4 epidemics that almost happened (but didn't)

Ebola stands as one of the most deadly viruses known to us, with a fatality rate of about 50% among those infected. It can be transmitted through various bodily fluids, including blood and sweat, and even the deceased can spread the disease, often during funeral rites. On December 26th, 2013, a two-year-old boy in southern Guinea fell ill and tragically passed away just two days later. It took four months for local doctors, working alongside the international community, to identify Ebola as the cause, mainly because it had never been detected outside of Central Africa. During those four months, Ebola gained a head start that resulted in devastating consequences. The outbreak persisted for two years, becoming the largest Ebola epidemic on record. Over 28,000 people contracted the disease, and more than 11,000 lost their lives.

In 2013, Guinea lacked a formal emergency response system, had limited trained contact tracers, and possessed no rapid tests, border screenings, or licensed Ebola vaccines. However, after the epidemic, Guinea, with support from the US and other international partners, completely transformed its epidemic response system. In January 2021, the system faced its first real test when a nurse in southern Guinea developed symptoms such as headache, vomiting, and fever. She passed away a few days later. As per traditional burial customs, her family prepared her body for the funeral. Within a week, the nurse's husband and other family members began experiencing symptoms. Health officials quickly suspected Ebola and conducted tests, which confirmed their suspicions. Guinea activated its epidemic alert system the following day.

A series of rapid actions ensued. Guinea's National Agency for Health Security established 38 emergency operations centers at the district level, along with a national center. Teams of epidemiologists and contact tracers diligently worked to determine the individuals who had been exposed and when, leading to an initial contact list of 23 people, which swiftly grew to over 1,100. Advanced rapid testing capabilities were deployed in the city where the outbreak originated. Public health workers screened more than 2 million travelers at Guinea's borders with Liberia and Cote d'Ivoire. A large-scale vaccination campaign was launched. Additionally, over 900 community mobilizers informed the population about the outbreak and suggested alternative burial practices that respected community customs while reducing the risk of Ebola transmission.

Thanks to these comprehensive measures, the 2021 outbreak concluded just four months after its initiation. Only 23 individuals contracted Ebola, and the death toll stood at 12. This represents less than 1% of the fatalities from the previous outbreak. The cost of controlling the 2021 outbreak reached $100 million, a considerable sum but significantly lower than the global economic cost of the previous epidemic, which amounted to $53 billion.

However, it is not a case of every country simply copying Guinea's approach. While responding swiftly to an outbreak is crucial, a successful response can differ greatly depending on the disease and the country. For instance, Brazil successfully curbed a yellow fever outbreak, primarily by implementing an extensive vaccination campaign. This approach worked well due to Brazil's significant role as a global producer of the yellow fever vaccine and its population's familiarity with routine vaccinations. Yet, not all diseases require mass vaccination programs.

In Burkina Faso, when a truck driver tested positive for cholera in August 2021, health care workers promptly notified the government, and immediate contact tracing began. Since cholera is caused by bacteria, antibiotics were administered to those exposed or potentially exposed. This swift response effectively halted the outbreak within a few weeks. Despite West Africa being prone to cholera outbreaks, with over 100,000 cases and 3,700 deaths in 2021, Burkina Faso, well-prepared, reported zero deaths that year.

In Chiang Mai, Thailand, health officials piloted a community-driven outbreak alert system focused on monitoring animal health. This is crucial as some animal outbreaks have the potential to spill over and affect humans. Villagers utilized a mobile app to inform health authorities of animal outbreaks. Over a span of 16 months, 36 animal outbreaks were identified.

For any outbreak response system to be effective, it must be trusted, valued, and embraced by communities. This entails reaching people in their own languages, respecting their culture, beliefs, and practices. Moreover, it is essential to recognize that we cannot expect to remain idle for years and then abruptly swing into action when an outbreak occurs. Investing in robust and sustainable health infrastructure, accessible to everyone, especially the most vulnerable populations, is one of the most effective ways to save lives.