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← Beating Ebola | Bruce Aylward | TEDxPlaceDesNations

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Showing Revision 75 created 05/12/2016 by Denise RQ.

  1. When I was asked to, invited, rather,
    to give this talk a couple of months ago
  2. we discussed a number
    of titles with the organizers
  3. and a lot of different titles
    were kicked around and were discussed,
  4. but nobody suggested
    this one that you see here today.
  5. The reason for that was, two months ago,
  6. Ebola was escalating exponentially
  7. and spreading over wider geographic areas
    than we had ever seen
  8. and the world was terrified, concerned,
    and alarmed by this disease
  9. in a way we've not seen in recent history.
  10. But today, I can stand here
    and I can talk to you about beating Ebola
  11. because of people
    whom you've never heard of,
  12. people like Peter Clement,
  13. a Liberian doctor,
    who's working in Lofa County,
  14. a place that many of you
    have never heard of, probably, in Liberia.
  15. The reason that Lofa County
    is so important
  16. is because about five months ago,
  17. when the epidemic
    was just starting to escalate,
  18. Lofa County was right at the center,
    the epicenter of this epidemic.
  19. At that time,
    MSF and the treatment center there,
  20. were seeing dozens of patients
    every single day,
  21. and these patients, these communities,
    were becoming more and more terrified
  22. as time went by, with this disease
    and what it was doing to their families,
  23. to their communities,
    to their children, to their relatives.
  24. And so Peter Clement was charged with
    driving that 12-hour-long rough road
  25. from Monrovia, the capital,
    up to Lofa County
  26. to try and help bring control
    to the escalating epidemic there.
  27. And what Peter found when he arrived
    was a terror that I just mentioned to you.
  28. So he sat down with the local chiefs,
    and he listened.
  29. And what he heard was heartbreaking.
  30. He heard about the devastation
    and the desperation of people
  31. affected by this disease.
  32. He heard the heartbreaking stories
  33. about not just the damage
    that Ebola did to people,
  34. but what it did to families,
    and what it did to communities.
  35. And he listened to the local chiefs
    there, and what they told him --
  36. They said: "When our children are sick,
    when our children are dying,
  37. we can't hold them at a time
    when we want to be closest to them.
  38. When our relatives die, we can't take care
    of them as our tradition demands.
  39. We are not allowed to wash
    the bodies to bury them
  40. the way our communities
    and our rituals demand.
  41. And for this reason,
  42. they were deeply disturbed,
    deeply alarmed
  43. and the entire epidemic
    was unraveling in front of them.
  44. People were turning on
    the healthcare workers who had come,
  45. the heroes who come to try
    and help save the community,
  46. to help work with the community,
    and they were unable to access them.
  47. And what happened then was
    Peter explained to the leaders.
  48. The leaders listened.
    They turned the tables.
  49. And Peter explained what Ebola was.
    He explained what the disease was.
  50. He explained what it did
    to their communities,
  51. and he explained that Ebola threatened
    everything that made us human:
  52. Ebola means you can't hold your children
    the way you would in this situation,
  53. you can't bury your dead
    the way that you would,
  54. you have to trust these people
    in the space suits to do that for you.
  55. And ladies and gentlemen,
  56. what happened then
    was rather extraordinary:
  57. the community, health workers,
    and Peter sat down together
  58. and they put together a new plan
    for controlling Ebola in that Lofa County.
  59. And the reason that this is
    such an important story,
  60. ladies and gentlemen,
  61. is because today, this County,
  62. which is right at the center
    of this epidemic you've been watching,
  63. you've been seeing on the newspapers,
  64. you've been seeing
    on the television screens,
  65. today, Lofa County is nearly eight weeks
    without seeing a single case of Ebola.
  66. (Applause)
  67. This doesn't mean
    that the job is done, obviously;
  68. there's still a huge risk
    that there'll be additional cases there,
  69. but what it does teach us
    is that Ebola can be beaten.
  70. That's the key thing.
  71. Even on the scale,
  72. even with the rapid kind of growth
    that we saw in this environment here,
  73. we now know Ebola can be beaten.
  74. When communities come together
    with healthcare workers, work together,
  75. that's when this disease can be stopped.
  76. But how did Ebola end up
    in Lofa County in the first place?
  77. Well, for that, we have to go back
    12 months, to the start of this epidemic.
  78. And as many you know,
    this virus went undetected,
  79. it evaded detection
    for three or four months when it began.
