Ebola at the Borders of Global Health

What is it about?

In 2014 the World Health Organization was widely criticised for “failing” to anticipate that an outbreak of Ebola in a remote forested region of Guinea at would trigger a medical and humanitarian disaster in West Africa. Drawing on internal WHO documents and interviews with key actors in the epidemic response, I argue that the supposed failure is best understood as a consequence of Ebola shifting medical identity and the WHO’s systems for managing emerging infectious disease (EID) risks. In particular, I argue that in the four decades prior to the 2014-16 outbreak Ebola fluctuated between what I call “securitisation and neglect.” The result was to relegate Ebola to the fringes of global health concerns at just the moment when the virus was crossing international borders and triggering urban outbreaks for the first time. My analysis also highlights the limitations of pandemic preparedness systems that seek to triage or grade risk responses to EIDs without regard for the way that these epidemic and pandemic threats are themselves the products of securitisation discourses. I conclude by suggesting that the failure to predict that the outbreak in Guinea would grow to become the largest Ebola epidemic in history had less to do with institutional factors than with the neglect of a particular category of medical knowledge and expertise.

Featured Image

Why is it important?

Global health, and international health before it, has long been preoccupied by the surveillance of infectious diseases thought to pose a risk to the health of populations and the free circulation of goods and services. Since the 2001 terrorist attacks on the United States and the 2003 SARS epidemic, this surveillance has increasingly focussed on emerging infectious diseases – a class of pathogens thought to possess a marked ability to traverse borders and threaten global health security. But while there is an extensive anthropological literature on the securitisation of infectious disease risks, few of these studies address the role of medical knowledge and expertise, and the programmatic priorities of global health institutions, in shaping these security discourses and mechanisms. Nor has there been much sustained historical analysis of the way in which infectious diseases now seen as security threats have, at other times, been neglected. This paper seeks to correct those deficits by offering a critical epistemology of Ebola, a pathogen long considered an iconic EID but which has also suffered from medical and institutional neglect, most notably in the period immediately prior to the 2014 outbreak.

Perspectives