The Ebola Virus Disease, AFCON 2015 and election 2016

Dr. George Amofah is the chief scribe of the Ghana Public Health Association (GPHA). He is a common house figure in the health sector. Having practice in both rural and urban communities as a medic and having served in various managerial positions, including serving as the director for Public Health, Dr. Amofah has seen it all. All these years, he has kept to a sober demeanour, hardly rocking the boat with his expertise and rich experiences.

But this week, it became very necessary for the astute public health practitioner to speak and he spoke in volumes. When he heard that Ghana was readying itself to host AFCON 2015, Dr Amofah could not simply keep quite. Hear him as he address the GPHA members: "Dear colleagues, I wish to express my disquiet, apprehension and vehement opposition (speaking purely from professional and technical viewpoint) to any proposal to host the AFCON 2015 tournament in Ghana at this stage of the Ebola epidemic in the sub-region". By then, many of us mortals started asking; how do you mean? But to Senior Amofah, the reasons for his outburst are obvious:

"1. The EVD epidemic is currently NOT even peaking, with WHO predicting that over 10,000 cases may be reached shortly, and has admitted that the disease is running faster than current WORLDWIDE capacity to deal with it.

2. The tournament usually will take nearly 3 weeks or so, and people who were incubating the disease will have enough time to manifest symptoms, and begin transmitting the virus while in Ghana to others (emphasis mine).

3. Such tournaments go with 'high risk' activities, such as group gathering, sexual exploitation by commercial sex workers, use of group toilet and urinal facilities (unhygienic even at best of times), challenges in waste disposal etc etc etc

4. There will certainly be influx of actual patients 'fleeing' from infected countries if the scenario described under (1) is anything to go by.

5. While the country may be able to deal with isolated case or two occurring at the same time, the opportunity for multiple 'hot' spots emanating from multiple exposures spread across the country will definitely overwhelm our capacity to deal with any eventuality. AND AT WHAT BENEFIT IN THE FIRST PLACE!!"

Those are the true words of the public health "soothsayer". And none of us can say the man is "too known" because he knows more than two. Concluding his evidence and theory based advice, he said "I can go on and on but I think we will be putting ourselves into an unwarranted risk with major consequences. Whoever has influence and authority should advice the authorities NOT to accept any such offer at this time. Probably, much much later, e.g in 2017 when we will know how the epidemic will span out" 

So what has forced the man with many years of public service to speak in such frightening manner? The culprit is known as Ebola -a disease that possess an unknown risk to the very survival of both woman and mankind. The WHO is very clear - the Ebola epidemic is not peaking yet; meaning the incidence is still rising and case fatality rate is still sky rocketing. 

The epidemic is "running faster than current WORLDWIDE capacity to deal with it" - meaning with all the technological and scientific advancement in our public health thinking, the Ebola viruses are still superior at this moment. Reminded of our falsely perceived "we are in control of this world attitude" folks are forced to give all kinds of labels to the EVD. Some people take the easy road to declare the epidemic as demonic.  Speaking from such high spiritual grounds is the easiest way to prevent those of us from the "carnal-thinking" world from asking them further questions. So those spiritual folks win their arguments before they open their mouths. Some too have formulated new conspiracy theories. Others have revived old racism inspired theories, all trying to find easy ways to explain the EVD epidemic. 

Some of those theories are only a confirmation of folks' own perceptions of a conspiracy world. Yet others have shrank the long scientific process of developing a drug. A whole process starting from in vitro experimentation to various phases of randomised controlled trials, with all the scientific and ethical scrutiny has been contracted. 

Folks have simply announced efficacious drugs for EVD such as bathing with saline water, chewing bitter cola, etc, none of which can survive the very first step of producing a drug in the pharmacological world. Yet, just like the spiritualist and the conspiracy theorist, we cannot question them much since we do not have a better alternative solution to EVD yet.

What we can do is to try and raise folks' perceptions of the risk that EVD possess to us all. A perception of risk is one of the critical determinants of how folks will behave towards a health treat anywhere under the sun. Those who perceived themselves to be vulnerable to malaria will take malarone even when it is not necessary. Those with a higher risk perception of injuring their health and life in the event of a car accident will wear seatbelt, even inside stationary cars. 

