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Bruce Aylward: Humanity vs. Ebola. How we could win a terrifying war

December 11, 2014

“Ebola threatens everything that makes us human,” says Bruce Aylward of the World Health Organization. And when the Ebola epidemic exploded in 2014, it caused a worldwide panic. But humanity can beat Ebola -- and Aylward shows four strategies that show how we are succeeding. The fight against Ebola is not yet won, he says, but it can be.

Bruce Aylward - Epidemiologist
As the Assistant Director-General of the World Health Organization’s Polio and Emergencies Cluster, Bruce Aylward works to ensure that polio stays under control and that the world is prepared to respond to health crises. Full bio

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Double-click the English subtitles below to play the video.
When I was invited to give this talk
a couple of months ago,
00:12
we discussed a number
of titles with the organizers,
00:17
and a lot of different items were
kicked around and were discussed.
00:21
But nobody suggested this one,
00:24
and the reason for that
was two months ago,
00:26
Ebola was escalating exponentially
00:29
and spreading over wider geographic areas
than we had ever seen,
00:32
and the world was terrified,
concerned and alarmed
00:36
by this disease, in a way we've not
seen in recent history.
00:40
But today, I can stand here
and I can talk to you about beating Ebola
00:44
because of people
whom you've never heard of,
00:51
people like Peter Clement, a Liberian
doctor who's working in Lofa County,
00:54
a place that many of you have
never heard of, probably, in Liberia.
01:02
The reason that Lofa County
is so important
01:07
is because about five months ago,
01:09
when the epidemic was
just starting to escalate,
01:12
Lofa County was right at the center,
the epicenter of this epidemic.
01:16
At that time, MSF
and the treatment center there,
01:21
they were seeing dozens of patients
every single day,
01:25
and these patients, these communities
were becoming more and more terrified
01:28
as time went by, with this disease
and what it was doing to their families,
01:32
to their communities,
to their children, to their relatives.
01:36
And so Peter Clement was charged with
driving that 12-hour-long rough road
01:40
from Monrovia, the capital,
up to Lofa County,
01:45
to try and help bring control
to the escalating epidemic there.
01:49
And what Peter found when he arrived was
the terror that I just mentioned to you.
01:53
So he sat down with the local chiefs,
and he listened.
01:59
And what he heard was heartbreaking.
02:03
He heard about the devastation
and the desperation
02:07
of people affected by this disease.
02:11
He heard the heartbreaking stories
02:14
about not just the damage
that Ebola did to people,
02:16
but what it did to families
and what it did to communities.
02:20
And he listened to the local chiefs there
and what they told him --
02:24
They said, "When our children are sick,
when our children are dying,
02:29
we can't hold them at a time when
we want to be closest to them.
02:32
When our relatives die, we can't take care
of them as our tradition demands.
02:36
We are not allowed to wash
the bodies to bury them
02:41
the way our communities and
our rituals demand.
02:43
And for this reason, they were
deeply disturbed, deeply alarmed
02:47
and the entire epidemic
was unraveling in front of them.
02:50
People were turning on the healthcare
workers who had come,
02:54
the heroes who had come to try
and help save the community,
02:57
to help work with the community,
and they were unable to access them.
03:00
And what happened then was
Peter explained to the leaders.
03:05
The leaders listened.
They turned the tables.
03:10
And Peter explained what Ebola was.
He explained what the disease was.
03:13
He explained what it did
to their communities.
03:16
And he explained that Ebola threatened
everything that made us human.
03:19
Ebola means you can't hold your children
the way you would in this situation.
03:24
You can't bury your dead
the way that you would.
03:28
You have to trust these people
in these space suits to do that for you.
03:31
And ladies and gentlemen, what
happened then was rather extraordinary:
03:35
The community and the health workers,
Peter, they sat down together
03:39
and they put together a new plan
for controlling Ebola in Lofa County.
03:42
