The International Politics of Ebola

Anne Roemer-Mahler, Simon Rushton

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781138293588
• eBook ISBN: 9781351866811
• Edition: 1
• Topic: Politics & International Relations
• Subtopic: Politics
• Index: Politics & International Relations

The outbreak of Ebola virus disease that gripped Liberia, Guinea and Sierra Leone through much of 2014 and 2015 was undoubtedly a health emergency, yet it was also a global political event. This book examines the international politics of the Ebola outbreak in all of its dimensions, critically assessing the global response, examining what the outbreak can tell us about contemporary global health governance, and examining the inequalities and injustices that were laid bare. In doing so, the book shows how some of the concepts, debates and findings from the growing field of global health research in International Relations can help both in furthering understanding of the Ebola crisis and also in improving policy responses to future infectious disease outbreaks. This book was originally published as a special edition of Third World Quarterly.

Introduction: Ebola and International Relations

Anne Roemer-Mahler^a and Simon Rushton^b

^aCentre for Global Health Policy, University of Sussex, Brighton, UK^bDepartment of Politics, University of Sheffield, UK

ABSTRACT

The outbreak of Ebola Virus Disease (EVD) that gripped Liberia, Guinea and Sierra Leone through much of 2014 and 2015 was an enormous and in many ways unprecedented health emergency. Yet the outbreak was not only a global health event – it was also a global political event. In this introduction to the special issue we discuss the contribution that International Relations scholarship can make to analysing and understanding the Ebola outbreak and the global response to it. We group our comments around four key themes: (1) allocating responsibility in a diffuse global health governance system; (2) the causes and effects of Ebola being perceived as a global crisis; (3) the downsides of a security-driven approach to global health emergencies; and (4) issues of inequality both between and within countries, including those around gender, resources and power.

The outbreak of Ebola Virus Disease (EVD) that gripped Liberia, Guinea and Sierra Leone through much of 2014 and 2015 was an enormous and in many ways unprecedented health emergency. At the time of writing (early November 2015) Liberia and Sierra Leone have been officially declared by the World Health Organization (WHO) to be Ebola free, although a small number of cases continue to be diagnosed in Guinea. Although the emergency appears to be passing, no-one is yet declaring with any confidence that the outbreak is over. In all over 11,000 people have died, making this the most deadly Ebola outbreak in history. Indeed, it surpasses the combined total of deaths caused by all of the previous Ebola outbreaks since the discovery of the virus in 1976. The West African outbreak of 2014–15 was the first to occur in the region, and the first to take hold in densely populated urban areas. It also received a level of global public and media attention far beyond that of most global health crises.

Harrowing stories and images from the region were beamed around the world, but despite the efforts of Médecins sans Frontières (MSF) and others working in the region to raise the alarm, concerted international efforts to provide assistance were slow to materialise. As late as September 2014 (almost six months into the outbreak), Joanne Liu, International President of MSF, was still condemning the global response as ‘lethally inadequate’. The proof of that statement was clear for all to see in the regular updates of new cases and deaths. This was an outbreak that was out of control, with huge consequences for individuals and communities in the region.

As examined in several of the papers in this issue, however, it was when consequences began to be felt outside the region that the international response began to take on a new urgency. The repatriation of infected health workers to the USA, the UK and Spain raised fears of the disease spreading beyond West Africa. The discovery of cases in Nigeria, Mali and the USA demonstrated the ease with which the virus could cross state boundaries. In response, neighbouring countries in the region attempted to close their borders – an action condemned by the WHO, the UN Security Council and others. By September 2014 it was becoming increasingly apparent that the ongoing outbreak was not only a global health problem but also a global political problem.

Understanding Ebola: what can International Relations offer?

In November 2014 a group of scholars working on various aspects of the global politics of health gathered for a one-day workshop at the University of Sussex, hosted by the Centre for Global Health Policy as part of an ESRC-sponsored seminar series on Global Health Security. The aim of the workshop was to allow researchers from International Relations (IR) and cognate disciplines to share their thoughts and reflections on the responses to the Ebola outbreak. Some of the discussion papers presented at the workshop were then developed into the articles gathered together in this special issue of Third World Quarterly.

As these articles show, the engagement of IR with the Ebola outbreak – and indeed with global health politics more generally – is both broad and varied, crossing sub-disciplinary boundaries and encompassing a wide range of theoretical, conceptual and methodological approaches. Some of the papers in this issue explicitly tackle policy questions, some pursue a more conceptual and theoretical approach. Indeed, this special issue is deliberately eclectic, illustrating the different dimensions of an ‘International Relations response’ to the outbreak, while showcasing the richness and diversity of what IR research has to offer to our understanding of global health politics.

IR has had a long engagement with charting the emergence of a new global health governance architecture over the past two decades, and in critically examining the political and economic interests and motivations that have underpinned that process.¹ Driven by the idea that tackling disease is important not only for people’s well-being but also for economic development and security reasons, global political attention and financial resources for health both increased rapidly after 1990. Development assistance for health has more than quadrupled in that time;² a host of new organisations – public, private and hybrid – were created de novo to perform key roles in global health governance,³ alongside such bodies as the WHO, which had been the lead international health agency in the post-Second World War global institutional architecture. In addition, bodies such as the UN Security Council and the G8, which had not previously seen health issues as being part of their mandate, began to pay attention to the impact that disease could have on their ‘core business’.

