Beating Ebola | Bruce Aylward | TEDxPlaceDesNations

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/ted

Ebola: efforts to combat the unprecedented outbreak in West Africa can succeed, and have already led to marked improvements in certain areas, but the fight will not be ‎over until the last case is addressed.

When I was asked to, invited, rather,
to give this talk a couple of months ago

we discussed a number
of titles with the organizers

and a lot of different titles
were kicked around and were discussed,

but nobody suggested
this one that you see here today.

The reason for that was, two months ago,

Ebola was escalating exponentially

and spreading over wider geographic areas
than we had ever seen

and the world was terrified, concerned,
and alarmed by this disease

in a way we've not seen in recent history.

But today, I can stand here
and I can talk to you about beating Ebola

because of people
whom you've never heard of,

people like Peter Clement,

a Liberian doctor,
who's working in Lofa County,

a place that many of you
have never heard of, probably, in Liberia.

The reason that Lofa County
is so important

is because about five months ago,

when the epidemic
was just starting to escalate,

Lofa County was right at the center,
the epicenter of this epidemic.

At that time,
MSF and the treatment center there,

were seeing dozens of patients
every single day,

and these patients, these communities,
were becoming more and more terrified

as time went by, with this disease
and what it was doing to their families,

to their communities,
to their children, to their relatives.

And so Peter Clement was charged with
driving that 12-hour-long rough road

from Monrovia, the capital,
up to Lofa County

to try and help bring control
to the escalating epidemic there.

And what Peter found when he arrived
was a terror that I just mentioned to you.

So he sat down with the local chiefs,
and he listened.

And what he heard was heartbreaking.

He heard about the devastation
and the desperation of people

affected by this disease.

He heard the heartbreaking stories

about not just the damage
that Ebola did to people,

but what it did to families,
and what it did to communities.

And he listened to the local chiefs
there, and what they told him --

They said: "When our children are sick,
when our children are dying,

we can't hold them at a time
when we want to be closest to them.

When our relatives die, we can't take care
of them as our tradition demands.

We are not allowed to wash
the bodies to bury them

the way our communities
and our rituals demand.

And for this reason,

they were deeply disturbed,
deeply alarmed

and the entire epidemic
was unraveling in front of them.

People were turning on
the healthcare workers who had come,

the heroes who come to try
and help save the community,

to help work with the community,
and they were unable to access them.

And what happened then was
Peter explained to the leaders.

The leaders listened.
They turned the tables.

And Peter explained what Ebola was.
He explained what the disease was.

He explained what it did
to their communities,

and he explained that Ebola threatened
everything that made us human:

Ebola means you can't hold your children
the way you would in this situation,

you can't bury your dead
the way that you would,

you have to trust these people
in the space suits to do that for you.

And ladies and gentlemen,

what happened then
was rather extraordinary:

the community, health workers,
and Peter sat down together

and they put together a new plan
for controlling Ebola in that Lofa County.

And the reason that this is
such an important story,

ladies and gentlemen,

is because today, this County,

which is right at the center
of this epidemic you've been watching,

you've been seeing on the newspapers,

you've been seeing
on the television screens,

today, Lofa County is nearly eight weeks
without seeing a single case of Ebola.

(Applause)

This doesn't mean
that the job is done, obviously;

there's still a huge risk
that there'll be additional cases there,

but what it does teach us
is that Ebola can be beaten.

That's the key thing.

Even on the scale,

even with the rapid kind of growth
that we saw in this environment here,

we now know Ebola can be beaten.

When communities come together
with healthcare workers, work together,

that's when this disease can be stopped.

But how did Ebola end up
in Lofa County in the first place?

Well, for that, we have to go back
12 months, to the start of this epidemic.

And as many you know,
this virus went undetected,

it evaded detection
for three or four months when it began.

That's because this is not
a disease of West Africa,

it's a disease of Central Africa,
half a continent away.

People hadn't seen the disease before;

health workers hadn't seen
the disease before.

They didn't know
what they were dealing with.

And to make it
even more complicated,

the virus itself was causing a symptom,
a type of a presentation

that wasn't classical of the disease,

so people didn't even recognize
the disease, people who knew Ebola.

For that reason it evaded
detection for some time,

but contrary to public belief
sometimes these days,

once the virus was detected,
there was a rapid surge in of support.

MSF rapidly set up an Ebola treatment
center as many of you know, in the area.

The World Health Organization
and the partners it works with deployed

eventually hundreds of people
over the next two months

to be able to help track the virus.

The problem, ladies and gentlemen, is

by then, this virus, well known
now as Ebola, had spread too far.

It had already outstripped
what was one of the largest responses

that had been mounted so far
to an Ebola outbreak.

By the middle of the year,

not just Guinea but now Sierra Leone
and Liberia were also infected.

The virus was spreading geographically,
the numbers were increasing,

and at this time,

not only were hundreds of people
infected and dying of the disease

but as importantly,

the front line responders, the people
who had gone to try and help,

the healthcare workers,
the other responders

were also sick and dying by the dozens.