  80. That's because this is not
    a disease of West Africa,
  81. it's a disease of Central Africa,
    half a continent away.
  82. People hadn't seen the disease before;
  83. health workers hadn't seen
    the disease before.
  84. They didn't know
    what they were dealing with.
  85. And to make it
    even more complicated,
  86. the virus itself was causing a symptom,
    a type of a presentation
  87. that wasn't classical of the disease,
  88. so people didn't even recognize
    the disease, people who knew Ebola.
  89. For that reason it evaded
    detection for some time,
  90. but contrary to public belief
    sometimes these days,
  91. once the virus was detected,
    there was a rapid surge in of support.
  92. MSF rapidly set up an Ebola treatment
    center as many of you know, in the area.
  93. The World Health Organization
    and the partners it works with deployed
  94. eventually hundreds of people
    over the next two months
  95. to be able to help track the virus.
  96. The problem, ladies and gentlemen, is
  97. by then, this virus, well known
    now as Ebola, had spread too far.
  98. It had already outstripped
    what was one of the largest responses
  99. that had been mounted so far
    to an Ebola outbreak.
  100. By the middle of the year,
  101. not just Guinea but now Sierra Leone
    and Liberia were also infected.
  102. The virus was spreading geographically,
    the numbers were increasing,
  103. and at this time,
  104. not only were hundreds of people
    infected and dying of the disease
  105. but as importantly,
  106. the front line responders, the people
    who had gone to try and help,
  107. the healthcare workers,
    the other responders
  108. were also sick and dying by the dozens.
  109. The presidents of these countries
    recognized the emergencies.
  110. They met right around that time,
  111. they agreed on common action,
    and they put together
  112. an emergency joint operation center
    in Conakry
  113. to try and work together to finish
    this disease and get it stopped,
  114. to implement the strategies
    we talked about.
  115. But what happened then was something
    we had never seen before with Ebola.
  116. What happened then was the virus,
    or someone sick with the virus,
  117. boarded an airplane,
    flew to another country,
  118. and for the first time,
  119. we saw in another distant country
    the virus pop up again.
  120. This time it was in Nigeria,
  121. in the teeming metropolis
    of Lagos, 21 million people;
  122. now the virus was in that environment.
  123. And as you can anticipate, there was
    international alarm, international concern
  124. on a scale that we haven't seen
    in recent years
  125. caused by a disease like this.
  126. The World Health Organization immediately
    called together an expert panel,
  127. looked at the situation,
    declared an international emergency.
  128. And in doing so, the expectation would be
  129. that there be a huge outpouring
    of international assistance
  130. to help these countries which were in
    so much trouble and concern at that time.
  131. But what we saw
    was something very different.
  132. There was some great response.
  133. A number of countries came to assist
    - many NGOs and others, as you know -
  134. but at the same time,
    the opposite happened in many places.
  135. Alarm escalated, and very soon,
  136. these countries found themselves
  137. not receiving the support they needed
    but increasingly isolated.
  138. What we saw was commercial airlines
    [stopped] flying into these countries,
  139. and people who hadn't even been
    exposed to the virus
  140. were no longer allowed to travel.
  141. This caused not only problems,
    obviously, for the countries themselves
  142. but also for the response.
  143. Those organizations
    that we're trying to bring people in,
  144. to try and help them
    respond to the outbreak,
  145. could not get people on airplanes,
  146. couldn't get them into the countries
    to be able to respond.
  147. In that situation, ladies and gentleman,
    a virus like Ebola takes advantage.
  148. And what we saw then was something
    also we hadn't seen before:
  149. not only did this virus
    continue in the places
  150. where they'd already become infected
    but then it started to escalate
  151. and we saw the case numbers
    that you see here,
  152. something we never seen
    before on such a scale,
  153. and exponential increase of Ebola cases
  154. not just in these countries or the areas
    already infected in these countries
  155. but also spreading further
    and deeper into these countries.
  156. Ladies and gentleman,
  157. this was one of the most concerning,
    international emergencies in public health
  158. we've ever seen.
  159. And what happened
    in these countries then,
  160. many of you saw, again, on the television,
    read about in the newspapers,
  161. we saw the health system start to collapse
    under the weight of this epidemic.
  162. We saw the schools begin to close,
  163. markets no longer functioned the way
    that they should in these countries.
  164. We saw the misinformation,
    the misperceptions, started to spread
  165. even faster through the communities
  166. which became even more alarmed
    about the situation.
