“Self-Preservation and Stigmatization: The Ebola Epidemic Versus the Coronavirus Pandemic”

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Augustine Kpehe Ngafuan

By Augustine Kpehe Ngafuan 

While serving as Minister of Foreign Affairs of Liberia, I chaired an ad-hoc Cabinet Committee that organized an elaborate indoor program in August 2013 to celebrate ten consecutive years of peace in Liberia. The jam-packed program was attended by representatives of foreign governments, signatories to the 2003 Comprehensive Peace Agreement (CPA) signed in Accra, Ghana that ended the Liberian Civil War, traditional and religious leaders, as well as invitees from political parties, civil society organizations, youth, student and women groups. Maintaining the peace for ten consecutive years in a country that had been rattled by fourteen years (1989-2003) of bloody civil war that took away the lives of approximately 250,000 persons (BBC, 2018) and massively destroyed the country, was a sufficient cause for celebration, especially when one considers the finding of renowned development economist, Prof. Paul Coulier: “Only around half of the countries in which a conflict has ended manage to make it through a decade without relapsing into war. Low-income countries face disproportionately high risks of relapse” (Coullier, 2007, p. 27).

Ten Years of Peace Shattered by a Different Enemy

But our joy would be short-lived. In late March 2014, our hard-won peace was again put under threat, this time not by an invasion of gun-firing rebels but by a much more dangerous and insidious enemy – an enemy whose shots were fired without a sound, an enemy very skilled in slipping through frontlines and fortresses to wreak havoc. The new enemy was the Ebola Virus Disease (EVD), which began ravaging West Africa in December 2013 from a small village in Guinea, not too far from the Liberian border.

Liberia Government’s Response

To combat this ferocious enemy, the Government of Liberia headed by President Ellen Johnson Sirleaf developed and implemented, with guidance and support from the World Health Organization (WHO) and other partners, an “Ebola Response Roadmap”, which inter alia provided for the implementation of screening and other preventive health protocols at health centers across the country and at airports and other international inlets. The Government dedicated significant sums of its own scant resources to the fight while appealing to international partners for financial and medical assistance. The Government also heightened surveillance, community engagement, social mobilization and awareness campaigns to address the pervasive and crystallized denial in some quarters of the general public of the existence and deadly nature of the disease. Denial, as it were, made it doubly difficult for citizens to abandon centuries-old traditional, socio-cultural and religious practices that facilitated the spread of the virus.

As the disease continued to prove stubborn leading to an increase in the death toll, the Government upped its response by declaring a state of emergency on August 6, 2014 followed by the imposition of curfew in Monrovia and other parts of the country. The Government’s state of emergency declaration was followed on August 8, 2014 by WHO’s declaration of the Ebola outbreak as a “Public Health Emergency of International Concern (PHEIC)” (WHO, 2014). In order to personally lead the fight, President Sirleaf grounded herself in country beginning in July 2014 and did not make any international trip for nearly eight months thereafter. Her Vice President, Joseph Nyumah Boakai, would follow her lead in August 2014.  This left the burden of making the case for Liberia abroad largely on my shoulders and, to some extent, that of the Minister of Finance and Development Planning. The fight was collective as virtually all other ministers and officials of government working on the home front also contributed immensely to battling the virus.

Battling Harsh Travel Restrictions and Stigmatization

Besides passionately advocating for urgent financial and medical assistance from bilateral and multilateral partners, my job during the Ebola crisis also entailed protesting the slew of panic-driven, draconian measures taken by some countries against Liberia and, by extension, the other countries (Sierra Leone and Guinea) hard-hit by Ebola.  In flagrant disregard of expert advice from the World Health Organization (WHO) and the International Civil Aviation Organization (ICAO) (Singh, n.d.) as well as UN Security Council Resolution 2177 (UN Security Council, 2014), several countries imposed blanket travel bans on travelers from Liberia, Guinea and Sierra Leone and some went further to ban flights to and from the three countries altogether. A few countries, some as far away as the Caribbean, imposed outright bans on the issuance of visas to persons holding Liberian, Guinean or Sierra Leonean passports. The ban on visa issuance granted no consideration for citizens of our countries who did not reside in or had not travel to our region within the 21- day incubation period (WHO, n.d.) of the Ebola Virus Dissase. Persons infected with Ebola showed symptoms within an incubation period of 2 to 21 days, which meant that if a traveler (whether or not the person is a Liberian, Sierra Leonean, or Guinean) had not traveled to any of our hard-hit countries for more than 21 days, it was virtually impossible for that person to be infected with the virus, let alone transmit it. But very few countries were prepared to pay heed to the science of how and when the disease is transmitted. In fact, a fellow West African country refused landing and refueling rights to a humanitarian flight bringing in medical supplies and personal protective equipment (PPE) to buttress the fight against Ebola in Liberia.

