The Politics of Fear

Médecins sans Frontières and the West African Ebola Epidemic

Edited by Michiel Hofman and Sokhieng Au

Médecins sans Frontières's commissioned, independent analysis of Ebola 2014, the defining health event of our century so far
A vital historical and political document for both auditing our response to the disease and informing future responses
Contains insights highly relevant to current and future epidemics, including Zika and other looming threats
Comprises 11 in-depth chapters on the extent and politics of the outbreak, supplemented with four vignettes from persons on the ground during the response

The Politics of Fear

Médecins sans Frontières and the West African Ebola Epidemic

Edited by Michiel Hofman and Sokhieng Au

Description

The 2014-2015 Ebola epidemic in West Africa was an unprecedented medical and political emergency that cast an unflattering light on multiple corners of government and international response. Fear, not rational planning, appeared to drive many decisions made at population and leadership levels, which in turn brought about a response that was as uneven as it was unprecedented: entire populations were decimated or destroyed, vaccine trials were fast-tracked, health staff died, untested medications were used (or not used) in controversial ways, humanitarian workers returned home to enforced isolation, and military was employed to sometimes disturbing ends.

The epidemic revealed serious fault lines at all levels of theory and practice of global public health: national governments were shown to be helpless and unprepared for calamity at this scale; the World Health Organization was roundly condemned for its ineffectiveness; the US quietly created its own African CDC a year after the epidemic began. Amid such chaos, Médecins sans Frontières was forced to act with unprecdented autonomy — and amid great criticism — in responding to the disease, taking unprecedented steps in deploying services and advocating for international aid.

The Politics of Fear provides a primary documentary resource for recounting and learning from the Ebola epidemic. Comprising eleven topic-based chapters and four eyewitness vignettes from both MSF- and non-MSF-affiliated contributors (all of whom have been given access to MSF Ebola archives from Guinea, Sierra Leone, and Liberia for research), it aims to provide a politically agnostic account of the defining health event of the 21st century so far, one that will hopefully inform current opinions and future responses.

The Politics of Fear

Médecins sans Frontières and the West African Ebola Epidemic

Edited by Michiel Hofman and Sokhieng Au

Section I. Terms of Engagement
1. Ebola: The failure of global health governance?
Claire Wenham
2. MSF and the Military
Adia Benton
3. Fear and solidarity in global health: Médecins Sans Frontières and the 2014 Ebola outbreak in West Africa
Joao Nunes
Section II. Systems and Actors
4. Between mistrust and routine: epidemic management in Guinea, Mali, and Niger
Jean-François Caremel
5. Roll out of and response to the epidemic: Impressions from the field perspective
Thomas Kratz
6. Collateral effects of Ebola virus disease on the national health programs in Guinea, 2014
Niouma Nestor Leno
Section III. Therapeutics
7. Unproven humanitarian assistance: MSF and the ethics of using experimental vaccines and treatments during the Ebola epidemic
Annette Rid
8. Z-Mapp for white people only
Timothy O'Dempsey
9. Balancing patient care, epidemic containment, and risks of staff contamination
Armand Sprecher
Section IV. (Im)mobility
10. Care or containment? Field practices and perceptions of norms for contact follow up
Alice Desclaux, Stéphane Doyon, Khoudia Sow, and Almudena Mari Saez
11. Challenges of Instituting Effective 'Medevac' Policies
Duncan McLean

The Politics of Fear

Médecins sans Frontières and the West African Ebola Epidemic

Edited by Michiel Hofman and Sokhieng Au

Author Information

Edited by Michiel Hofman, Senior Humanitarian Specialist, Médecins sans Frontières, and Edited by Sokhieng Au, Program Staff, Advocacy and Analysis Unit, Médecins sans Frontières

Michiel Hofman worked on MSF field missions between 1993 and 1998 as Emergency Coordinator and Head of Mission in Liberia, DRC, Bosnia, Burundi, Sri Lanka, Brazil, South Sudan, and Kosovo, returning to his other career as freelance journalist between missions. Between 1999 and 2001, he co-founded the Antares Foundation, a Dutch non-profit organization that supports local NGOs in providing psycho-social support for staff working in high-stress environments. He returned to MSF in 2001 as Country Director in Russia, Operations Director in Amsterdam, and Country Director for Afghanistan. Since 2011 he has worked as senior humanitarian specialist for MSF based out of Belfast, concentrating on research, training, and operational support as well as publications in the humanitarian field.

Sokhieng Au is a program staff member with the Advocacy and Analysis Unit of Médecins sans Frontières and a research fellow in the Cultural History since 1750 program at Katholieke Universiteit, Leuven, Belgium. She earned a PhD in history from University of California, Berkeley, and an MPH from the Johns Hopkins Bloomberg School of Public Health.

Contributors:

Adia Benton, Professor of Anthropology, Northwestern University, Evanston, IL, USA.

Jean-François Caremel, CERMES3, France.

Alice Desclaux, Researcher, Institut de Microbiologie et des Maladies Infectieuses, Dakar, Senegal.

Stephane Doyon, MSF Spain.

Thomas Kratz, Information Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin Germany.

Duncan McLean, Lecturer in History at Charles University and Anglo-American University, Prague, Czech Republic; Analyst, MSF France.

Niouma Nestor Leno, Comité National de Lutte contre le SIDA, Guinea.

Joao Nunes, Lecturer in international relations, University of York, UK.

Timothy O'Dempsey, Senior Lecturer in Clinical Tropical Medicine, Liverpool School of Tropical Medicine, UK

Annette Rid, Senior Lecturer in Bioethics, King's College London, UK.

Almudena Mari Saez, Centre de Recherche et de Formation à la prise en charge de Fann, Dakar, Senegal.

Khoudia Sow, Ministry of Health, Senegal.

Armand Sprecher, MSF-OCB.

Clare Wenham, Research Fellow in International Politics, Aberystwyth University, UK.

Vignettes:

Patricia Currick, nurse with MSF Operational Centre (OC) Amsterdam and Brussels.

Lindis Hurum, emergency coordinator, MSF Norway.

Mark Poncin. Research Unit on Humanitarian Stakes and Practices, MSF OC Geneva.

Mercedes Tatay. UN Field Coordinator, WHO Ebola Outbreak Response, Sierra Leone.