Vox - Ebola outbreak: the deadliest in historyhttps://cdn.vox-cdn.com/community_logos/52517/voxv.png2018-10-26T07:34:19-04:00http://www.vox.com/rss/stream/57124562018-10-26T07:34:19-04:002018-10-26T07:34:19-04:00Trump officials have barred experts from fighting one of the worst Ebola outbreaks in history
<figure>
<img alt="" src="https://cdn.vox-cdn.com/thumbor/RmfnhAhWnV8f1B692B_5VhmzakU=/200x0:3400x2400/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/61910677/GettyImages_1021909244.1540498776.jpg" />
<figcaption>Health workers carry out the body of a patient with unconfirmed Ebola virus on August 22, 2018 in Mangina, near Beni, in the North Kivu province. | John Wessels/AFP/Getty Images</figcaption>
</figure>
<p>“There’s a fear of a Benghazi-type situation, that Americans might be targeted.”</p> <p id="pBtyju">One of the largest Ebola outbreaks in history shows no signs of slowing — and the Trump administration barred US health experts who want to help at the outbreak’s epicenter in the <a href="https://www.vox.com/science-and-health/2018/10/11/17959850/ebola-outbreak-congo-2018">Democratic Republic of Congo</a> from traveling there.</p>
<p id="uifMmB">Centers for Disease Control and Prevention officials were working in Beni, the city that’s ground zero for the outbreak in eastern DRC, for a few days in late August and early September. Experts say that’s an unusually short period of time for infectious disease responses; CDC deployments usually last at least four weeks, and many run for several months. </p>
<p id="SoOK0h">But then the White House’s National Security Council (NSC) coordinated a government review of the security risks, involving representatives from multiple government agencies and departments. The review determined that CDC officials could not return to areas where militant attacks threaten security, including Beni. <a href="https://www.statnews.com/2018/10/14/cdc-withdrew-ebola-experts-outbreak-zone/">Stat News</a> first reported on October 14 that the US had pulled out of the area. </p>
<p id="BzMR3k">“It’s unprecedented that the CDC expertise is not at the very center of the response because that has been the pattern for the other outbreaks,” Stephen Morrison, a global health expert at the Center for Strategic and International Studies think tank in Washington, told Vox. “We have some people on CDC staff who are veterans of almost two dozen outbreaks.” </p>
<p id="tqHsMt">Others who have been on the ground working to curb this Ebola outbreak, which has led to 251 cases and 127 deaths so far, say they didn’t notice the CDC’s brief presence at all. A senior humanitarian official not affiliated with the Trump administration told Vox that he believed CDC experts were never in Beni. </p>
<p id="WQQz2I">Another non-administration senior humanitarian official added that while America has vehicles on the ground in the city, they’ve gone unused. “Those three armored US Embassy vehicles sitting in the UN parking lot in Beni for two months have never moved,” the official said. </p>
<p id="wmlZZF">However, CDC officials insist in conversations with Vox that its experts did work in Beni. </p>
<p id="IzUBKW">The relatively tepid response from the US, at a time when the outbreak is spiraling, has former CDC officials and global health experts concerned. “I do worry that in the worst-case scenario, we could have an outbreak of tens of thousands of people,” said Daniel Bausch, the director of the UK Public Health Rapid Support Team, “and complete destabilization of an already unstable region.” </p>
<h3 id="e0NeMc">This is an “unprecedented” response — in a bad way</h3>
<p id="NzBaas">Tom Frieden, the former head of the CDC who responded to the Ebola outbreak in West Africa from 2014 to 2016, said that “it’s unusual” and “not optimal” for CDC experts not to work at the outbreak’s epicenter. </p>
<p id="bCvAKK">Others agree: The DRC health workers and others who are on the ground fighting the Ebola outbreak “are not winning the game,” Morrison said. “They need to have every player they can get on the field that is competent, experienced, and able to fix these problems.”</p>
<p id="obTxfP">The outbreak started in July and has <a href="https://www.vox.com/science-and-health/2018/10/11/17959850/ebola-outbreak-congo-2018">worsened in recent weeks</a>, after a <a href="https://www.nytimes.com/2018/10/21/world/africa/congo-kidnapping-ebola.html">spate of violent attacks on civilians</a> by Congolese rebels temporarily halted the public health response. </p>
<div class="c-float-right"><div id="nTz5od"><div data-anthem-component="aside:1924888"></div></div></div>
<p id="j5L2GO">A CDC spokesperson said its staff has been in Kinshasa, 1,000 miles away from the outbreak zone, since early September, “where they continue to support the response.” But even before then, CDC’s involvement in eastern DRC was uncharacteristically limited. The CDC said its director, Robert Redfield, was in Beni for one day, while other staff were there for only “several days.” </p>
<figure class="e-image">
<img alt=" " data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/dPbgZspvU9yHj3XJ7dQNnCx-Pbo=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/13333681/GettyImages_1017726962.jpg">
<cite>AFP/Getty Images</cite>
<figcaption>An Ebola patient is lifted up by two medical workers after being admitted into a biosecure emergency care unit on August 15, 2018, in Beni.</figcaption>
</figure>
<p id="rHeRhN">Redfield told <a href="https://www.statnews.com/2018/10/23/cdc-director-says-he-pushed-to-keep-u-s-experts-in-ebola-zone-but-was-overruled/">Stat executive editor Rick Berke on Tuesday</a> that he wants CDC officials on the ground in the DRC’s eastern region to help with the outbreak response, but that he was overruled by security concerns. </p>
