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