And the reason that this is such
an important story, ladies and gentlemen,
03:47
is because today, this county, which is
right at the center of this epidemic
03:51
you've been watching,
you've been seeing in the newspapers,
03:56
you've been seeing on
the television screens,
03:59
today Lofa County is nearly eight weeks
without seeing a single case of Ebola.
04:03
(Applause)
04:09
Now, this doesn't mean that
the job is done, obviously.
04:16
There's still a huge risk
that there will be additional cases there.
04:20
But what it does teach us
is that Ebola can be beaten.
04:23
That's the key thing.
04:26
Even on this scale,
04:28
even with the rapid kind of growth
that we saw in this environment here,
04:29
we now know Ebola can be beaten.
04:33
When communities come together
with health care workers, work together,
04:36
that's when this disease can be stopped.
04:40
But how did Ebola end up
in Lofa County in the first place?
04:43
Well, for that, we have to go back
12 months, to the start of this epidemic.
04:47
And as many of you know,
this virus went undetected,
04:51
it evaded detection for three
or four months when it began.
04:55
That's because this is not
a disease of West Africa,
04:59
it's a disease of Central Africa,
half a continent away.
05:01
People hadn't seen the disease before;
05:04
health workers hadn't seen
the disease before.
05:06
They didn't know what
they were dealing with,
05:09
and to make it
even more complicated,
05:11
the virus itself was causing a symptom,
a type of a presentation
05:13
that wasn't classical of the disease.
05:18
So people didn't even recognize
the disease, people who knew Ebola.
05:20
For that reason it evaded detection
for some time,
05:24
But contrary to public belief
sometimes these days,
05:28
once the virus was detected,
there was a rapid surge in of support.
05:31
MSF rapidly set up an Ebola treatment
center, as many of you know, in the area.
05:37
The World Health Organization
and the partners that it works with
05:42
deployed eventually hundreds of people
over the next two months
05:45
to be able to help track the virus.
05:49
The problem, ladies and gentlemen,
is by then, this virus,
05:51
well known now as Ebola,
had spread too far.
05:55
It had already outstripped what was
one of the largest responses
05:59
that had been mounted so far
to an Ebola outbreak.
06:02
By the middle of the year,
not just Guinea
06:06
but now Sierra Leone and Liberia
were also infected.
06:08
As the virus was spreading geographically,
the numbers were increasing
06:12
and at this time, not only were
hundreds of people infected
06:17
and dying of the disease,
06:22
but as importantly,
the front line responders,
06:24
the people who had gone to try and help,
06:27
the health care workers, the other
responders
06:29
were also sick and dying by the dozens.
06:33
The presidents of these countries
recognized the emergencies.
06:36
They met right around that time,
they agreed on common action
06:39
and they put together an emergency
joint operation center in Conakry
06:42
to try and work together to finish this
disease and get it stopped,
06:46
to implement the strategies
we talked about.
06:51
But what happened then was something
we had never seen before with Ebola.
06:54
What happened then was the virus,
or someone sick with the virus,
06:58
boarded an airplane,
flew to another country,
07:01
and for the first time,
we saw in another distant country
07:05
the virus pop up again.
07:09
This time it was in Nigeria,
in the teeming metropolis of Lagos,
07:12
21 million people.
07:16
Now the virus was in that environment.
07:18
And as you can anticipate,
there was international alarm,
07:21
international concern on a scale that
we hadn't seen in recent years
07:24
caused by a disease like this.
07:28
The World Health Organization immediately
called together an expert panel,
07:31
looked at the situation,
declared an international emergency.
07:35
And in doing so, the expectation would be
that there would be a huge outpouring
07:39
of international assistance
to help these countries
07:44
which were in so much trouble
and concern at that time.
07:47
But what we saw was
something very different.
07:51
There was some great response.
07:54
A number of countries came to assist --
many, many NGOs and others, as you know,
07:58
but at the same time, the opposite
happened in many places.
08:02
Alarm escalated, and very soon
these countries found themselves
