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← Humanity vs. Ebola. How we could win a terrifying war

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Showing Revision 8 created 02/03/2015 by Morton Bast.

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