2014: The Year We Put “Just” In Front Of Malaria

How privilege, fear, and nationalism hinder the eradication of infectious diseases.

 
“Epidemics on the other side of the world are a threat to us all.”
– Peter Piot, Director, London School of Hygiene & Tropical Medicine

he year is 1976. Peter Piot, a 27-year-old training to be a clinical microbiologist, receives a blood sample from Zaire (now the Democratic Republic of Congo). It’s in a typical blue coffee thermos and the label contains a “?” and “Yellow Fever.” No, the sample isn’t from a local. It’s from a Belgian nun and she was evacuated from Yambuka to the capital city of Kinshasa. Piot, after consulting with researchers from all over the world and ruling out, among others, the Marburg virus, realizes he’s looking at an entirely different animal.

The animal turned out to be Ebola. Piot had just become a co-discoverer.

Little did he know that the animal he discovered 38 years ago would create a panic that would hinder efforts to combat another animal, one that Burmese fossils prove has been evolving for at least 100 million years, an infectious disease with such an ancient history that it has perhaps been killing us throughout the entire course of our evolution, a parasitic protozoan that kills nearly a million of us each year, that was Shakespeare’s go-to disease metaphor when he wanted something wicked, and that one in seven of us are carrying around right now in our bodies. Any guesses?

Oh c’mon. It’s just malaria.

The year 2014 will likely be forever known as the first time the phrase “just malaria” was used frequently enough to carve out its own place in our lexicon. Doctors said it. Talking heads said it. We said it at the water cooler and even used it to create this meme:

But it didn’t have to be that way. So why was it?

“It’s hard to describe,” Piot told the BBC when asked about that time in 1976, “but the main emotion I had was one of real, incredible excitement. “There was a feeling of being very privileged, that this was a moment of discovery.”

Piot, now the director of the renowned London School of Hygiene & Tropical Medicine, felt and likely understood the extent of his privilege. And the countless hours I’ve spent alongside today’s tropical medicine researchers — from Stephen Hoffman and Peter Billingsley of Maryland-based biotech company Sanaria to François Nosten of the Thailand-based Shoklo Malaria Research Unit — have proved to me that they do as well.

Just so we’re on the same page here, by “privilege” I mean general, built-in, widely beneficial social advantages (such as being white).

Most tropical medicine specialists could have made loads more money and had far easier lives if they’d joined up with Big Pharma or chosen to research which diaper brand truly holds the most urine or how to slow down the scourge of male pattern baldness. In short, if they’d selected patients with more privilege.

Bill Shore, author of The Imaginations of Unreasonable Men, got it right when he wrote:

Doctors who specialize in tropical medicine went through the same rigors of medical training and accumulated the same amount of medical-school debt as their colleagues who chose pediatrics, oncology, cardiology, or neurology. But, when they chose different diseases, they chose different patients. As a result, they gave up the comforts of American medicine and many of its rewards.

When disease strikes people who lack privilege, there is typically little effort or enthusiasm to do anything about it unless said disease can or does intrude — in obvious ways — into the lives of those with privilege.

See: efforts to end HIV/AIDS vs. efforts to end malaria.

See also: 2014 media coverage of Ebola (5,147 deaths) vs. malaria (est. 627,000 deaths).

I say “in obvious ways” because if we unpack our privilege and heed Zen Master Thích Nhất Hạnh’s mantra “We are here to awaken from our illusion of separateness,” it is easier to see that disease anywhere impacts humanity everywhere. The malaria rampant in sub-Saharan Africa means that the people there have a harder time letting their brilliance flourish. It means fewer children are being educated and contributing to the progress of our world. It means the emerging market forever remains emerging. And it means that other diseases and even societal horrors such as modern slavery can prey on the vulnerability it creates. But if we are unable or unwilling to do that unpacking then the Oh shit! moment is delayed until the disease — Ebola this time, something else next time — infects “our” nation because, in part, we’ve ignored the faraway “other.”

Enter stage left: Panic and Ebola are chauffeured in by nationalism privilege.

Enter stage right: Headlines march to center stage and tell their story:

• Voice of America: “Ebola Sabotages Guinea’s Anti-Malaria Fight”
• BBC News Health: “Fears that Ebola crisis will set back malaria fight”
• Doctors Without Borders: “MSF Begins Malaria Program in Ebola-Ravaged Monrovia, Liberia”

Two weeks ago I sat with notebook and pen and admiration as Bill Gates addressed such issues head-on at the annual meeting of the American Society of Tropical Medicine & Hygiene. Here was one of the world’s premier gatherings of tropical medicine geniuses, 4,000+ attendees who were all contemplating the same question: How would Bill Gates address the Ebola elephant in the room?

Gates responded by speaking about malaria. Of course he gave Ebola its rightful nod, but then he quickly moved on to the importance of eradicating malaria, how our position to end it within a generation is one of the “greatest global health opportunities the world has ever had.”

To directly address the links between Ebola and nationalism privilege I checked in with Dr. Barry Olson, a student affairs administrator, faculty member, and scholar practitioner at NC State University. He is widely respected as a thinker on privilege and his recent talk at Richmond College (see PDF slides here) examined the myriad links between men and privilege. He dove right in:

There is an extreme amount of privilege being exerted from many fronts. First and foremost there seems to be a high amount of nationalistic privilege. We pride ourselves as a country chock-full of resources and saviors; of the best educated and most skilled doctors, nurses, and scientists, yet now the discussions seem to turn to ‘closing the borders,’ to ‘protecting our own’ and to ‘keeping America safe.’