08:06
not receiving the support they needed,
but increasingly isolated.
08:10
What we saw was commercial airlines
started flying into these countries
08:14
and people who hadn't even been
exposed to the virus
08:19
were no longer allowed to travel.
08:22
This cause not only problems, obviously,
for the countries themselves,
08:24
but also for the response.
08:28
Those organizations that were
trying to bring people in,
08:30
to try and help them
respond to the outbreak,
08:33
they could not get
people on airplanes,
08:35
they could not get them into the
countries to be able to respond.
08:37
In that situation,
ladies and gentleman,
08:40
a virus like Ebola takes advantage.
08:42
And what we saw then was something
also we hadn't seen before.
08:45
Not only did this virus
continue in the places
08:50
where they'd already become infected,
but then it started to escalate
08:53
and we saw the case numbers
that you see here,
08:57
something we'd never seen before
on such a scale,
08:59
an exponential increase of Ebola cases
09:02
not just in these countries or the areas
already infected in these countries
09:05
but also spreading further and
deeper into these countries.
09:10
Ladies and gentleman,
this was one of the most concerning
09:14
international emergencies in public health
we've ever seen.
09:17
And what happened in these countries then,
09:22
many of you saw, again, on the television,
read about in the newspapers,
09:24
we saw the health system start to collapse
under the weight of this epidemic.
09:28
We saw the schools begin to close,
markets no longer started,
09:34
no longer functioned the way
that they should in these countries.
09:38
We saw that misinformation and
misperceptions started to spread
09:42
even faster through the communities,
which became even more alarmed
09:46
about the situation.
09:49
They started to recoil from those people
that you saw in those space suits,
09:51
as they call them,
who had come to help them.
09:55
And then the situation
deteriorated even further.
09:57
The countries had to declare
a state of emergency.
10:00
Large populations needed to be quarantined
in some areas, and then riots broke out.
10:03
It was a very, very terrifying situation.
10:08
Around the world,
many people began to ask,
10:12
can we ever stop Ebola
when it starts to spread like this?
10:15
And they started to ask, how well
do we really know this virus?
10:19
The reality is we don't know
Ebola extremely well.
10:23
It's a relatively modern disease
in terms of what we know about it.
10:26
We've known the disease only for 40 years,
10:30
since it first popped up
in Central Africa in 1976.
10:33
But despite that, we do know many things:
10:36
We know that this virus
probably survives in a type of a bat.
10:39
We know that it probably enters
a human population
10:44
when we come in contact with a wild animal
10:47
that has been infected with the virus
and probably sickened by it.
10:49
Then we know that the virus
spreads from person to person
10:53
through contaminated body fluids.
10:56
And as you've all seen,
10:58
we know the horrific disease
that it then causes in humans,
11:00
where we see this disease cause
severe fevers, diarrhea, vomiting,
11:03
and then unfortunately, in 70 percent
of the cases or often more, death.
11:08
This is a very dangerous,
debilitating, and deadly disease.
11:14
But despite the fact that we've not known
this disease for a particularly long time,
11:20
and we don't know everything about it,
we do know how to stop this disease.
11:24
There are four things
that are critical to stopping Ebola.
11:29
First and foremost, the communities
have got to understand this disease,
11:32
they've got to understand
how it spreads and how to stop it.
11:37
And then we've got to be able to have
systems that can find every single case,
11:40
every contact of those cases,
11:44
and begin to track the transmission chains
so that you can stop transmission.
11:46
We have to have treatment centers,
specialized Ebola treatment centers,
11:50
where the workers can be protected
11:54
as they try to provide support
to the people who are infected,
11:57
so that they might survive the disease.
12:01
And then for those who do die,
12:04
we have to ensure there is a safe, but at
the same time dignified, burial process,
12:06
so that there is no spread
at that time as well.
12:12
So we do know how to stop Ebola, and these