Those with higher risk perception of contracting an STI have attempted to wear more than one condom ahead of their sexual exploits. As I typed these words, U.S lawmakers are questioning the Obama's administration on its response to the Ebola epidemic. At a hearing held by a House Energy and Commerce subcommittee, Rep. Fred Upton (R., Mich.) took the administration response to the cleaners. Hear him "we need to protect the American people first and foremost. 

People's lives are at stake, and the response so far has been unacceptable." In response to the lawmakers Thursday hearing, President Barack Obama cancelled his travel plans for the second conservative day so he could hold a meeting with senior advisers at the White House on the Ebola crisis. Across the Atlantic on the same last Thursday, EU leaders took a decision to strengthen Ebola screening for people entering Europe from affected countries in West Africa. 

The perception of risk in Europe were amplified on Thursday, when a passenger on an Air France flight who showed symptoms similar to Ebola virus was rushed from a Madrid airport to a hospital, as Spain's Government moved to take a more aggressive approach towards the deadly virus. One confounding factor that made this passenger in question a chief suspect is because of his recent visit to Lagos. 

Otherwise, it may as well be that he was just having the normal jet lag problems, yet he was taken from the airport by ambulance to Madrid's Carlos III hospital for testing. Not only that, Air France idled the plane in Madrid, cancelled the return flight and announced that it would disinfect the plane before putting it back to service. Meanwhile on same last Thursday, Germany announced a six fold increase in funding to fight the epidemic in West Africa after facing harsh criticism from its citizens that it had been slow in delivery on its pledge to help the region at the center of the outbreak.

These are the actions folks with a higher risk perception towards the EVD are taking and their leaders are responding with all the seriousness it deserves. Folks with very low risk perception simply do not care. And in this situation, the "I do not care attitude" of West Africans is the most dangerous weapon in the 'hands' of the Ebola Viruses. This is why Dr. George Amofah's advice should get to the Jubelee house sooner than later. This is why the IMANI founder, Franklin Cudjoe’s resolved to launch a campaign to resist Ghana's hosting of AFCON 2015 should attract support from all of us. This is why we need to listen to anybody who is questioning the decision to host the football mundane right here in 2015.

But why will anybody insist of hosting a tournament that others are running away? Is any Mahama caught in a doubling down effect? In blackjack, "doubling down" is a move that promises a big reward, but only when the player takes a big risk. If you feel confident enough in your chances of winning after being dealt two cards, you can double your bet, but you're only allowed to take one additional card. So when "doubling down" is extended metaphorically, that high-risk, high-reward strategy can be seen as admirably bold or woefully foolhardy — or perhaps a little of both.

I think a certain Mahama is doubling down the road. It is possible that the 2016 general elections could be a confounding factor in our current debate on EVD and AFCON 2015. The two Mahamas may be thinking; if we host AFCON 2015, the public debate will be evenly distributed between football and the economy. And there may even be an aftermath presidential commission to make some people shared crocodile tears and keep the public busy. This might camouflage our inefficiencies in managing the economy and by the time Ghanaians will get back from partying around the various stadia, we are back to the Jubelee house. So it may not be too surprising that in the midst of the debate, my brother Minister Mahama Ayariga has already made his (and perhaps his boss) intentions clear: Ghana is ready to host AFCON 2015, he declared with a beaming smile!

I cannot begrudge any Mahama for thinking this way. It is possible that any of us would have thought in similar fashion if we were saddled with a Banana republic heading towards a general election. But we cannot leave this decision to partisan thinkers only. EVD has no respecter of political labels. Let's listen to the voices of "neutral" reason. We simply still do not know enough about EVD to make a decision that will invite all West African neighbors into our limited spaces of sweat-sharing stadia in just two months away 2015. To echo the voice of Dr. Amofah, If you are closer to any Mahama, whether in the ministries or at the Jubelee house, please tell them: AFCON 2015 may indeed help with the 2016 general elections, but there might not be a Ghana left to rule afterwards. And by the way, let all Mahamas and their advisers take note; for a disease that spread through body contact, all it takes to have a completely empty stadium during an AFCON match in Accra is one single positive Ebola case in Ghana. May it not come to that is my prayer!

John Kingsley Krugu

The writer is the PRO of the Ghana Public Health Association and a Doctoral Fellow of Maastricht University in the Netherlands. Email: [email protected]