Not surprisingly therefore, during the Ebola crisis, the Ministry of Foreign Affairs of Liberia and its diplomatic missions across the world became the recipient of countless complaints from Liberians who had suffered dehumanizing encounters that bordered on stigmatization at the hands of authorities and ordinary citizens of some foreign countries.

One of such incidents that made local and international headlines and drew outrage from Liberians both at home and abroad involved a pregnant Liberian lady by the name of Monique Tatu Allison who was detained in early October 2014 at the Jomo Kenyatta International Airport under harsh conditions for nearly 48-hours (Universal Health 2030, 2014). Monique had traveled to Kenya to visit her aunt, but Kenyan immigration authorities could not allow her entry into Nairobi. Her crime? Her country was being ravaged by Ebola and she possessed a Liberian passport. The fact that Monique adduced evidence to prove that she resided in Europe and had not been to Liberia since the start of the Ebola outbreak did not suffice, as the immigration authorities were hell-bent on deporting her back to Europe. When news of Monique’s ordeal reached me, I posthaste phoned my Kenyan counterpart, Amina Mohammed, Cabinet Secretary for Foreign Affairs who, after many hours of frantic efforts, prevailed on Kenyan health and security authorities to grant Monique entry into Nairobi.

Another extremely heart-rending incident of stigmatization was the experience of a young Liberian lady, Ms. A. Boffah Kollie, who was rejected entry into the Philippines at the Manila Airport. Boffah had earned a scholarship to pursue graduate studies in Medicine in the Philippines. In a formal complaint to the Ministry of Foreign Affairs dated October 28,2014, Boffah wrote,

“When I submitted my Liberian passport to immigration and security authorities at the airport, they picked me up and placed me in an isolated room. When I asked why I was denied entry, they said to me that I was from an Ebola affected country. I asked that they conduct whatever medical examination as may be required, but they refused. I was humiliated and dehumanized in the terminal. I was practically bundled onto a plane (name withheld) and given a mask to cover my nose and mouth and placed in the very back seat of the plane. I was under tight escort by the Immigration and other security personnel in every country I had to transit in till I reached Roberts International Airport in Liberia.”

All diplomatic efforts made by the Ministry of Foreign Affairs to convince the authorities of the Philippines to reverse their stance against Ms. Kollie only proved to be exercises in futility.

To draw the attention and prick the conscience of the international community regarding the rising wave of stigmatization and stereotyping, I granted interviews to BBC and other international wires, issued a formal Liberian government statement against the rising wave of stigmatization (Ministry of Foreign Affairs of Liberia, 2014), and even escalated our concerns to the African Union, the UN Security Council, and the UN General Assembly. At the Extraordinary Meeting of the Executive Council of the African Union (AU) on the Ebola Outbreak held on September 8, 2014 in Addis Ababa, Ethiopia, I asserted:

“Some of our fellow African countries have even gone as far as imposing “total travel bans” on all persons (except their own citizens) from Liberia and other worst-hit countries… Some of the countries taking these draconian measures are not contiguous with any of the affected countries and receive far less travelers from our region as compared to some countries in Europe or the United States that have not imposed  travel bans on us but have instead instituted screening procedures and other safeguards at their airports and other ports of entry…While we do not contest the right of countries to protect, first and foremost, the interest of their citizens and residents, we however feel that if we all should remain true to our often- touted commitment to African solidarity and the ideals of the founding fathers of the OAU/AU, African countries should institute measures that not only protect their own citizens and residents but also promote the greater good of African solidarity. That greater good would require African countries to resist the temptation of taking hysterical measures that make it more difficult for Ebola afflicted countries to quickly unshackle themselves from the grips of the deadly virus.” (Statement of Hon. Ngafuan at AU Extraordinary Meeting on Ebola (09/08/2014), 2014)

