5 Ebola Lessons
More than a year into West Africa’s devastating outbreak, humanity still has much to learn. The experts weigh in.
Story by Andrew Myers • Illustration by Dung Hoang
Science Trumps Politics
Almost the minute she deplaned on October 24, Kaci Hickox was whisked to a CDC quarantine tent and questioned like a criminal. Soon, she would make national headlines by defying state-mandated quarantines for health workers returning from West Africa.
For Hickox, fighting a killer epidemic far away begins close to home—in how we respect returning health workers. “My questioning was not coordinated or compassionate. It is a completely chaotic system that discourages others from going,” she says, pointing to November reports from relief groups showing a 17 percent drop in recruits. She adds: “If we can’t recruit, we can’t defeat Ebola.”
The solution, for Hickox, rests in finding expert voices able to rise above the political din to build trust in the science. “We know that asymptomatic people cannot transmit disease,” Hickox says. “We need public health experts to drive the conversation based on science, not politics.”
Kaci Hickox, MSN/MPH ’11, served as the nurse and medical team lead of a Médecins Sans Frontières (MSF) Ebola center.
Double-Down on Basic Science
As one who studies deadly viruses, Andrew Pekosz believes in knowing the foe well before an epidemic begins. It’s best to focus on research during the lulls between outbreaks, not amid them, he says. Unfortunately, with Ebola, out of sight was out of mind—a costly and avoidable mistake. “It is precisely when Ebola is in hiding that we need to double-down on basic science,” he says. “When we wait for outbreaks, it’s too late for research to reveal what fuels, and what stops, these killer diseases.”
Pekosz would pour resources into studying the virus’s biology, its sensitivities to antiviral drugs, how antibodies might neutralize it, and how the virus might mutate to ignite some future epidemic.
“We need to focus on the long term,” he says. “It’s far better to spend money in the lab and avoid having to treat the sick in the field.”
Words Save Lives
This autumn, Elizabeth Serlemitsos arrived in Ebola’s epicenter in Liberia. With two decades in public health work in Africa, Serlemitsos found herself embroiled in a crisis unlike any she had ever known.
As a public health communicator, she affirms that words save lives. In Lofa, Liberia, the team reversed a horrible crisis through communication. The messages—that Ebola is real and that people should not touch the bodies or possessions of the sick or the dead—were disseminated by radio, in print and, most often, face-to-face by thousands of volunteer voices.
“This was about empowering people to protect themselves through personal and home hygiene and much more challenging cultural shifts,” she says. It required Liberians to relinquish closely held burial customs and accept cremation.
“Liberians didn’t like cremation, but they understood the need,” Serlemitsos says. “They accepted that they have to do things differently to see Ebola end.”
Elizabeth Serlemitsos, MPH, MBA, is Liberia Ebola program director for the Center for Communication Programs.
Expect the Unexpected
The West Africa Ebola epidemic is an object lesson in preparedness on many levels, says health systems expert David Peters.
“Epidemics always have some facet that catches us off guard. In this case, Ebola struck in areas of Africa not known for Ebola. The people, systems and the infrastructure weren’t in place to meet it head-on,” Peters says.
Preparedness requires a complete spectrum of measures, he counsels, including community engagement and public health systems that focus on identifying and isolating cases, providing safe and good quality clinical care, and hygienic and safe burial.
Health systems need to be developed so they can prevent and respond quickly to crises. It also means building capacity in advance in places where one might not always expect the need.
“If you are there from the start and people trust the system,” Peters says, “the response will be better.”
In the days after being named to direct Liberia’s Ebola response, Tolbert Nyenswah watched as the disease tore through his homeland. Dead bodies lay in the streets. Patients streamed in, 150 new cases each day. Panic ruled.
“It was a catastrophe, but the international effort was huge,” Nyenswah says now, amid the relative calm of an epidemic in decline, thanks to a global response and his leadership.
Efforts included new treatment units and laboratories as well as community mobilization. The first order, however, was to increase ambulances and burial teams to quickly and safely isolate the sick and remove contagious corpses. “A single body can infect a hundred others. All these efforts broke Ebola’s back,” he says.
Big crises, he asserts, require the biggest responses. “Ebola is not for Africa alone. It is for the world. The world came late,” Nyenswah says, “but it came large.”
Tolbert Nyenswah, MPH ’12, is senior assistant minister of Health & Social Welfare for Liberia.