strategies work, ladies and gentlemen.
12:16
The virus was stopped in Nigeria
by these four strategies
12:21
and the people implementing
them, obviously.
12:25
It was stopped in Senegal, where it had
spread, and also in the other countries
12:27
that were affected by this virus,
in this outbreak.
12:31
So there's no question that
these strategies actually work.
12:35
The big question, ladies and gentlemen,
was whether these strategies could work
12:39
on this scale, in this situation,
with so many countries affected
12:44
with the kind of exponential
growth that you saw.
12:48
That was the big question that we were
facing just two or three months ago.
12:52
Today we know the answer to that question.
12:56
And we know that answer
because of the extraordinary work
13:01
of an incredible group of NGOs,
of governments, of local leaders,
13:03
of U.N. agencies and many humanitarian
and other organizations
13:08
that came and joined the fight
to try and stop Ebola in West Africa.
13:13
But what had to be done there
was slightly different.
13:17
These countries took those strategies
I just showed you;
13:20
the community engagement,
the case finding, contact tracing, etc.,
13:23
and they turned them on their head.
13:28
There was so much disease,
they approached it differently.
13:30
What they decided to do was they would
first try and slow down this epidemic
13:33
by rapidly building as many beds as
possible in specialized treatment centers
13:39
so that they could prevent the disease
from spreading from those were infected.
13:44
They would rapidly build out
many, many burial teams
13:49
so that they could safely
deal with the dead,
13:51
and with that, they would try
and slow this outbreak
13:54
to see if it could actually then
be controlled using the classic approach
13:56
of case finding and contact tracing.
14:00
And when I went to West Africa
about three months ago,
14:03
when I was there
what I saw was extraordinary.
14:06
I saw presidents opening emergency
operation centers themselves against Ebola
14:09
so that they could personally coordinate
and oversee and champion
14:14
this surge of international support
to try and stop this disease.
14:18
We saw militaries from within
those countries and from far beyond
14:22
coming in to help build
Ebola treatment centers
14:26
that could be used to isolate
those who were sick.
14:28
We saw the Red Cross movement working with
its partner agencies on the ground there
14:32
to help train the communities so that
they could actually safely bury their dead
14:36
in a dignified manner themselves.
14:41
And we saw the U.N. agencies,
the World Food Program,
14:44
build a tremendous air bridge
14:47
that could get responders to every single
corner of these countries rapidly
14:49
to be able to implement the strategies
that we just talked about.
14:52
What we saw, ladies and gentlemen,
which was probably most impressive,
14:56
was this incredible work
by the governments,
14:59
by the leaders in these countries,
with the communities,
15:02
to try to ensure people
understood this disease,
15:05
understood the extraordinary things they
would have to do to try and stop Ebola.
15:08
And as a result, ladies and gentlemen,
15:14
we saw something that we did not know
only two or three months earlier,
15:16
whether or not it would be possible.
15:21
What we saw was
what you see now in this graph,
15:23
when we took stock on December 1.
15:26
What we saw was we could
bend that curve, so to speak,
15:29
change this exponential growth,
15:32
and bring some hope back
to the ability to control this outbreak.
15:35
And for this reason, ladies and gentlemen,
there's absolutely no question now
15:39
that we can catch up with this outbreak
in West Africa and we can beat Ebola.
15:43
The big question, though,
that many people are asking,
15:49
even when they saw this curve, they said,
15:53
"Well, hang on a minute --
that's great you can slow it down,
15:55
but can you actually
drive it down to zero?"
15:58
We already answered that question
back at the beginning of this talk,
16:00
when I spoke about Lofa County in Liberia.
16:03
We told you the story
how Lofa County got to a situation
16:07
where they have not seen
Ebola for eight weeks.
16:11
But there are similar stories from
the other countries as well.
16:14
From Gueckedou in Guinea,
16:17
the first area where the first case was
actually diagnosed.
16:19
We've seen very, very few cases