  167. They started to recoil
  168. from those people that you saw
    in those space suits, as they call them,
  169. who had come to help them.
  170. And then the situation
    deteriorated even further:
  171. the countries had to declare
    a state of emergency,
  172. large populations need to be quarantined
    in some areas, and then riots broke out.
  173. It was a very, very terrifying situation.
  174. And the world, many people began to ask:
  175. "Can we ever stop Ebola
    when it starts to spread like this?"
  176. And they started to ask: "How well
    do we really know this virus?"
  177. The reality is we don't know
    Ebola extremely well.
  178. It's a relatively modern disease
    in terms of what we know about it
  179. we've known the disease only for 40 years
  180. since it first popped up
    in Central Africa in 1976.
  181. But despite that, we do know many things:
  182. we know that this virus probably
    survives in a type of a bat,
  183. we know that it probably enters
    a human population
  184. when we come in contact with a wild animal
  185. that has been infected with the virus
    and probably sickened by it.
  186. Then we know that the virus
    spreads from person to person
  187. through contaminated body fluids.
  188. And as you've all seen,
  189. we know the horrific disease
    that it then causes in humans,
  190. where we see this disease caused
    severe fevers, diarrhea, vomiting,
  191. and then, unfortunately, and in 70%
    of the cases or often more, death.
  192. This is a very dangerous,
    debilitating, and deadly disease.
  193. But despite the fact that we've not known
    this disease for a particularly long time,
  194. and we don't know everything about it,
    we do know how to stop this disease.
  195. There are four things
    that are critical to stopping Ebola.
  196. First and foremost, the communities
    have got to understand this disease,
  197. they've got to understand
    how it spreads and how to stop it.
  198. And then we've got
    to be able to have systems
  199. that could find every single case,
    every contact of those cases,
  200. and begin to track the transmission chain
    so that you can stop transmission.
  201. We have to have treatment centers,
    specialized Ebola treatment centers,
  202. where the workers can be protected
  203. as they try to provide support
    to the people who are infected,
  204. so that they might survive the disease
  205. And then, for those who do die,
  206. we have to ensure there is a safe but at
    the same time dignified burial process,
  207. so that there is no spread
    at that time as well.
  208. So we do know how to stop Ebola,
  209. and these strategies work,
    ladies and gentlemen.
  210. The virus was stopped in Nigeria
    by these four strategies,
  211. and the people
    implementing them, obviously.
  212. It was stopped in Senegal
    where it had spread,
  213. and also in the other countries
  214. that were affected by this virus,
    in this outbreak.
  215. So there's no question
    that these strategies actually work.
  216. The big question, ladies and gentlemen,
  217. was whether these strategies could work
    on this scale, in this situation,
  218. with so many countries affected
    with the exponential growth that you saw.
  219. That was the big question that we were
    facing just two for three months ago.
  220. Today, we know the answer
    to that question.
  221. We know that answer
    because of the extraordinary work
  222. of an incredible group of NGOs,
    of governments, of local leaders,
  223. of UN agencies, and many humanitarian
    and other organizations
  224. that came and joined the fight
    to try and stop Ebola in West Africa.
  225. But what had to be done
    there was slightly different.
  226. These countries took
    those strategies I just showed you;
  227. the communities, the community engagement,
    the case finding and contact tracing,
  228. and they turn them on their head.
  229. There was so much disease,
    they approached it differently.
  230. What they decided to do was
  231. they would first try
    and slow down this epidemic
  232. by rapidly building
    as many beds as possible
  233. in specialized treatment centers,
  234. so that they could prevent the disease
    from spreading from those were infected.
  235. They would rapidly build out
    many many burial teams
  236. so they could safely deal
    with the dead,
  237. and with that, they would try
    and slow this outbreak to see
  238. if it could actually then be controlled
  239. using the classic approach
    of case finding and contact tracing.
  240. And when I went to West Africa
    about three months ago, when I was there,
  241. what I saw was extraordinary.
  242. I saw presidents
  243. opening emergency operation centers
    themselves against Ebola
  244. so that they could personally coordinate,
    and oversee, and champion
  245. this surge of international support
    to try and stop this disease.
  246. We saw militaries
  247. from within those countries
    and from far beyond,
  248. coming in to help build
    Ebola treatment centers
  249. that could be used to isolate
    those who are sick.
  250. We saw the Red Cross Movement
  251. working with its partner agencies
    on the ground there
  252. to help train the community so that they
    could actually safely bury their dead
  253. in a dignified manner themselves.
