. Still, a by-product of the Politifact "award" is the impression that this process of politicization is somehow over and that we’ll do better next time.

That may not be true. On December 10th, the WHO reported that infection rates in Sierra Leone have surpassed those in Liberia; the total number of cases in Liberia is more than 7,800, but Sierra Leone had about 9,200 as of December 29th. The outbreak is so severe that government officials called to "cancel" Christmas and New Year's celebrations. The military are restricting the congregation of family and friends as well as travel to and from the capital. The UK, which provides most of the international aid to Sierra Leone, engaged in a kind of delayed pantomime of American overreactions to Ebola: It rolled out its own version of opaque and extraneous quarantine restrictions for returning healthcare workers.

In Liberia, where the situation has improved greatly, fears about the disease’s contagiousness led to a kind of quarantine of politics. Elections originally scheduled for early October were continually postponed until December 20th, which resulted in severely depressed turnout. In a nation where years of civil war have deeply undermined trust in government and its institutions, some worried a constitutional crisis would be one of Ebola’s deadliest symptoms, according to a report from On The Media .

Decrying the politicization of Ebola is noble and natural, but it’s mistaken. Disease and responses to disease are always politicized and always have political consequences. This is an opportunity to better understand the political history of science and, in the case of the Ebola, a colonial legacy that continues today. The Eclair case may help; after all, those who forget the past are condemned to repeat it — isn't that how the saying goes?

the eclair case may help explain the present-day response to a politically charged epidemic

The Eclair first grabbed headlines in England because it was placed in quarantine — something that struck contemporaries as draconian, punishing those who had already suffered the outrages of disease. British port authorities restricted the remaining crew members to the ship, where the sailors continued to die of yellow fever. As the death toll climbed, the crowded and unsanitary conditions of quarantine sparked public outrage. The press demanded a cessation of the quarantine, hailing the survivors as heroes. Eventually the naval authorities buckled under the public pressure and permitted the crew to undergo quarantine in more comfortable quarters on land (faintly echoing reactions to nurse Kaci Hickox’s travails).

The affair of the Eclair stirred more than just British domestic sentiments. It also sparked two interrelated disputes around international quarantine law and the science of contagion. The outbreak hadn’t been limited only to the Eclair’s crew: The ship had visited the island Boa Vista, a Portuguese colony, and was likely responsible for spreading yellow fever among the island’s inhabitants. By the time the Eclair arrived back in England, yellow fever had reached epidemic levels on Boa Vista. Ultimately, it killed perhaps a third of the local population.

The Portuguese government was furious with what it saw as British negligence. For years, major European powers had tried, and failed, to reach some kind of agreement concerning quarantine measures. In many cases, nations instituted quarantine on the basis of rumors, and the lack of clear international law made quarantine a dirty tactic in colonial commerce. By imposing long and unnecessary quarantines on foreign vessels, nations could impede rivals’ trade. The absence of international agreements on infectious diseases carried from port to port by sailors — illnesses like plague, cholera, and yellow fever —meant that more episodes like that of the Eclair were inevitable.

by imposing long and unnecessary quarantines on foreign vessels, nations could impede rivals' trade

As if that weren’t enough, there were scientific disputes about the evidence supporting quarantine. In the case of the Eclair, the British government quickly convened an epidemiological committee to investigate the outbreak and the spread of the disease. While the panel managed to smooth over relations with Portugal, it opened a new battleground for two hardboiled medical minds: Sir William Pym and Dr. Alexander Bryson.

At the time, it was widely accepted that remittent malarial fevers—the "marsh miasmata"—were endemic to the coastal regions of Western Africa (and the Caribbean colonies). It was common knowledge that European mariners serving in the colonies could easily catch such diseases. But for Pym and Bryson, the crux of the disagreement between was scientific: Was the yellow fever a severer form of the usual fevers, caused by climate and cleanliness, or was it a separate and highly contagious disease altogether?

Pym had served as a naval surgeon, and headed the British investigation into the outbreak at Boa Vista. He wrote passionately to Parliament about the contagious nature of yellow fever, favoring stringent and mandatory quarantine policies for vessels arriving from ports known to be infected by plague, cholera, and yellow fever. He lauded the British authorities for the unpopular decision of quarantining the Eclair — calling it a victory for public health. This landed him in the crosshairs of Bryson, an energetic Scottish physician and president of the Royal Philosophical Society of Edinburgh. Bryson squared off against Pym and his circle, arguing stridently for the environmental and conditional causes of the disease in medical journals.

pym lauded the british authorities for the unpopular decision of quarantine

Contagionists like Pym formed part of the establishment which wanted an international quarantine law, notes medical historian Mark Harrison. Bryson, and other "anti-contagionist" reformers, derided the science of quarantine as "old-fashioned," "superstitious" and even "Papist" (a British byword for the backward and ritualistic mentality of Continental Catholics). The idea that contagion was not spread through ships was especially appealing to maritime capitalists who saw quarantine laws as an obstacle to the easy movement of goods and cash. These merchants were sympathetic to the medical theory that disease could become contagious, but only under conditions of extreme crowding, oppressive heat, poor ventilation, and bad hygiene — as in the hold of a ship or crowded port towns.

