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As 2015 began, the world received a sobering message.
Not only have the number of Ebola cases exceeded 20,000, but in some affected countries, especially Sierra Leone, the virus is still spreading. The death toll now tops 8,000 and the usual answers to how this outbreak got so huge so quickly - poverty, bad governance, cultural practices, endemic disease in Guinea, Liberia and Sierra Leone - are giving way to a deeper questioning of the poor public health response.
Critics are turning to the structural causes of weak health systems and increasingly showing that international lending policies, including and especially those employed by the IMF, should carry much of the blame.The IMF has been active in West Africa for many years; the
first IMF loan to Liberia was in 1963. And for almost as long, public health activists have pointed to the detrimental effects of the strings the IMF attaches to its loans, known as
conditionalities, which
more often than not constrain investment in public sector health services. As a December 2014
comment in medical journal, the
Lancet explained, the IMF has provided support to Guinea and Sierra Leone for nearly two decades, and to Liberia for seven years. All three countries were engaged in IMF programmes when the Ebola crisis began.
IMF conditionalities meant countries have had to prioritise repaying debt and interest payments over funding critical social and health services. Countries such as Guinea, Sierra Leone and Liberia have
had to limit not only the number of health workers they were able to hire (Liberia had only 60 doctors before the Ebola outbreak, Sierra Leone had 136), they've also had to cap wages to a pitifully low level to meet broader IMF policy directives. The Lancet comment also points out that in Sierra Leone, IMF-mandated policies explicitly sought to reduce public sector employment. In 1995 -1996, the IMF required the retrenchment of 28 per cent of public employees. The World Health Organisation reported a reduction of community health workers from 0.11 per 1,000 population in 2004 to 0.02 in 2008. Caps on wage spending continued into the 2000s.
The Lancet authors state, "By 2004, [Sierra Leone] spent about 1.2 per cent of GDP less on civil service wages than the sub-Saharan African mean."
Comment: The newly emerging Australian Bat Lyssavirus in a captive juvenile black flying fox exhibited progressive neurologic signs, including sudden aggression, vocalization, dysphagia, and paresis over 9 days and then died. This virus is considered endemic in Australian bat populations and causes a neurological disease in people indistinguishable from clinical rabies. There are two distant variants of ABLV, one that circulates in frugivorous bats (genus Pteropus) and the other in insectivorous microbats (genus Saccolaimus). Three fatal human cases of ABLV infection have been reported and each manifested as acute encephalitis but with variable incubation periods. Importantly, two equine cases arose in 2013, the first occurrence of ABLV in a species other than bats or humans.