The presidents of these countries
recognized the emergencies.

They met right around that time,

they agreed on common action,
and they put together

an emergency joint operation center
in Conakry

to try and work together to finish
this disease and get it stopped,

to implement the strategies
we talked about.

But what happened then was something
we had never seen before with Ebola.

What happened then was the virus,
or someone sick with the virus,

boarded an airplane,
flew to another country,

and for the first time,

we saw in another distant country
the virus pop up again.

This time it was in Nigeria,

in the teeming metropolis
of Lagos, 21 million people;

now the virus was in that environment.

And as you can anticipate, there was
international alarm, international concern

on a scale that we haven't seen
in recent years

caused by a disease like this.

The World Health Organization immediately
called together an expert panel,

looked at the situation,
declared an international emergency.

And in doing so, the expectation would be

that there be a huge outpouring
of international assistance

to help these countries which were in
so much trouble and concern at that time.

But what we saw
was something very different.

There was some great response.

A number of countries came to assist
- many NGOs and others, as you know -

but at the same time,
the opposite happened in many places.

Alarm escalated, and very soon,

these countries found themselves

not receiving the support they needed
but increasingly isolated.

What we saw was commercial airlines
[stopped] flying into these countries,

and people who hadn't even been
exposed to the virus

were no longer allowed to travel.

This caused not only problems,
obviously, for the countries themselves

but also for the response.

Those organizations
that we're trying to bring people in,

to try and help them
respond to the outbreak,

could not get people on airplanes,

couldn't get them into the countries
to be able to respond.

In that situation, ladies and gentleman,
a virus like Ebola takes advantage.

And what we saw then was something
also we hadn't seen before:

not only did this virus
continue in the places

where they'd already become infected
but then it started to escalate

and we saw the case numbers
that you see here,

something we never seen
before on such a scale,

and exponential increase of Ebola cases

not just in these countries or the areas
already infected in these countries

but also spreading further
and deeper into these countries.

Ladies and gentleman,

this was one of the most concerning,
international emergencies in public health

we've ever seen.

And what happened
in these countries then,

many of you saw, again, on the television,
read about in the newspapers,

we saw the health system start to collapse
under the weight of this epidemic.

We saw the schools begin to close,

markets no longer functioned the way
that they should in these countries.

We saw the misinformation,
the misperceptions, started to spread

even faster through the communities

which became even more alarmed
about the situation.

They started to recoil

from those people that you saw
in those space suits, as they call them,

who had come to help them.

And then the situation
deteriorated even further:

the countries had to declare
a state of emergency,

large populations need to be quarantined
in some areas, and then riots broke out.

It was a very, very terrifying situation.

And the world, many people began to ask:

"Can we ever stop Ebola
when it starts to spread like this?"

And they started to ask: "How well
do we really know this virus?"

The reality is we don't know
Ebola extremely well.

It's a relatively modern disease
in terms of what we know about it

we've known the disease only for 40 years

since it first popped up
in Central Africa in 1976.

But despite that, we do know many things:

we know that this virus probably
survives in a type of a bat,

we know that it probably enters
a human population

when we come in contact with a wild animal

that has been infected with the virus
and probably sickened by it.

Then we know that the virus
spreads from person to person

through contaminated body fluids.

And as you've all seen,

we know the horrific disease
that it then causes in humans,

where we see this disease caused
severe fevers, diarrhea, vomiting,

and then, unfortunately, and in 70%
of the cases or often more, death.

This is a very dangerous,
debilitating, and deadly disease.

But despite the fact that we've not known
this disease for a particularly long time,

and we don't know everything about it,
we do know how to stop this disease.

There are four things
that are critical to stopping Ebola.

First and foremost, the communities
have got to understand this disease,

they've got to understand
how it spreads and how to stop it.

And then we've got
to be able to have systems

that could find every single case,
every contact of those cases,

and begin to track the transmission chain
so that you can stop transmission.

We have to have treatment centers,
specialized Ebola treatment centers,

where the workers can be protected

as they try to provide support
to the people who are infected,

so that they might survive the disease

And then, for those who do die,

we have to ensure there is a safe but at
the same time dignified burial process,

so that there is no spread
at that time as well.

So we do know how to stop Ebola,

and these strategies work,
ladies and gentlemen.

The virus was stopped in Nigeria
by these four strategies,

and the people
implementing them, obviously.

It was stopped in Senegal
where it had spread,

and also in the other countries

that were affected by this virus,
in this outbreak.

So there's no question
that these strategies actually work.

The big question, ladies and gentlemen,

was whether these strategies could work
on this scale, in this situation,

with so many countries affected
with the exponential growth that you saw.

That was the big question that we were
facing just two for three months ago.

Today, we know the answer
to that question.

