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Insights: "We Are Not a Culture of Outbreak Prevention"

May 04, 2017 00:00 AM UTC
- Updated May 05, 2020 16:19 PM UTC

Doctors from the Ebola front lines explain how to get ahead of the next outbreak.

[MUSIC PLAYING] BRYAN WALSH: What do we take from this? Because this is not going to be the last time we face this disease. There will be other ones out there, ones we know about and probably more frightening diseases we don't know about yet, we haven't discovered yet. So what lesson should we take as a global health community to make sure that we're better prepared the next time before face this. NAHID BHADELIA: Yeah, I think we're a culture of outbreak response. At best, we're a culture of outbreak preparedness, but we are not a culture outbreak prevention. We seem to chase one pathogen after another. It's Ebola, then it's Zika, and then it's yellow fever. And the truth is, pennies on the dollar, if you could invest in some of the basic things that, you know, really allow continued surveillance for infectious diseases in communities, you would actually increase that yield and catch everything that comes along. I find it interesting that your organization is Last Mile Health because I always talk about the fact that at the terminal end of all international surveillance for infectious diseases are communities that have no access to care. I mean, the way surveillance works is there is a cluster of people who get sick, they go to health care, the clinician picks up the fact that there is something abnormal, the clinician reports it to somewhere up, to a functioning public health system. Then that public health system responds up to WHO, and the alarm bells go off and there is an efficient response, right? Within the country and WHO. But that first mile or last mile, however you want to put it, a majority that people are not getting to care. And if they are, one thing that sort of makes a lot of people surprised when I speak about this is that in resource-limited settings, you are diagnosed by treatment. You go in, you have a clinical syndrome of some sort, and they give you malaria medication. If you don't get better, then they say, oh, it might be something else, maybe it's typhoid, right? Because of that, it takes-- there's a built-in delay for us to pick up outbreaks or clusters before they become outbreaks. RAJ PANJABI: Yeah. Well said. I think I'd build on your point in terms of lessons learned. Look, if we still can't learn the lesson from the first patient, Emile, patient zero, 2-year-old boy who gets sick with fever, vomiting, and diarrhea, December 2013, in the rainforest across the border from where Nahid and I were working in southern Guinea, he dies December 2013. A few weeks later, his sister dies. A few weeks later, his mother dies. And this mysterious disease at the time would spread from one community to another in the rainforest borderlands between these countries, Sierra Leone, Liberia and Guinea, and it wasn't until three months later in March 2014 when this was identified as Ebola. When every minute counted, we're losing months. When every year accounted with HIV disease, we lost decades. In the case of Zika, we've lost many years, as well, to understand this disease. Every one of those illnesses were zoonotic diseases starting in animal reservoirs. Those animals are interacting with human populations in forest communities, all in the same rainforest belt throughout west and central Africa in these particular cases. The amount of loss of life, the amount of billions of dollars this cost the economies has been tremendous. And if you ask, what is common? Well, one issue is that 60% to 75% of new emerging infectious diseases are zoonotic. And if you ask then what else is common in addition to epidemiology of disease, is this-- is the investments in health care. There's been a, you know, as our friend Paul Farmer would call it, a clinical desert in these settings, right? Where there's just not enough investment going into these places, and you're seeing massive costs from it. I mean, that one child, his disease killed him, killed his family, killed a number of communities. It wasn't until March 2014 we caught it. It spread like wildfire across West Africa, reached the shores of this country, cost billions of dollars. We lost 500 health workers in our three countries and places where there were things like 50 doctors after the war. And companies shut down, airlines started cutting off their routes, routes to West Africa. So you know, there is a real consequence of not investing in the basic idea of getting health care for everyone everywhere, and it turns out, you know, probably one of the big lessons is that blind spots in rural health care can lead to hotspots of disease. That places us all at greater risk. [MUSIC PLAYING]