in the last couple of months,
16:24
and here in Kenema, in Sierra Leone,
another area in the epicenter,
16:27
we have not seen the virus
for more than a couple of weeks --
16:32
way too early to declare
victory, obviously,
16:35
but evidence, ladies and gentlemen,
16:38
not only can the response
catch up to the disease,
16:40
but this disease can be driven to zero.
16:43
The challenge now, of course,
is doing this on the scale needed
16:46
right across these three countries,
and that is a huge challenge.
16:51
Because when you've been at something
for this long, on this scale,
16:56
two other big threats
come in to join the virus.
17:01
The first of those is complacency,
17:05
the risk that as this
disease curve starts to bend,
17:08
the media look elsewhere,
the world looks elsewhere.
17:11
Complacency always a risk.
17:14
And the other risk, of course, is when
you've been working so hard for so long,
17:16
and slept so few hours
over the past months,
17:20
people are tired, people become fatigued,
17:24
and these new risks
start to creep into the response.
17:26
Ladies and gentlemen, I can tell you today
I've just come back from West Africa.
17:30
The people of these countries,
the leaders of these countries,
17:35
they are not complacent.
17:38
They want to drive Ebola to zero
in their countries.
17:40
And these people, yes, they're tired,
but they are not fatigued.
17:44
They have an energy, they have a courage,
17:47
they have the strength
to get this finished.
17:50
What they need, ladies
and gentlemen, at this point,
17:52
is the unwavering support of the
international community,
17:55
to stand with them,
17:58
to bolster and bring even more support
at this time, to get the job finished.
18:00
Because finishing Ebola right now
means turning the tables on this virus,
18:05
and beginning to hunt it.
18:10
Remember, this virus, this whole crisis,
rather, started with one case,
18:12
and is going to finish with one case.
18:17
But it will only finish if those countries
have got enough epidemiologists,
18:19
enough health workers, enough logisticians
and enough other people working with them
18:24
to be able to find every one
of those cases, track their contacts
18:28
and make sure that this disease
stops once and for all.
18:32
Ladies and gentleman, Ebola can be beaten.
18:36
Now we need you to take this story out
to tell it to the people who will listen
18:39
and educate them
on what it means to beat Ebola,
18:44
and more importantly,
we need you to advocate with the people
18:47
who can help us bring the resources we
need to these countries,
18:51
to beat this disease.
18:54
There are a lot of people out there
who will survive and will thrive,
18:56
in part because of what you do
to help us beat Ebola.
19:00
Thank you.
19:04
(Applause)
19:05
Translator:Eriko T.
Reviewer:Morton Bast

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Bruce Aylward - Epidemiologist
As the Assistant Director-General of the World Health Organization’s Polio and Emergencies Cluster, Bruce Aylward works to ensure that polio stays under control and that the world is prepared to respond to health crises.

Why you should listen

A Canadian physician and epidemiologist who has authored some 100 peer-reviewed articles and chapters, Bruce Aylward is an expert on infectious diseases. He joined the World Health Organization in 1992 and worked in the field for seven years on national immunization programs for measles, tetanus and hepatitis in the Middle East, Africa and Asia. 

Aylward has overseen and managed the scale-up of the Global Polio Eradication Initiative since 1998, during which time the program expanded to operate in every country of the world, the annual global budget increased to $700 million a year, polio-funded staff deployed by WHO grew to over 3,500 people worldwide, and new monovalent oral poliovirus vaccines were developed for the programme. In 2014, only three countries remained polio-endemic.

He says: "It's been estimated that our investment in smallpox eradication pays off every 26 days."

Since 2011, Aylward has also led WHO’s work in preparedness, readiness and response to health emergencies. By developing global strategies, analyzing health trends and advising on policies and country collaboration, the WHO helps make sure that outbreaks — like the 2014 ebola epidemic — stay under control. 

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