At the Open Debate of the UN Security Council on “Peace and Security in Africa: Ebola” held on September 18, 2014 where I and my counterparts from Sierra Leone and Guinea were invited to make remarks, I stated:

“While we commend some members of the international community for lending hands of solidarity and empathy to us as we grapple with this virus, we are shocked and remain concerned by the actions of others in imposing travel and other restrictions on Ebola-affected countries. These actions, which run counter to advice from WHO, ICAO and other experts, border on blanket stigmatization and have now started to seriously undermine humanitarian efforts in our countries. We therefore call upon the concerned member states to reconsider their policies in light of the expert advice provided by the specialized international agencies.” (Hon. Ngafuan Speaking @ the UN Security Council Emergency Ebola Meeting – September 18, 2014, 2014)

Essentially, the point that I and many other persons in the Ebola affected countries were making was that “we all are affected, but we all are NOT infected”.

Comparing EVD and Covid-19

Fast forward to April 2020 and the Coronavirus (COVID-19) pandemic; and what we see is truly frightening. In comparison, unlike the EVD epidemic that was mostly localized in essentially three of the four Mano River countries of West Africa (Liberia, Guinea and Sierra Leone), cases of COVID-19 have been reported in more than 200 countries and territories worldwide as of this writing. The US Centers for Disease Control (CDC) reports (Centers for Disease Control and Prevention (CDC), 2019) that during the two and half year period (December 2013-June 2016) of the Ebola crisis, 28,652 persons were confirmed or suspected to have been infected with the disease resulting to 11,325 deaths. The CDC report also shows that Liberia recorded the highest number of human deaths (4,810), followed by Sierra Leone (3,956). In contrast, according to data produced by John Hopkins University, as at April 13, 2020, the COVID-19 pandemic has infected 1,897,373 persons resulting to  117,569 deaths worldwide (John Hopkins University & Medicine, 2020) in a space of just less than five months! The same John Hopkins data showed that Liberia has, as of April 13, 2020, recorded 59 cases of Coronavirus with 5 deaths; Guinea 319 cases with no death; and Sierra Leone 10 cases with no death.

Furthermore, while the global case fatality rate of the COVID-19 pandemic of 3.4% (Lovelace & Higgins-Dunn, 2020) is dwarfed by the case fatality rate of the EVD epidemic, which averages around 50% but can be as high as 90% (WHO, 2020), COVID-19 is far more contagious than EVD. EVD is not airborne and is “transmitted among humans through close and direct physical contact with infected bodily fluids, the most infectious being blood, faeces and vomit” (WHO, 2014), while COVID-19 has multiple modes of transmission, including airborne transmission mainly from coughing and sneezing. Furthermore, EVD only transmits when the infected person begins to show symptoms unlike COVID-19 that can be transmitted when the infected person is still asymptomatic (The New York TImes, 2020). The grim reality this points to is that while COVID-19 may not be as deadly as Ebola because of its lower case fatality rate, the absolute number of persons that could ultimately die from the pandemic could far outpace that of Ebola by many multiples due to the sheer colossal number of persons that could get infected as a result of the exponential spread of the virus. A well respected epidemiologist and disease modeler, Dr. Neil M. Ferguson, even projected that 2.2 million persons could die in the United States alone in a worst-case, apocalyptic scenario if COVID-19 is not quickly stopped in its tracks. (Kristof, 2020)

Self-Preservation Fuels Hasher Reactions by Countries

The potential of COVID-19 to spread exponentially and consequently lead to a significant number of deaths has led governments and ordinary citizens across the world to hit the panic button. Several countries are now in a race against time to impose harsh, draconian, and coercive measures aimed at protecting their populations from the rampaging enemy. A permanent fixture in the cocktail of measures countries have adopted to combat COVID19 include lockdowns of entire cities, provinces or states and the imposition of very stringent travel restrictions to include the closure of airports to all commercial flights. As the fear level in the general public rises in a given country, so too has the clamor from a significant segment of its population for harsher government response to include the banning of flights or travels from abroad, particularly from countries hard-hit by COVID-19. (World Economic Forum (WEF), 2020)