  254. And we saw the UN agencies,
    the World Food Program,
  255. build a tremendous air bridge
    that could get responders
  256. to every single corner
    of these countries rapidly
  257. to be able to implement the strategies
    that we just talked about.
  258. What we saw, ladies and gentlemen,
    which is probably most impressive,
  259. was this incredible work
    by the governments,
  260. by the leaders in these countries,
    with the communities,
  261. to try insure
    people understood this disease,
  262. understood the extraordinary things
    they'd have to do to try and stop Ebola.
  263. And as a result, ladies and gentlemen,
  264. we saw something that we did not know
    only two or three months earlier,
  265. whether or not it would be possible.
  266. What we saw was
  267. what you see now in this graph
    when we took stock on December 1.
  268. What we saw was
    we could bend that curve, so to speak,
  269. change this exponential growth,
  270. and bring some hope back
    to the ability to control this outbreak.
  271. And for this reason, ladies and gentlemen,
    there's absolutely no question now
  272. that we can catch up with this outbreak
    in West Africa, and we can beat Ebola.
  273. The big question though,
    that many people are asking,
  274. even when they saw this curve, [is]:
  275. "Well, hang on a minute;
    that's great, you can slow it down,
  276. but can you actually
    drive it down to zero?"
  277. We've already answered that question
    right back at the beginning of this talk,
  278. when I spoke about Lofa County in Liberia.
  279. We told you the story
    how Lofa County got to a situation
  280. where they have not seen Ebola
    for eight weeks.
  281. But there are similar stories
    from the other countries as well.
  282. From Guéckédou in Guinea,
  283. the first area where the first case
    was actually diagnosed.
  284. We've seen very, very few cases
    in the last couple of months,
  285. and here in Kenema, in Sierra Leone
    - another area in the epicenter -
  286. we have not seen the virus
    for more than a couple of weeks.
  287. Way too early to declare
    victory, obviously,
  288. but evidence, ladies and gentlemen,
  289. not only can the response
    catch up to the disease
  290. but this disease can be driven to zero.
  291. The challenge now, of course,
    is doing this on the scale needed
  292. right across these three countries,
    and that is a huge challenge.
  293. Because when you've been at
    something for this long, on this scale,
  294. two other big threats
    come in to join the virus.
  295. The first of those is complacency,
  296. the risk that as this disease curve
    starts to bend,
  297. the media look elsewhere,
    the world looks elsewhere.
  298. Complacency's always a risk.
  299. And the other risk, of course, is
    when you've been working so hard
  300. for so long and slept so few hours
    over the past months,
  301. people are tired, people become fatigued,
  302. and these new risks
    start to creep into the response.
  303. Ladies and gentlemen, I can tell you today
    I've just come back from West Africa.
  304. The people of this countries,
    the leaders of these countries,
  305. are not complacent.
  306. They want to drive Ebola
    to zero in their countries.
  307. And these people, yes they're tired,
    but they are not fatigued.
  308. They have an energy, they have a courage,
  309. they have the strength
    to get this finished.
  310. What they need,
    ladies and gentlemen, at this point,
  311. is the unwavering support
    of the international community,
  312. to stand with them, to bolster,
  313. and bring even more support
    at this time, to get the job finished.
  314. Because finishing Ebola right now means
  315. turning the tables on this virus
    and beginning to hunt it.
  316. Remember, this virus, this whole crisis,
    rather, started with one case,
  317. and is going to finish with one case.
  318. But it will only finish if those countries
    have got enough epidemiologists,
  319. enough health workers, enough logisticians
    and enough other people working with them
  320. to be able to find every one
    of those cases, track their contacts,
  321. and make sure that this disease
    stops once and for all.
  322. I can tell you just having come back,
  323. they are not complacent,
    they are not fatigued,
  324. and they will finish the job,
    if they have the support that they need.
  325. Ladies and gentlemen,
    you know the story of Ebola,
  326. we just told you the story
    of Ebola, Ebola can be beaten.
  327. Now, we need you to take this story out
  328. to tell it to the people who will listen
  329. and educate them
    on what it means to beat Ebola,
  330. and more importantly,
    we need you to advocate with the people
  331. who can help us bring the resources
    we need to these countries,
  332. to beat this disease.
  333. Ladies and gentleman,
  334. there are a lot of people out there
    who will survive and will thrive
  335. in part because of what you do
    to help us beat Ebola.
  336. Thank you.
  337. (Applause)