Lessons about epidemics that thinktankers should take into account

8 March 2020

A couple of forewarnings: first, I am not a global health expert and these lessons are drawn solely from the experience of working on the response to the Ebola Virus Disease (EVD) outbreak in Sierra Leone in 2014 and 2015. Second, it’s not easy, personally, to revisit this content, but it’s relevant and important to do so.

In August 2014, months after EVD was declared a global health emergency, and as cases reached Sierra Leone’s urban centres, panic had settled. The tipping point for most international organisations working in the country was when airlines cancelled flights to and from the region. What ensued was an exodus of foreigners scrambling to get on those final flights in fear of being ‘locked in’ the country. For those of us who had left Freetown for the August holiday (and for whom it had been a home for several years) our panic was adverse: how would we get back to Freetown?

Asking the right questions to the right people

We all know the premise: if you don’t ask the right questions, chances are you won’t get the right answers. Nevertheless, in the frame of a health emergency, it also matters to whom you ask those questions.

In an age of [mis]information overload, it is easy to find an opinion to trust. However, when it comes to science,  it’s not really about opinions, it’s about facts. And during the early months of the EVD outbreak there weren’t enough facts or experts on the virus, nor on the outbreak that would ensue.

Fear and the lack of experts

In August 2014, there was no way to predict the infection curve: how many cases there would be and how long the outbreak would last. This left the health science community baffled and under an immense amount of pressure to provide answers, fast.

During the height of the epidemic, the number of confirmed EVD cases pretty much matched the number of deaths, there were few designated hospitals to isolate and treat these patients, and these did not have enough beds to provide adequate medical care for those patients. By the end of 2014, however, we had pretty straightforward advice on how to prevent contracting the disease, and behavioural change communication campaigns were in place.

As for foreigners living in Sierra Leone at very low-risk of infection (meaning, those of us who didn’t work providing medical care to EVD patients), two immediate fears we faced were not being able to fly out of the country, and being quarantined when back in our home countries. Flight shut down fears were put to rest by consultation with airlines and travel officials, and home country quarantine fears were quickly dispelled with government and border control advice and checks upon arrival.

Perhaps the biggest fear that put everyone in the country at risk was that all medical facilities had been shut down. In a critical turn for the worst during the outbreak, due to unpreparedness in face of an unknown virus, almost the entire medical community in Sierra Leone was infected with the Ebola virus and died. Local experts on infectious diseases were gone as the disease spread through urban centres towards the capital.

To put it simply, in the first couple of months after the health emergency was declared, if you had to deliver a child, if you broke a leg, caught malaria, or got appendicitis, there was no access to urgent medical care. In an already weakened health system, the loss of so many members of the medical community was devastating.

In mid-2014, the world knew little about the disease and there had been no cases of that particular strain of the virus outside of the region yet. As West Africa turned to the world and asked in desperation, ‘where are the experts?’, the response was a deafening silence. There were no experts.

As the outbreak continued and the science community struggled to catch up with the virus’ behaviour, the government had to act. We saw entire communities quarantined, people were placed in isolation units, schools were shut, and weekends were spent in lock-down. In a society where the majority of the population has a day-to-day livelihood, the economic impact of quarantined communities and weekends in lock-down was unprecedented.

The biggest handicap that this response faced in those early months was the lack of coordination amongst the private sector, government, international NGOs, the media, and the local and international medical community. This resulted in contradictory information shared in different spaces which, in turn, fueled fear and panic around the world.

Were these fears unfounded? No. Inaccurate information spreading fear and panic was all around.

Trusting the experts

There are expert bodies out there, and what I’ve learned is that anyone who is a non-expert should trust them and follow their advice only.

While the advice of these expert bodies might not be as fast as we would like (or need) it to be, we have to trust that when it finally does come it is based on science and research- not opinions- especially when it comes to disease and outbreak.

On a personal note, the sharp increase of cases of COVID-19 and the amount of garbage information that is out there about the outbreak has awakened sharp memories of my experience working in the epi-centre of a global health epidemic, and the importance of promoting information and advice provided by expert bodies. This is perhaps the only similitude I will draw between these two outbreaks- everything else, including the reaction of the public, is different in every way.

Through the past few weeks, I’ve reminded myself of the biggest lesson from five years ago: unless you are a health expert on the topic in question, your most valuable source of information should be the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) on what precautions to take. As for travel advice, you should follow your government’s advice. They are and should continue to be the trusted source of information about your health and safety during an epidemic.

The role of think tanks

Fear is caused by the unknown too: most people are prone to believing sources that are closer to ‘home’. Technical information and advice from international bodies (such as the WHO) can seem too far from home for the general public. We saw this during the EVD outbreak: working with local leaders, at community level, was a turning point in prevention and containment.

Think tanks here can play the role of information brokers. While most think tanks will not be experts in a particular disease, they can serve as credible sources of information by hosting expert facts and advice, or directing the public to the best expert information sources. They can work with experts to help translate their findings and fact-based recommendations at national and community levels, responding to local needs and concerns.

And so, by helping to amplify expert voices, think tanks can play a role in communicating accurate information to the public. They will also have to do this role in a coordinated approach with other actors: government, NGOs, the science community, the media, and the general public. A response to a health epidemic requires coordination.

Fear is human nature, but so is communication. And think tanks here can help fight disinformation by identifying and debating those who promote unfounded arguments, countering them with credible and reputable sources. By engaging with the public, they can help us ask the right questions to the right people.