The United States imposed travel restrictions on China on February 2, 2020 (Kessler, 2020) joining a list of 37 other countries that had imposed similar restrictions on China when the Coronavirus outbreak was still largely localized in Wuhan City in Hubei Province in China. Reports have also emerged about overt and subtle acts of discrimination and stigmatization against Chinese nationals and Chinese-owned businesses, particularly restaurants, in some parts of the world (CNN, 2020). Paradoxically, media outlets have in recent days reported news of dehumanizing and xenophobic attacks in Guangzhou, China against African nationals who have been stigmatized for being behind a second wave of coronavirus infections in China (Aljazeera, 2020).  It is noteworthy that the WHO, in a statement dated January 27, 2020, publicly advised, just as it did during the Ebola crisis, against the imposition of travel bans on countries with cases of COVID- 19 (WHO, 2020). In a Situation Report issued on February 24, 2020, the WHO also frowned on “instances of public stigmatization among specific populations, and the rise of harmful stereotypes” (WHO, 2020).

But as the disease began to rapidly envelope the USA and many other countries in Europe, Asia and Africa, many countries found it enticing to flatly ignore WHO’s guidance. The United States would later expand travel bans on persons traveling from the European Union and the UK. The European Union (EU) itself would later ban flights from abroad into countries of the EU.  Interestingly, since it declared the COVID 19 crisis a pandemic on March 11, 2020, the WHO itself has practically ignored or have found it extremely difficult to speak against the outright disregard of its guidance against travel restrictions and stigmatization.

Weak and Poor Countries Now Imposing Travel Restrictions on Powerful Countries

Indeed, the world is now witnessing a new normal as a result of COVID-19. Tolbert Nyenswah, the Liberian public health expert who led the Ebola response in Liberia, buttressed this point in a recent interview, “Think back to the Ebola outbreak in West Africa a few years back. Seven out of the 28,652 suspected cases escaped the African continent in two and a half years and yet the industrialized world was in a full-scale panic; today, it is the industrialized world that is exporting an infectious disease to the global south. But while not as deadly, COVID-19 is far more contagious.” And in this panic-laden new normal occasioned by COVID-19, even small or less developed countries, particularly in Africa, that had long been at the receiving ends of travel restrictions from Europe and the United States, now find themselves on the giving end of travel restrictions. Few weeks ago, Nigeria, Ghana, Kenya and few other African countries put blanket travel bans on the United States, China, the UK and other countries hard-hit by COVID-19 (Penney, 2020). And who could ever imagine that a day could come when a small, aid-dependent country like Liberia would muster the boldness to impose travel restrictions” on the United States without suffering adverse diplomatic or other consequences? Thanks to the Coronavirus pandemic, that day came and passed a few weeks ago with virtually no notice when Liberian President George Weah, in an address to the nation (FrontPageAfrica, 2020) upon the confirmation of Liberia’s first Coronavirus case, announced,  as part of a package of measures to stem the spread of the virus, the banning of “all travels to and from all countries with 200 or more Coronavirus cases.” At the time of President Weah’s address on March 9, 2020, the United States was among the countries that had registered more than 200 Coronavirus cases. Ironically, my country, Liberia, that loudly and vehemently protested the imposition of “harsh” travel restrictions during the Ebola crisis is now implementing “harsh” travel restrictions during the COVID-19 pandemic. Interestingly, these tough measures by the Government have received the support of an overwhelming majority of Liberians.

