Bruce Aylward: Humanity vs. Ebola. The winning strategies in a terrifying war

40,648 views

2015-02-03 ・ TED


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Bruce Aylward: Humanity vs. Ebola. The winning strategies in a terrifying war

40,648 views ・ 2015-02-03

TED


Please double-click on the English subtitles below to play the video.

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Translator: Eriko T Reviewer: Morton Bast
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When I was invited to give this talk a couple of months ago,
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we discussed a number of titles with the organizers,
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and a lot of different items were 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,
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Ebola was escalating exponentially
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and spreading over wider geographic areas than we had ever seen,
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and the world was terrified, concerned and alarmed
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by this disease, in a way we've not seen in recent history.
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But today, I can stand here and I can talk to you about beating Ebola
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because of people whom you've never heard of,
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people like Peter Clement, a Liberian doctor who's working in Lofa County,
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a place that many of you have never heard of, probably, in Liberia.
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The reason that Lofa County 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,
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Lofa County was right at the center, the epicenter of this epidemic.
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At that time, MSF and the treatment center there,
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they were seeing dozens of patients every single day,
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and these patients, these communities 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,
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to their communities, to their children, to their relatives.
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And so Peter Clement was charged with driving that 12-hour-long rough road
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from Monrovia, the capital, up to Lofa County,
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to try and help bring control 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.
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So he sat down with the local chiefs, 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
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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,
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but what it did to families and what it did to communities.
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And he listened to the local chiefs there and what they told him --
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They said, "When our children are sick, 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.
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When our relatives die, we can't take care of them as our tradition demands.
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We are not allowed to wash the bodies to bury them
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the way our communities and our rituals demand.
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And for this reason, they were deeply disturbed, deeply alarmed
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and the entire epidemic was unraveling in front of them.
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People were turning on the healthcare workers who had come,
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the heroes who had come to try and help save the community,
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to help work with the community, and they were unable to access them.
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And what happened then was Peter explained to the leaders.
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The leaders listened. They turned the tables.
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And Peter explained what Ebola was. He explained what the disease was.
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He explained what it did to their communities.
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And he explained that Ebola threatened everything that made us human.
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Ebola means you can't hold your children the way you would in this situation.
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You can't bury your dead the way that you would.
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You have to trust these people in these space suits to do that for you.
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And ladies and gentlemen, what happened then was rather extraordinary:
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The community and the health workers, Peter, they sat down together
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and they put together a new plan for controlling Ebola in Lofa County.
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And the reason that this is such an important story, ladies and gentlemen,
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is because today, this county, which is right at the center of this epidemic
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you've been watching, you've been seeing in the newspapers,
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you've been seeing on the television screens,
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today Lofa County is nearly eight weeks 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.
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There's still a huge risk that there will be additional cases there.
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But what it does teach us 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,
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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,
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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?
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Well, for that, we have to go back 12 months, to the start of this epidemic.
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And as many of you know, this virus went undetected,
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it evaded detection for three or four months when it began.
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That's because this is not a disease of West Africa,
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it's a disease of Central Africa, 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.
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They didn't know what they were dealing with,
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and to make it even more complicated,
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the virus itself was causing a symptom, 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.
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For that reason it evaded detection for some time,
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But contrary to public belief sometimes these days,
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once the virus was detected, 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.
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The World Health Organization and the partners that it works with
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deployed eventually hundreds of people 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,
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well known now as Ebola, had spread too far.
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It had already outstripped what was one of the largest responses
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that had been mounted so far to an Ebola outbreak.
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By the middle of the year, not just Guinea
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but now Sierra Leone and Liberia were also infected.
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As the virus was spreading geographically, the numbers were increasing
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and at this time, not only were hundreds of people infected
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and dying of the disease,
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but as importantly, 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
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were also sick and dying by the dozens.
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The presidents of these countries recognized the emergencies.
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They met right around that time, they agreed on common action
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and they put together an emergency joint operation center in Conakry
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to try and work together to finish this disease and get it stopped,
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to implement the strategies we talked about.
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But what happened then was something we had never seen before with Ebola.
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What happened then was the virus, or someone sick with the virus,
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boarded an airplane, flew to another country,
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and for the first time, 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,
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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,
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international concern on a scale that 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,
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looked at the situation, declared an international emergency.
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And in doing so, the expectation would be that there would be a huge outpouring
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of international assistance to help these countries
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which were in so much trouble and concern at that time.
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But what we saw was 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,
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but at the same time, the opposite happened in many places.
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Alarm escalated, and very soon these countries found themselves
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not receiving the support they needed, but increasingly isolated.
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What we saw was commercial airlines [stopped] flying into these countries
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and people who hadn't even been exposed to the virus
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were no longer allowed to travel.
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This caused not only problems, obviously, 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,
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to try and help them respond to the outbreak,
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they could not get people on airplanes,
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they could not get them into the countries to be able to respond.
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In that situation, 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.
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Not only did this virus continue in the places
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where they'd already become infected, but then it started to escalate
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and we saw the case numbers that you see here,
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something we'd never seen before 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
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but also spreading further and deeper into these countries.
