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

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Showing Revision 12 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. As 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,
  100. but as importantly,
    the front line responders,
  101. the people who had gone to try and help,
  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 Lagos,
  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 expectation would be
    that there would be a huge outpouring
  123. of international assistance
    to help these countries
  124. which were in so much trouble
    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 was 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 into 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. an 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 most concerning
  151. international emergencies in public health
    we've ever seen.
  152. And what happened in these countries then,
  153. many of you saw, again, on the television,
    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 that misinformation and
    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 those space suits,
  161. as they call them,
    who had 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, and then riots broke out.
  165. It was a very, very terrifying situation.
  166. Around 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 40 years,
  172. since it first popped up
    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
  177. that has been 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,
  181. we know the horrific disease
    that it then causes in humans,
  182. where we see this disease cause
    severe fevers, diarrhea, vomiting,
  183. and then unfortunately, in 70 percent
    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,
  192. and begin to track the transmission chains
    so that you can stop transmission.
  193. We have to have treatment centers,
    specialized Ebola treatment centers,
  194. where the workers can be protected
  195. as they try to provide support
    to the people who are infected,
  196. so that they might survive the disease.
  197. And then for those who do die,
  198. we have to ensure 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
  208. with the kind of exponential
    growth that you saw.
  209. That was the big question that we were
    facing just two or three months ago.
  210. Today we know the answer to that question.
  211. And we know that answer
    because of the extraordinary work
  212. of an incredible group of NGOs,
    of governments, of local leaders,
  213. of U.N. 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 community engagement,
    the case finding, contact tracing, etc.,
  218. and they turned 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 in specialized treatment centers
  222. so that they could prevent the disease
    from spreading from those were infected.
  223. They would rapidly build out
    many, many burial teams
  224. so that they could safely
    deal with the dead,
  225. and with that, they would try
    and slow this outbreak
  226. to see if it could actually then
    be controlled using the classic approach
  227. of case finding and contact tracing.
  228. And when I went to West Africa
    about three months ago,
  229. when I was there
    what I saw was extraordinary.
  230. I saw presidents opening emergency
    operation centers themselves against Ebola
  231. so that they could personally coordinate
    and oversee and champion
  232. this surge of international support
    to try and stop this disease.
  233. We saw militaries from within
    those countries and from far beyond
  234. coming in to help build
    Ebola treatment centers
  235. that could be used to isolate
    those who were sick.
  236. We saw the Red Cross movement working with
    its partner agencies on the ground there
  237. to help train the communities so that
    they could actually safely bury their dead
  238. in a dignified manner themselves.
  239. And we saw the U.N. agencies,
    the World Food Program,
  240. build a tremendous air bridge
  241. that could get responders to every single
    corner of these countries rapidly
  242. to be able to implement the strategies
    that we just talked about.
  243. What we saw, ladies and gentlemen,
    which was probably most impressive,
  244. was this incredible work
    by the governments,
  245. by the leaders in these countries,
    with the communities,
  246. to try to ensure people
    understood this disease,
  247. understood the extraordinary things they
    would have to do to try and stop Ebola.
  248. And as a result, ladies and gentlemen,
  249. we saw something that we did not know
    only two or three months earlier,
  250. whether or not it would be possible.
  251. What we saw was
    what you see now in this graph,
  252. when we took stock on December 1.
  253. What we saw was we could
    bend that curve, so to speak,
  254. change this exponential growth,
  255. and bring some hope back
    to the ability to control this outbreak.
  256. And for this reason, ladies and gentlemen,
    there's absolutely no question now
  257. that we can catch up with this outbreak
    in West Africa and we can beat Ebola.
  258. The big question, though,
    that many people are asking,
  259. even when they saw this curve, they said,
  260. "Well, hang on a minute --
    that's great you can slow it down,
  261. but can you actually
    drive it down to zero?"
  262. We already answered that question
    back at the beginning of this talk,
  263. when I spoke about Lofa County in Liberia.
  264. We told you the story
    how Lofa County got to a situation
  265. where they have not seen
    Ebola for eight weeks.
  266. But there are similar stories from
    the other countries as well.
  267. From Gueckedou in Guinea,
  268. the first area where the first case was
    actually diagnosed.
  269. We've seen very, very few cases
    in the last couple of months,
  270. and here in Kenema, in Sierra Leone,
    another area in the epicenter,
  271. we have not seen the virus
    for more than a couple of weeks --
  272. way too early to declare
    victory, obviously,
  273. but evidence, ladies and gentlemen,
  274. not only can the response
    catch up to the disease,
  275. but this disease can be driven to zero.
  276. The challenge now, of course,
    is doing this on the scale needed
  277. right across these three countries,
    and that is a huge challenge.
  278. Because when you've been at something
    for this long, on this scale,
  279. two other big threats
    come in to join the virus.
  280. The first of those is complacency,
  281. the risk that as this
    disease curve starts to bend,
  282. the media look elsewhere,
    the world looks elsewhere.
  283. Complacency always a risk.
  284. And the other risk, of course, is when
    you've been working so hard for so long,
  285. and slept so few hours
    over the past months,
  286. people are tired, people become fatigued,
  287. and these new risks
    start to creep into the response.
  288. Ladies and gentlemen, I can tell you today
    I've just come back from West Africa.
  289. The people of these countries,
    the leaders of these countries,
  290. they are not complacent.
  291. They want to drive Ebola to zero
    in their countries.
  292. And these people, yes, they're tired,
    but they are not fatigued.
  293. They have an energy, they have a courage,
  294. they have the strength
    to get this finished.
  295. What they need, ladies
    and gentlemen, at this point,
  296. is the unwavering support of the
    international community,
  297. to stand with them,
  298. to bolster and bring even more support
    at this time, to get the job finished.
  299. Because finishing Ebola right now
    means turning the tables on this virus,
  300. and beginning to hunt it.
  301. Remember, this virus, this whole crisis,
    rather, started with one case,
  302. and is going to finish with one case.
  303. But it will only finish if those countries
    have got enough epidemiologists,
  304. enough health workers, enough logisticians
    and enough other people working with them
  305. to be able to find every one
    of those cases, track their contacts
  306. and make sure that this disease
    stops once and for all.
  307. Ladies and gentleman, Ebola can be beaten.
  308. Now we need you to take this story out
    to tell it to the people who will listen
  309. and educate them
    on what it means to beat Ebola,
  310. and more importantly,
    we need you to advocate with the people
  311. who can help us bring the resources we
    need to these countries,
  312. to beat this disease.
  313. There are a lot of people out there
    who will survive and will thrive,
  314. in part because of what you do
    to help us beat Ebola.
  315. Thank you.
  316. (Applause)