The message of “keeping America safe” is incredibly important, but not, as I believe Dr. Olson was alluding to, when it means diluting talk about the world’s interconnectivity and heightening American nationalistic insularity. And this is what is happening, even at the ASTMH annual meeting, where some of the world’s greatest Ebola researchers were banned from attending — because they would have to travel from Ebola-afflicted countries.

A cursory analysis of CDC Director Tom Frieden’s public appearances show that he too has felt this pressure to speak of keeping America safe while pulling back on the way in which he originally spoke about Ebola: by espousing the very real notion that, despite how great and separate we think we are, we are actually vulnerable and interconnected — get this — just like everybody else in the world. Frieden has wrapped this message to We the people in a variety of ways so as not to come off as accusatory, but his current public educational direction has turned away from speaking in unselfish abstractions such as “connected” in favor of selfish concretes such as this line from his article in The Huffington Post titled, “The High Stakes in Fighting Ebola: Leave One Burning Ember and the Epidemic Could Re-Ignite”:

“The best way to protect Americans [from Ebola] is to stop the outbreak in West Africa.”

In other words, help them not to help them and because we are them, but because it will help us. This unacknowledged privilege can manifest itself as anger and as anger’s older sibling: fear. As Dr. Olson said:

The recent flood of Ebola-related fear-mongering is troubling on many levels. We demonize those same people who are caregivers and helpers, and seem to act as ‘resident experts’ on the control of the spread of Ebola. One would think that the truly scientific discussions surrounding the spread of the disease would be occurring, yet reasonable Americans are now calling for the heads of our leadership, including the president. Fear-mongering continues on radio talk shows, insinuating that our government (or other governments) designed the Ebola virus to destroy other countries. Fear sells, and it breeds anxiety.

But it damn sure generates attention. And money. Fear and anxiety is what helped generate the billions of dollars that poured in to combat HIV/AIDS. The same can be said for Ebola. But then there’s just malaria. Killing millions and yet no more a part of our lives than unicorns. I’ve been there. Prior to conducting research for my book, Malaria, Poems, I saw malaria as mostly factoids. Numbers and bars on a chart, but nothing real.

In 2012, 482,000 children didn’t see their 6th birthday due to malaria.

I continue to see unacknowledged privilege as the root of why we haven’t eradicated malaria. The scare now is Ebola but what next? If we are “us” and they are “them” it’s awfully difficult to sit down in an increasingly global world and have rational conversations about the important topics that impact us all. Like climate change. Or healthcare systems. Or penal reform. Or malaria. In fact, Frieden has been forced to spend national television time working more as parent allaying and at times redirecting the angry emotional responses of children rather than specifically addressing the complexities of Ebola:

“We can never forget that the enemy here is a virus. The enemy is Ebola; not people, not countries, not communities, a virus.”

The enemy. Just like war. Frieden knew and used the language that most easily fires us up. His slick move was used to at once embrace the drumbeat of our jingoism while attempting to pivot our perspective from “us vs. them” to “us vs. it.”

But here’s the reality: Malaria has been with us for millions of years and yet we still do not have a vaccine for it, though I believe Sanaria is getting quite close. We’ve created brilliant methods that work to prevent and usually cure it, but why haven’t we eradicated it? Because malaria, both the Plasmodium parasites and the Anopheles mosquito vector, are fascinatingly and dangerously complex and adaptive, and because we humans have simply not rallied and then applied our compassion toward ending it for each other. Here’s the radically short history of tropical medicine through the lens of malaria: Once we wiped it out in the West we let it ravage everywhere else until we wanted to travel to — and dominate — everywhere else.

Recognizing our privileges may at first make us feel guilty or as though our hard work and achievements are being devalued. While these are rather natural defense mechanisms, they are not the purpose of privilege recognition. The purpose is to see ourselves and ultimately the world we’re part of with a little more clarity so that we can then wield our privilege for good.

I’m white. I’m male. I was born in the United States. I’m heterosexual. I’m able-bodied. I speak English.

Based purely on circumstances beyond my control I’ve been born with perhaps six of modern humanity’s greatest privileges. I don’t feel bad for carrying those privileges but failing to recognize the full extent of the advantages they provide would be akin to burying my head in the sand. Yes, I’ve busted my ass to achieve certain things in life but all of that hard work has been bolstered along the way. To deny that would be to believe in the bootstrapping myth. You know, that I achieved all kinds of awesome things by pulling myself up by my bootstraps. Such a thing doesn’t exist. Who built the sturdy chair I’m sitting on? The computer I’m typing on? The safe society that allows me the freedom to write? The spark of love and biology and circumstance that brought my parents together, and their parents, and their parents?

While we as a society have yet to fully develop the language and sensitivity needed to discuss privilege, the following Facebook post by Asha Leong stirred up some controversy, in part because it struck the nerve of truths we like to keep locked up and safe:

We can’t escape the media’s buzz about Ebola. The virus is here and it certainly is scary — I am not trying to fuel the anti-hysteria hysteria. But this has been scary elsewhere for years and should have been for us, too. Experts warned of the potential of this happening but nobody cared (myself included). Frieden has said repeatedly that, “Everything we’ve seen until now reinforces what we’ve known for the past 40 years. We know how to stop outbreaks of Ebola.”

And yet here we are. We didn’t control it and we weren’t prepared. Why not? I believe it’s because we got in our own way. Our perceived wants were masked as needs. How many of us a few months ago knew more about erectile dysfunction than the potential spread of Ebola?

My hand is raised.

We aren’t forced to see the way malaria destroys the bodies of children or the economies of countries. That’s privilege. We don’t have to understand our positionality on this issue and do something about it — but we should. May we pivot from “just malaria” to a place of engaged empathy. May we see as family those beyond our homes and beyond our borders. May we end malaria in a generation and be privileged enough to watch as other diseases are easier to defeat as a result.