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Ladies and gentleman, this was one of the most concerning
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international emergencies in public health 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,
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we saw the health system start to collapse under the weight of this epidemic.
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We saw the schools begin to close, markets no longer started,
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no longer functioned the way that they should in these countries.
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We saw that misinformation and misperceptions started to spread
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even faster through the communities, 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,
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as they call them, who had come to help them.
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And then the situation deteriorated even further.
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The countries had to declare a state of emergency.
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Large populations needed to be quarantined 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,
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can we ever stop Ebola when it starts to spread like this?
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And they started to ask, how well do we really know this virus?
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The reality is we don't know Ebola extremely well.
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It's a relatively modern disease 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.
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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.
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We know that it probably enters 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.
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Then we know that the virus 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,
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where we see this disease cause severe fevers, diarrhea, vomiting,
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and then unfortunately, in 70 percent of the cases or often more, death.
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This is a very dangerous, debilitating, and deadly disease.
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But despite the fact that we've not known 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.
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There are four things that are critical to stopping Ebola.
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First and foremost, the communities have got to understand this disease,
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they've got to understand 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,
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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.
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We have to have 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,
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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,
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so that there is no spread at that time as well.
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So we do know how to stop Ebola, and these strategies work, ladies and gentlemen.
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The virus was stopped in Nigeria by these four strategies
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and the people implementing them, obviously.
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It was stopped in Senegal, where it had spread, and also in the other countries
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that were affected by this virus, in this outbreak.
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So there's no question that these strategies actually work.
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The big question, ladies and gentlemen, was whether these strategies could work
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on this scale, in this situation, with so many countries affected
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with the kind of exponential growth that you saw.
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That was the big question that we were 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
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of an incredible group of NGOs, of governments, of local leaders,
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of U.N. agencies and many humanitarian and other organizations
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that came and joined the fight to try and stop Ebola in West Africa.
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But what had to be done there was slightly different.
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These countries took those strategies I just showed you;
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the community engagement, 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.
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What they decided to do was they would first try and slow down this epidemic
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by rapidly building as many beds as possible in specialized treatment centers
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so that they could prevent the disease from spreading from those were infected.
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They would rapidly build out many, many burial teams
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so that they could safely deal with the dead,
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and with that, they would try and slow this outbreak
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to see if it could actually then 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,
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when I was there what I saw was extraordinary.
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I saw presidents opening emergency operation centers themselves against Ebola
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so that they could personally coordinate and oversee and champion
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this surge of international support to try and stop this disease.
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We saw militaries from within those countries and from far beyond
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coming in to help build Ebola treatment centers
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that could be used to isolate those who were sick.
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We saw the Red Cross movement working with 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
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in a dignified manner themselves.
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And we saw the U.N. agencies, 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
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to be able to implement the strategies that we just talked about.
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What we saw, ladies and gentlemen, which was probably most impressive,
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was this incredible work by the governments,
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by the leaders in these countries, with the communities,
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to try to ensure people understood this disease,
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understood the extraordinary things they 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,
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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,
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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,
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change this exponential growth,
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and bring some hope back to the ability to control this outbreak.
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And for this reason, ladies and gentlemen, 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.
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The big question, though, that many people are asking,
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even when they saw this curve, they said,
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"Well, hang on a minute -- that's great you can slow it down,
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but can you actually drive it down to zero?"
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We already answered that question 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
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where they have not seen Ebola for eight weeks.
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But there are similar stories from 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.
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We've seen very, very few cases in the last couple of months,
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and here in Kenema, in Sierra Leone, another area in the epicenter,
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we have not seen the virus for more than a couple of weeks --
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way too early to declare 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,
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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
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right across these three countries, and that is a huge challenge.
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Because when you've been at something for this long, on this scale,
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two other big threats 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,
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the media look 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,
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and slept so few hours 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.
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Ladies and gentlemen, I can tell you today I've just come back from West Africa.
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The people 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.
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And these people, yes, they're tired, 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.
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What they need, ladies and gentlemen, at this point,
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is the unwavering support of the international community,
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to stand with them,
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to bolster and bring even more support at this time, to get the job finished.
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Because finishing Ebola right now 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,
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and is going to finish with one case.
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But it will only finish if those countries have got enough epidemiologists,
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enough health workers, enough logisticians and enough other people working with them
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to be able to find every one of those cases, track their contacts
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and make sure that this disease 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
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and educate them on what it means to beat Ebola,
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and more importantly, we need you to advocate with the people
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who can help us bring the resources we 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,
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in part because of what you do to help us beat Ebola.
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Thank you.
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(Applause)
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