We know that answer
because of the extraordinary work

of an incredible group of NGOs,
of governments, of local leaders,

of UN agencies, and many humanitarian
and other organizations

that came and joined the fight
to try and stop Ebola in West Africa.

But what had to be done
there was slightly different.

These countries took
those strategies I just showed you;

the communities, the community engagement,
the case finding and contact tracing,

and they turn them on their head.

There was so much disease,
they approached it differently.

What they decided to do was

they would first try
and slow down this epidemic

by rapidly building
as many beds as possible

in specialized treatment centers,

so that they could prevent the disease
from spreading from those were infected.

They would rapidly build out
many many burial teams

so they could safely deal
with the dead,

and with that, they would try
and slow this outbreak to see

if it could actually then be controlled

using the classic approach
of case finding and contact tracing.

And when I went to West Africa
about three months ago, when I was there,

what I saw was extraordinary.

I saw presidents

opening emergency operation centers
themselves against Ebola

so that they could personally coordinate,
and oversee, and champion

this surge of international support
to try and stop this disease.

We saw militaries

from within those countries
and from far beyond,

coming in to help build
Ebola treatment centers

that could be used to isolate
those who are sick.

We saw the Red Cross Movement

working with its partner agencies
on the ground there

to help train the community so that they
could actually safely bury their dead

in a dignified manner themselves.

And we saw the UN agencies,
the World Food Program,

build a tremendous air bridge
that could get responders

to every single corner
of these countries rapidly

to be able to implement the strategies
that we just talked about.

What we saw, ladies and gentlemen,
which is probably most impressive,

was this incredible work
by the governments,

by the leaders in these countries,
with the communities,

to try insure
people understood this disease,

understood the extraordinary things
they'd have to do to try and stop Ebola.

And as a result, ladies and gentlemen,

we saw something that we did not know
only two or three months earlier,

whether or not it would be possible.

What we saw was

what you see now in this graph
when we took stock on December 1.

What we saw was
we could bend that curve, so to speak,

change this exponential growth,

and bring some hope back
to the ability to control this outbreak.

And for this reason, ladies and gentlemen,
there's absolutely no question now

that we can catch up with this outbreak
in West Africa, and we can beat Ebola.

The big question though,
that many people are asking,

even when they saw this curve, [is]:

"Well, hang on a minute;
that's great, you can slow it down,

but can you actually
drive it down to zero?"

We've already answered that question
right back at the beginning of this talk,

when I spoke about Lofa County in Liberia.

We told you the story
how Lofa County got to a situation

where they have not seen Ebola
for eight weeks.

But there are similar stories
from the other countries as well.

From Guéckédou in Guinea,

the first area where the first case
was actually diagnosed.

We've seen very, very few cases
in the last couple of months,

and here in Kenema, in Sierra Leone
- another area in the epicenter -

we have not seen the virus
for more than a couple of weeks.

Way too early to declare
victory, obviously,

but evidence, ladies and gentlemen,

not only can the response
catch up to the disease

but this disease can be driven to zero.

The challenge now, of course,
is doing this on the scale needed

right across these three countries,
and that is a huge challenge.

Because when you've been at
something for this long, on this scale,

two other big threats
come in to join the virus.

The first of those is complacency,

the risk that as this disease curve
starts to bend,

the media look elsewhere,
the world looks elsewhere.

Complacency's always a risk.

And the other risk, of course, is
when you've been working so hard

for so long and slept so few hours
over the past months,

people are tired, people become fatigued,

and these new risks
start to creep into the response.

Ladies and gentlemen, I can tell you today
I've just come back from West Africa.

The people of this countries,
the leaders of these countries,

are not complacent.

They want to drive Ebola
to zero in their countries.

And these people, yes they're tired,
but they are not fatigued.

They have an energy, they have a courage,

they have the strength
to get this finished.

What they need,
ladies and gentlemen, at this point,

is the unwavering support
of the international community,

to stand with them, to bolster,

and bring even more support
at this time, to get the job finished.

Because finishing Ebola right now means

turning the tables on this virus
and beginning to hunt it.

Remember, this virus, this whole crisis,
rather, started with one case,

and is going to finish with one case.

But it will only finish if those countries
have got enough epidemiologists,

enough health workers, enough logisticians
and enough other people working with them

to be able to find every one
of those cases, track their contacts,

and make sure that this disease
stops once and for all.

I can tell you just having come back,

they are not complacent,
they are not fatigued,

and they will finish the job,
if they have the support that they need.

Ladies and gentlemen,
you know the story of Ebola,

we just told you the story
of Ebola, Ebola can be beaten.

Now, we need you to take this story out

to tell it to the people who will listen

and educate them
on what it means to beat Ebola,

and more importantly,
we need you to advocate with the people

who can help us bring the resources
we need to these countries,

to beat this disease.

Ladies and gentleman,

there are a lot of people out there
who will survive and will thrive

in part because of what you do
to help us beat Ebola.

Thank you.

(Applause)