Yet, despite two decades of political attention and significant investment in global health, the international response to the outbreak of Ebola in West Africa was slow and uncoordinated; neither a vaccine nor a cure were available despite years of research. The Ebola crisis, therefore, could be seen as having revealed the limits or, as some have argued, the outright failure of global health governance. Several articles in this issue explore the question of what light the Ebola crisis can shed on our understanding of contemporary global health governance. Kamradt-Scott examines the roles played by the WHO – a body that came in for significant criticism over its handling of the outbreak. Setting the WHO’s performance in the broader context of recent reform pressures and other constraints on the organisation, Kamradt-Scott examines the politically sensitive issue of the WHO’s role in ensuring global health security, and its responsibility for the underwhelming early response to the outbreak. Davies and Rushton, meanwhile, examine another body which some have argued should have done more: the UN’s peacekeeping mission in Liberia (UNMIL). The UNMIL mission, which was beginning a process of ‘drawdown’ at the time Ebola struck, was a well-established presence in Liberia and had an extensive track record in delivering healthcare services to parts of the Liberian population. When the outbreak began, however, the mission largely withdrew to its barracks – in large part because of the fear of Troop Contributing Countries that their personnel would become infected. Davies and Rushton use this example as a way into examining the question of the appropriate role of peacekeeping forces in cases of health emergency. What can they practically contribute, what roles are appropriate for them to play, and how much responsibility should they have for assisting host governments in addressing such crises?

Clare Wenham also picks up on the notion of responsibility in global health governance from a more theoretical vantage point, exploring the norm of ‘shared responsibility’ for combating infectious disease threats championed by a growing number of global health practitioners and organisations. She argues that, while attractive in theory, this notion of shared responsibility makes it difficult in practice to hold international actors accountable for their actions (or inaction). Wenham argues that ‘shared responsibility’ should be reframed as ‘multiple responsibilities’ for individual actors, with a far clearer division of labour between the different governance actors involved in responding to such events.

Language, and the way that global health issues are ‘framed’, has been another focus of scholars examining the global politics of health.⁴ This is reflected in a second theme touched upon by several articles in this issue: the causes and consequences of portraying the Ebola outbreak as a ‘crisis’ and/or as a threat to international security. McInnes contributes to the rich literature on agenda setting in global health.⁵ He does so by grappling with the question of why some issues (including, eventually, Ebola) receive global political attention while others do not. Taking a constructivist theoretical angle, he highlights the fact that the global attention to the outbreak was not a ‘natural’ response to an objective crisis event but was based on the perception of a crisis – a perception rooted in a process of social construction. Such an understanding of Ebola as a crisis became possible, McInnes argues, not merely because of the material facts of a fast spreading (but regional) epidemic (although that was an important condition), but because it resonated with a broader and well-established narrative of ‘global health’.

A key element of this narrative is the interpretation of diseases (especially rapidly spreading infectious diseases) as potential threats to national and international security. Drawing on ‘securitisation theory’,⁶ IR scholarship has devoted considerable attention to exploring the implications of this ‘health security’ agenda.⁷ Among other things, this literature has shown how viewing health as a security threat has helped mobilise political attention and resources – a phenomenon also observed in the Ebola outbreak. Yet some have raised concerns about the possible downsides of addressing health in security terms.⁸ One concern is that global health issues only become a priority when the West feels threatened. In examining the portrayal of Ebola in the print media in Australia, the UK and the USA Abeysinghe shows how the Ebola epidemic was transformed from a problem of West Africa to a problem of the West. The context of West Africa and affected populations was largely hidden to the extent that ‘Ebola cease[d] being an issue of global health’. Rather, it became a prism through which domestic party politics in Australia, the UK and the USA were played out. To a great extent, therefore, the Ebola outbreak as read through Western newspaper coverage became a story about the West and the West’s security – a reading that may have increased the pressure on Western political leaders to act, but which portrayed the outbreak in a way that was fundamentally detached from the ongoing human catastrophe in West Africa.

Though approaching the subject from a very different angle, Anderson and Beresford’s article also speaks to the relationship between West Africa and the wider world. In doing so, it addresses an area that is comparatively under-developed in IR: the relationship between domestic politics (especially within developing countries) and international-level responses to health crises. Through this, Anderson and Beresford highlight another of the downsides of seeing health as a security threat: a tendency for security-driven responses to be reactive in nature, with too little attention being paid to the underlying structural causes of insecurity. As Anderson and Beresford show, aid intended to help strengthen the post-conflict health system in Sierra Leone did little to tackle the political causes of that country’s chronically weak health system, which include acute external dependency, patron–client politics, endemic corruption and weak state capacity. Their conclusions draw our attention to the concern that the security-driven emergency modality of the international Ebola response, focused as it was on rapidly putting in place treatment facilities and searching for a pharmaceutical solution, overlooked important socioeconomic and political underpinnings of the ‘crisis’.

This technical, quick-fix approach of the international Ebola response is also interrogated in the articles by Roemer-Mahler and Elbe, and by Pallister-Wilkins. Roemer-Mahler and Elbe explore why the in...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• Citation Information
• Notes on Contributors
• 1 Introduction: Ebola and International Relations
• 2 Crisis! What crisis? Global health and the 2014–15 West African Ebola outbreak
• 3 WHO’s to blame? The World Health Organization and the 2014 Ebola outbreak in West Africa
• 4 Public health emergencies: a new peacekeeping mission? Insights from UNMIL’s role in the Liberia Ebola outbreak
• 5 Ebola respons-ibility: moving from shared to multiple responsibilities
• 6 Ebola at the borders: newspaper representations and the politics of border control
• 7 Infectious injustice: the political foundations of the Ebola crisis in Sierra Leone
• 8 The race for Ebola drugs: pharmaceuticals, security and global health governance
• 9 Personal Protective Equipment in the humanitarian governance of Ebola: between individual patient care and global biosecurity
• 10 Ebola, gender and conspicuously invisible women in global health governance
• 11 Ebola and the production of neglect in global health
• Index