Anti-contagionism found a ready audience in Enlightenment Europeans who were ready to see health as a matter of moral responsibility and rationality. Accordingly, health could be controlled and engineered by the advances of Western science. And this offered "scientific" grist for colonial narratives; by tying disease to behavior and natural environment—like the jungles of the African coast and Caribbean plantations—Europeans saw a part of their "civilizing" mission as improving the health conditions of non-European peoples. Scientific concerns about public health helped to justify the economic exploitation of peoples and lands; colonial interests colored contagion theory.

Western aid to Ebola-stricken nations has broken down along the old colonial lines, with little coordination or acknowledgement of the porous nature of the borders there. Though US officially never had colonial ties to Liberia, the nations’ histories are unique and complexly intertwined — Liberia was founded as a colony for former US slaves. American business interests there help trace our continuing role in Liberia’s health care economy and in the handling of the current outbreak.

The American tire manufacturer Firestone is a telling example. ProPublica has recently documented how that corporation aided and abetted the rise of the brutal dictator Charles Taylor. Under Taylor, Liberia was pitched into years of vicious internecine warfare, ravaging the country’s coffers and civic infrastructure. But even before Taylor, Firestone had a history of provoking social tensions between the descendants of resettled American slaves and native Africans, whom the settler elite called "aborigines." Firestone helped this upper class to ruthlessly exploit the local population. By the 1980s, the resentments violently erupted, paving the way for dictators like Samuel Doe and Charles Taylor to brutalize an already divided nation for close to 20 years. What was once regarded a bastion of stability in Africa is now one of its poorest nations.

what was once regarded as a bastion of stability in africa is now one of its poorest nations

Although the WHO has praised Firestone’s quick and competent response to the Ebola crisis, not everyone had corporate protection. The corporation’s ability to protect its workers and those living nearby illuminates the depth of its resources and its power to do good. At the same time, it pointedly outlines the limits of private obligations to the inhabitants of host nations.

These limitations are all the more hair-raising when over 80 percent of health care spending in Liberia and Sierra Leone comes from private sources like Firestone, according to a recent Kaiser study. In addition, the IMF imposed austerity measures which have curtailed local governments’ ability to meet the difficulties of widespread health emergencies. These regulations have contributed to the spread of Ebola by capping the amount of spending available for health facilities — and driving health care workers to seek employment in other countries that pay more, Cambridge sociologists claim. The IMF disputes this charge.

The international response to the disease has been bungled from the beginning, failing to stop what experts claim should have been a preventable outbreak. Budget slashing and bureaucracy have stretched the WHO thin, hobbling their efforts at containment. But amidst the finger pointing, perhaps we should pause to consider the long term effects of players like Firestone.

Firestone’s response to the outbreak is surely to their credit, as is the IMF’s $430 million pledge to fight the disease. But Firestone shaped Liberia’s history of political instability and so, like the IMF, shares in the responsibility for a lack of national infrastructure. The sheer startling amount of private spending, together with externally imposed restrictions on domestic health spending give a sense for just how much the response to the disease is dictated by the decisions — and agendas — of outside influences.

Ebola won't be the last global health scare

The eruption of yellow fever on Boa Vista ultimately burnt itself out, but it would take over half a century for the true cause of yellow fever to be uncovered: a virus borne by mosquitoes. For all the empirical vigor and academic vitriol, neither Pym nor Bryson had got it right — but then, neither had gotten it totally wrong. Ships could bring the disease to unsuspecting harbors in the blood of the infected. And overcrowding made it easier for mosquitoes to pass the disease. But fears around person-to-person transmission were unfounded, as were concerns about unsanitary "climes." Pym and Bryson’s worldviews colored their scientific understandings; their political and commercial interests intersected with their medical ones. And that’s not a thing of the past. Politifact’s cluster of lies, Firestone, and the IMF are modern examples of how medicine is never entirely free from politics. Political and economic agendas shape the way public health science is understood and implemented. Ebola won’t be the last global health scare; it’s time we took better stock of the politics of past epidemics, so we'll be better prepared for the ones in the future.