Finding the Fall Guy

As both the number of COVID-19 cases and deaths increased with jet-like speed in the United States, Europe, and other parts of the world, Monday morning quarterbacking also increased. With the benefit of hindsight, many have been tempted to entertain the question, “What if countries had imposed bans on international commercial flights and taken other harsher measures to contain the spread of COVID-19 much earlier? Would countries such as USA, Italy, Spain, the UK, and the world at large have been spared the massive loss of lives and precipitous economic downturn that we know today? US President Donald Trump (The New York Times, 2020), himself facing domestic criticism for ignoring intelligence warnings of the impending Coronavirus crisis in the United States and not taking proactive actions, and others have faulted the WHO for delaying to sound the alarm on the escalating public health threat through appropriate public health declarations. And as a reflection of the geopolitical undercurrent of the COVID-19 crisis, some of these critics have also faulted the organization for being too “trusting” and accommodating of China, particularly during the early stages of the crisis. Few critics have even arrowed the blame directly at WHO Director General Tedros Adhanom Ghebreyesus, disregarding the obvious fact that WHO is a body laden with a complex decision making process requiring prior deliberation and consensus every step of the way by an “International Health Regulations (2005) Emergency Committee” comprising public health experts of repute from many countries including the United States. But as I said in a recent article against death threats and racial insults directed at the WHO Director General, “COVID-19 has posed its unique set of challenges, confounding the best and smartest virologists and epidemiologists, indeed; the entire global community of medical research scientists and doctors. Medical specialists, the world over, are still struggling to fully grasp the nature and behavior of this deadly and insidious enemy.” (Ngafuan, 2020).

Hardly Any Space for Political Correctness

Assessing the Ebola crisis against the backdrop of the present realities posed by the COVID-19 pandemic, I am constrained to own up to the realization that in the new normal created by the COVID-19 pandemic where virtually every country has retreated into a cocoon of self-preservation, arguments similar to what I proffered at the AU Executive Council Meeting, the Open Debate of the UN Security Council on Ebola, and other fora in protest against harsh travel restrictions and stigmatization during the Ebola crisis may gain little or no traction and could even be considered completely inappropriate.

I am also inclined to conclude that as a public health challenge becomes more severe, the line between what would be considered rational measures taken by individuals, groups, or countries to protect themselves and acts of stigmatization gets blurred. Measures or reactions that would ordinarily trigger public derision for being overly harsh or stigmatizing or xenophobic are taken or occur with little or no condemnation. Indeed, it has gotten increasingly apparent that as the perception of a public health challenge as an existential threat increases in a given society, self-preservation becomes the overriding logic, the pause button is pressed on compunction and political correctness, and the ordinarily unfashionable becomes fashionable. Ironically, the same measured approach adopted by WHO and its expert advice against blanket travel restrictions and stigmatization, which proved to be very effective and was lauded by several countries during the Ebola crisis, have opened the organization up for criticism during this COVID-19 crisis.  And the very same 2005 International Health Regulations (IHR) that guided WHO’s decisions during the Ebola crisis is unfortunately proving to be wanting or out of sync with the pace and harsh reality of the COVID-19 pandemic.

Stronger International Cooperation or Harsher Individual Actions?

What the COVID-19 pandemic has brought to the fore is that a public health threat in any part of the world is a potential public health threat to all or most parts of the world. What began in Wuhan city as a “Chinese” problem has now become an Italian problem, a Spanish problem, an American problem, a South African problem, a Nigerian problem, a Liberian problem. Indeed, we are as strong as our weakest link and improvements in the public health situation of one country positively affects the global health situation of the entire world.  I therefore hope that in the post COVID-19 world, we would see stronger international cooperation and swifter international action to prevent or quickly snuff out any public health challenge that may sprout in any part of our one world. No doubt, the post-COVID-19 world would require the revisiting of the 2005 International Health Regulations (IHR) and other relevant instruments of the WHO as well as the rules of diplomatic engagements between and among states, as reflected in the Vienna Convention on Diplomatic Relations, to make them more responsive to the harsh challenges and nuances posed by pandemics of the breath and magnitude of COVID-19.

But I must concede that I also fear that the new post-COVID-19 world order could see the actions of individuals and nations being guided solely by the First Law of Nature (self-preservation) and that the “social distancing” of today could unwittingly leave a legacy of selfishness and “beggar-thy-neighbor” policies and practices that may in fact undermine the collective action needed to deal with individual or local challenges that can easily morph into common or global challenges.

About the Author: Augustine Kpehe Ngafuan served as Minister of Foreign Affairs (February 2012-October 2015) and Minister of Finance (August 2008-February 2012) of Liberia. He is an IMF-rostered Public Financial Management Expert and serves as an Independent Director on the Board of Ecobank Liberia Limited (EBLL).

