The first case was in a toddler, a boy the age of two, in a remote village of southern Guinea, near the border of Sierra Leone and Liberia. A week later the mysterious illness would claim the child’s mother, grandmother and sister—each, a frightening and rapid decline wracked by fever, diarrhea, and vomiting. Soon, there were fourteen of such deaths in and near the village of Meliandou, in the prefecture of Guéckédou. Seven of the early patients tested positive for cholera at the local hospital, but this wasn’t cholera.
As others were getting sick, the traditional village healers, sometimes called the “secret societies” by outsiders, would attempt to dispel the evil spirits that seemed to cause these hellish symptoms, keeping both the illness and the ultimate deaths shrouded from the rest of the world.
This is what happened in December 2013. “It was pretty much missed by the national authorities in Guinea,” said Dr. David Nabarro, a widely respected public health leader who would later be called upon to serve as the U.N. Secretary-General’s Special Envoy on Ebola. “It was thought by about February 2014 that it had burned out. But all that actually had happened is that it had gone underground. The deaths, when they occurred, were dealt with locally by the secret societies. They weren’t reported.”
Then more and more mistakes followed, said Nabarro at an extraordinary and candid discussion on Sunday morning, graciously hosted by Claudia Gonzalez and Richard Edelman at their home in New York.
When the cases started to build up again in April 2014, it was at last picked up by national authorities in Guinea. But at first, said Nabarro, it was misdiagnosed as Lassa fever, another hemorrhagic illness brought on by a virus.
Then, when it was finally recognized as Ebola, Nabarro recounted, “it just did not sound the global alarm. And, indeed, the NGOs were beginning to say, ‘There is a problem. It is Ebola.’ But it did not switch from being an NGO-identified problem to being a problem that was strongly voiced by the World Health Organization. And we know from email traces that doctors were writing to Geneva from the affected countries in May and in June 2014, and their concerns were not being properly heeded.”
“In June and July 2014, there were quite loud voices coming from the WHO’s regional office in Africa, and then the WHO Geneva office—but by that time, when the alarm was being sounded loud, it had already moved from Guinea into Liberia, and by June/July it was in Monrovia and was spreading with a doubling of cases every three weeks. It was like a wildfire burning out of control.”
So we can see these three escalating steps of failure in the global health response, he said: “One, at the very earliest stage, it was missed in country. It wasn’t identified as Ebola. Secondly, in May, it was identified but not properly voiced in country. And then by June/July, the voice was there, but it was not hitting global opinion.”
The Ebola outbreak of late 2013 to 2015—which may now be a faded memory to many, particularly to those of us in the developed world who understood its distant horror and scale only by the headlines—killed more than 11,000 people. And were the global effort in containment to have been delayed even a few months more, this outbreak could easily have claimed tens of thousands of additional lives, including in the U.S.
So what lessons can public health authorities around the world take away from this episode to ensure that, next time, our global response—and yes, it needs to be a global response—is better and quicker? On Sunday, Nabarro offered three. They are:
1) Always treat reports of clusters of unexpected and unexplained deaths with at least a “high index of suspicion” that the cause may be something of potential global concern.
2) Don’t ever let emailed reports from doctors, particularly those from non-governmental organizations, get buried in inboxes at the WHO (or any public health authority).
3) “Once the alarm is sounded, make sure that it’s sounded at the very loudest pitch possible—because action now is worth 10 or 20 times action in two months’ time.”
Nabarro, who is currently Special Adviser of the Secretary-General on the 2030 Agenda for Sustainable Development and Climate Change (the U.N. Is big on long titles), is in contention to be the next Director-General of the WHO—and he is a very worthy candidate in my view. But the WHO and other global health responders can only follow rules No. 1, 2, and 3, if they have ample funding and active support from the rest of the world.
The first tests of that support, indeed, may come as early as May, when the G20 Health Ministers meet in Berlin. At that meeting, there will be a four-hour simulation of possible pandemics (an extension of one presented at the World Economic Forum at the end of January) that has been organized at the request of German Chancellor Angela Merkel.
“We’ll see how countries react,” said Nabarro. Let’s hope their response is even remotely commensurate with the scale of the danger to the world when the next horrific pathogen emerges. And emerge it will.
This essay appears in today’s edition of the Coins2Day Brainstorm Health Daily. Get it delivered straight to your inbox.
