The Sunday Mail
Dr. Timothy Stamps
In the first part of this submission (Sunday Mail, October 12, 2014), I gave some of the evidence about the present epidemic available to me, as Health Advisor in the Office of the President and Cabinet.
In this second part, I hope to present some of the ways forward to deal with the epidemic, so we, as Zimbabweans, can lead the continent in future epidemics, or disease challenges which we will, inevitably, confront in the future.
First, I have to apologise for some of the photographs being left out of the first instalment.
Now, to the more important issue — the map omitted from Part One.
As you will see from the map, after the first major outbreak, in the then Zaire (DRC) nearly 40 years ago (1976), there have been 12 recorded outbreaks in the years 1994, 1995, 1996, 2000, 2001, 2002, 2003, 2007, 20012, and, of course, the massive one, this year.
Black indicates the number of people dying, and yellow indicates the number recorded as surviving after each episode.
Sir Peter Medawar, who died in 1967, memorably described a pathogenic virus as “a nasty bit of news, wrapped up in protein”. I think this admirably describes the Ebola virus.
It has only seven genes (for comparison, the human genome, described by American scientists in 2001, has several billion!), but, as we have seen this year, it is able to strike terror, as a result of its devastating death rate, into whole populations.
When the virus infects a cell, its polymerase tricks the cell into making the proteins that copies of the virus need. These include two especially important proteins, one of which stops anti-virus molecules called interferons being made, and the other one prevents their chema being listened to.
In addition, a virus gets the infected cell to produce a lot more glycoprotein than is needed for the newly created virus needs, and the surplus simply goes into the blood stream, antibodies which are released to target the virus stick this “decoy” sugary protein instead of to the virus.
Eventually, the virus’s spread causes, in some victims, an over-reaction (known as a cytokine storm). Whether this alone, or the physical blocking, because of the shape and numbers of viruses produced cause the visible effects of the disease, and the subsequent shock (leaky blood vessels, blood blisters, kidney and liver failure, etc) is a matter for experts more skilled than I am, but the result is a high death rate (about 70 percent, on average, of those known to health workers).
And, of course, health workers are not immune.
The next subject is a little more difficult for me, being a mere Health Advisor, so, I hope you will take my limitations into account when I trace the past, and the possible future, lessons to be learned.
Ebola epidemic
You will recall the fact that this disease, and its high fatality rate, has been known for more than 38 years. Compare this with another newly identified disease — nvCJD, or BSE, better known in the Press as “mad cow” disease.
Just 24 human cases (23 Brits and one French farmer) were known to have died from this rare condition, now known to be caused by a heat resistant, infective protein called a “prion”.
Before we jump to conclusions, just appreciate what panic this caused in the beef industry — the whole industry in Britain and France was threatened by catastrophic implosion, as a result of it becoming widely known that “Beef can cause a (fatal) Brain Disease in People”, as I remember one front page headline in the Sun screaming.
The result was a lot more tragic for British cattle farmers (and, financially for the taxpayer) than the disease itself.
It entered the bovine food chain by the practice of the bulk food companies of feeding chopped up sheep and, later, ailing cows in the form of added protein — to strict herbivores. In fact, the consumption of less than one gram of affected food can transmit the disease.
In 1979, the glorious monetarist, Thatcherite era, the rules about protein supplements were relaxed so as to allow crunched-up cows to be fed to cows, of course, with the aim of making supplements cheaper, and cattle fatter, quicker.
Regrettably, that relaxation allowed the prion to escape destruction (it is heat resistant) so we got cattle-to-cattle transmission.
To make matters worse, the “research” was incompetent, and stupid.
For one example, research was intended to find out whether there was vertical transmission (from mother to calf). Both mother and calf were fed the same infected supplement!
The MAFF (Government ministry of agriculture) refused to assist other researchers.
Worse, between 1992 and 1995, MAFF spent over GBP5 million each year on BSE research, and the taxpayer had to cough up GBP1,5 billion in 1997 to pay compensation for the cattle destroyed.
The most tragic consequence of all was the destruction of the lives of ordinary farmers. Yes, they got monetary compensation, but their whole lives, and those of their families, had been destroyed. Little wonder that the rate of depression, even suicide, in the farming community escalated.
People from other countries, like Angus Buchan from kwaZulu-Natal, came to help them over their grief and offer them spiritual comfort, as pyres of slaughtered cattle smouldered and spread the stench over their fields, which they were told by the authorities they could not use to graze any livestock (including sheep, goats or chickens) until they had a permit from MAFF in London.
A daily reminder of their “guilt”.
More bizarre still was the television showing (all channels) of the Minister of Agriculture, Mr J Gummer, watching his six-year-old daughter eating a hamburger so as to reassure the nation that there were no health risks from munching a “Big Mac”.
Their body language sent a different message
The way forward
I’ve been collecting cuttings from local newspapers about Ebola. I won’t bother with the number, but there are a lot.
More interesting is the future predictions and the number of articles proffering advice (always what “they” should do). Some have become instant experts — some even prophets!
And, of course, Tony Blair, who claimed to be both expert and prophet, had to have his pennyworth (on CNN). I suppose there’s no show without Punch.
But we have to plan the way forward seriously. And we have to be practical. On another scourge, Aids and HIV, I was urged to “close the borders”.
What borders?
Everyone who has been here for even a short space of time knows that our border, especially with Mozambique, is porous.
Diseases do not use visas.
Even if we man all our official border crossings (there are 21 of them, some very basic), we cannot cost-effectively man them all, 24 / 7.
If Dallas, Texas, can admit a case (he has now died, and infected two nurses at the Presbyterian hospital), and a case or two in Madrid, Spain, have become locally infected, what hope have we?
Perhaps it’s one of the unexpected benefits of illegal sanctions, or, as the MDC are fond of saying, travel restrictions. But I forebear to say pamberi ne masanctions!
In any case we’re trying to encourage tourism or so Minister Mzembi says. Because, in the long term, we have more existing health institutions than the economy can afford, so the International Monetary Fund tells us.
Another suggested way forward is, mimicking what the United States is doing in Liberia, spending a vast amount of money (which we do not have), building a whole network of hospitals throughout the country.
Why don’t we kill all the bats was another suggestion!
I refer you back to the beginning of this article where there are recorded 12 episodes of Ebola with 70-90 percent mortality rate, most of them occurring in one country (DRC) in the last decade.
Why has there been no research on ways to manage or treat the virus other than the 19th century one of isolation of affected victims?
Is it because we are Africans?
And, as I said to the World Health Assembly in 1995, one American life is “worth” 100 African lives? (These are figures from the UNDP relating to the human development index (HDI).
Yes, it saved us in Zimbabwe from the tragedy which befell the UK farmers who happened to be “guilty” of growing beef!
And this was caused by faulty government research!
And Blair?
I’ve heard it said “there are too many Africans anyway”. And, this was only partly in jest.
(To be continued)
Dr Timothy J Stamps is the Health Advisor in the Office of the President and Cabinet and former Minister of Health and Child Welfare.