References

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5 COMMENTS

  1. Honorable Ngafuan,

    Thank you for your well researched commentary in this news medium, The Liberian Observer. The commentary dwells on a critical analysis which compares and contrasts the COVID-19 disease caused by a particular strain of the Coronaviruses – another strain of this virus causes common cold in humans – and the Ebola disease caused by the Ebola virus, from the Filoviruses. It is quite gratifying that your commentary brought to light the humanitarian hardship encountered by traveling Liberians and citizens from Sierra Leone and Guinea.

    As Liberia’s Foreign Minister during the height of the Ebola crisis you accentuated, in your commentary, the diplomatic ramifications that were involved in the negative treatments citizens from the three Mano River countries faced during their travels. Interestingly, these proverbial small countries and others are now meting out the same treatment to more powerful and richer countries by banning travels from them dring this COVID-19 pandemic.

    Another viral disease not mentioned by you is the AIDS caused by the HIV, from the Retroviruses. Yes, as Coronavirus is now a concern during the George Weah’s administration, and Ebola was during Ellen Johnson-Sirleaf’s, AIDS was the major public health issue during the Samuel K. Doe’s presidency. As you may realize, all of these diseases are relatively new diseases on the world scene, obviously the newest being COVID-19.

    There is one thing that is common with the three viruses causing the three diseases, the Coronaviruses, Filoviruses, and Retroviruses are three distinct families of viruses with the same origin, RNA. What is fearful is that we do not know which one of the RNA families of viruses might suddenly create the next major public health crisis in the world and how it may affect the people of the proverbial small countries like Liberia.

  2. Self-preservation is necessarily and rightly so the first reaction. But, as the central thesis of this commentary, there must be increased collaboration and networking among all countries to provide for the early detection and containment of future contagion. Protectionism and isolationism cannot work to avert any global health crisis. There must be increased international collaboration in the post-Covid 19 world. The world today is more globalised, more interconnected and more interdependent. Mankind must increasingly cooperate for our collective survival or the lack of cooperation will put an end to mankind.

    This article is thoroughly researched. … very academic! Great job, Ngaf!!

  3. The issues raised by the former Minister of Foreign Affairs of Liberia in his commentary brings to the fore front both an intellectual and practical discourse germane to today’s realities as far as Liberia is concerned. I wish other well meaning Liberians and others could contribute to the discourse. And, as usual, thanks to the Observer for setting up this platform.

    In my earlier post I concentrated on the causative issues that triggered the commentary – diseases that disrupt the socioeconomic order of the world, and human life itself. I then threw some light on the pathogens involved and how they are related. Finally, a disturbing point was made that there is a possibility (probability) of a re-occurrence of the situation the world is presently facing due to the nature of the RNA viruses – dormant today, and suddenly being virulent and causing hovoc tomorrow. If that happens, how would Liberians be affected?

    As we stated in the earlier post, Liberians are presently experiencing the third (3rd) wave of public health crisis in the past 30-35 years with varying degrees of intensity – from Doe to Weah. Each of these episodes carried with it a certain degree of stigmatization, whether intra-national or inter-national. The minister documented well the stigmatization of the Ebola disease, which was international in nature , which is in accordance with his pirtfolio as former Minister of Foreign Affairs. The COVID-19 speaks for itself in this regard. There was also a degree of stigma attached to the AIDS, if anyone can recall. At that time, no one wanted to socialize with a person suspected of being infected with the HIV, the causatived pathogen, and Liberia was no exception – which means within a given country. That was before Earvin “Magic” Johnson contracted the disease.

    In the minister’s overarching point of contention: Self-preservation and stigmatization, self-preservation has been the age old game of the animal kingdom, and humans are no exception! Historically, wars (and the preparations thereof) are fought by humans to assert this fact. In contemporary history, there has been ideological war (cold war) between East and West – communism versus capitalism. There has also been socio-economic war between North and South – the rich western countries versus the poor developing countries. One prominent world leader of the North recently epitomized the word stigmatization by refering to all African countries of the South as “a__ hole countries”. Until otherwise ordered, this is the modus operandi of the world order!

    The question still remains: How will Liberia be prepared for the next wave of public health crisis, God forbade? Is it modern hospitals/medical clinics, 21st century schools, and modern roads and bridges, or status quo?

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