<p id="gTcZTe">“The [Ebola responders are] at an enormous disadvantage by not having the expertise the CDC has on the ground,” he said, adding that he’d be “happy” to travel there himself to help.</p>
<p id="hi7NLh">As of today, the CDC has only 18 staff deployed abroad to help with the Ebola response, and not all of them are even in the DRC (outside of the outbreak’s epicenter) — they’re spread out in Uganda, Rwanda, South Sudan, and Switzerland as well. </p>
<h3 id="CHJG8o">The CDC wants to be in Beni. The administration says it’s too risky.</h3>
<p id="Sim7en">The argument to keep health officials out of eastern DRC boils down to this: It’s a dangerous area, and no one wants to put US officials in harm’s way.</p>
<p id="IVgxrk">“This highly insecure environment makes this response extremely challenging and can complicate public health activities,” a State Department official told Vox. </p>
<p id="6SDXak">Some experts agree. There are intensifying attacks by a militant group in the area, J. Peter Pham, an Africa expert at the Atlantic Council in Washington, told Vox. Just this past Sunday, <a href="https://www.nytimes.com/2018/10/21/world/africa/congo-kidnapping-ebola.html">15 people</a> were slaughtered in an attack there. </p>
<p id="7Chp6o">“US personnel are especially vulnerable,” Pham said, because in the event of an emergency, there are few US troops or equipment in the area to help. And relations between the DRC government and the US have not been warm lately.</p>
<figure class="e-image">
<img alt="Dr. Robert Redfield, Director of the CDC, makes remarks at a PATH event on June, 11, 2018 in Washington, DC.&nbsp;" data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/mbqwgiG_ABsyQgXB4L4MkEseuIA=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/13333543/GettyImages_1001043576.jpg">
<cite>Bill O’Leary/The Washington Post via Getty Images</cite>
<figcaption>Dr. Robert Redfield, director of the CDC, makes remarks at a PATH event on June, 11, 2018, in Washington, DC. </figcaption>
</figure>
<p id="R4LcKX"><a href="https://www.acaps.org/about-acaps/in-short.html">ACAPS</a>, an independent group that ranks humanitarian access in countries, calls the DRC “nearly inaccessible,” along with a handful of other countries including Libya, Afghanistan, and Somalia. That’s just one level below the worst global ranking of “inaccessible.” </p>
<p id="1mUtJY">“We are deeply concerned about continued loss of life due to armed group attacks in the region,” the State Department official continued, adding that the department is “currently engaged in an interagency deliberative process.” </p>
<h3 id="I7HjnI">Other countries and NGOs are sending people to the DRC. The US isn’t.</h3>
<p id="u5wYMx">The response to this DRC outbreak may be unusual in part because it’s the first time Ebola has spread in an active war zone. </p>
<p id="09tlwp">In eastern DRC, <a href="http://www.unhcr.org/en-us/news/briefing/2018/8/5b7fc5ef4/spiralling-violence-puts-millions-risk-ebola-hit-eastern-drc.html">armed opposition groups</a> are carrying out deadly attacks on civilians, forcing more than a million people from their homes, according to the <a href="http://www.unhcr.org/en-us/news/briefing/2017/10/59eefe3e4/unhcr-warns-worsening-displacement-democratic-republic-congo.html">United Nations Refugee Agency</a>.</p>
<p id="DPi1JK">But while the US is staying back, officials from other countries, including Canada and the United Kingdom, as well as NGOs and humanitarian groups are sending personnel to help with the Ebola crisis. As of October 15, there were 450 responders on the ground. <a href="https://www.vox.com/science-and-health/2018/10/11/17959850/ebola-outbreak-congo-2018">One of them</a> — Scott Dowell of the Gates Foundation — was a veteran of CDC’s Ebola response unit, having helped in more than a dozen Ebola outbreaks. </p>
<figure class="e-image">
<img alt="Two medical workers are seen in a Biosecure Emergency Care Unit on August 15, 2018 in Beni." data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/QJFjiMpTJZAehg5JXLDOt2mdknw=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/13333563/GettyImages_1017727266.jpg">
<cite>John WesselsAFP/Getty Images</cite>
<figcaption>Two medical workers are seen in a biosecure emergency care unit on August 15, 2018, in Beni.</figcaption>
</figure>
<p id="gUSJWd">“We know the response is struggling,” said Morrison, the health expert from the Center for Strategic and International Studies. “Something much more needs to happen here. ... The security situation — security risks — are real, but they are manageable.” </p>
<p id="kZYAAO">Ron Klain, the former “Ebola czar” during the 2014-’16 outbreak in West Africa, is also concerned about the lack of an American presence. </p>
<p id="rzfJ2j">“The fact that our country’s top experts from CDC have been relegated to the sideline by the White House shows an unwillingness to put together the right team and security partnerships to enable these talented men and women to do their jobs,” Klain told Vox. </p>
<figure class="e-image">
<img alt=" " data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/ZwKqexwhPvI06h74K2ReomlXNxg=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/13333665/GettyImages_1021927704.jpg">
<cite>John Wessels/AFP/Getty Images</cite>
<figcaption>A group of Congolese look on as a suspected Ebola victim is picked up, on the road linking Beni to Mangina, on August 23, 2018 in Beni, in the North Kivu province.</figcaption>
</figure>
<h3 id="4CVk2J">“There’s a fear of a Benghazi-type situation”</h3>
<p id="bqKTkl">In February, the <a href="https://www.vox.com/science-and-health/2018/2/23/16974012/trump-pandemic-disease-response">Trump administration announced deep cuts</a> to the CDC, State Department, and USAID budgets. And because there was no sign that the $1 billion pot of money Congress gave USAID and the CDC <a href="https://obamawhitehouse.archives.gov/the-press-office/2015/11/16/fact-sheet-us-commitment-global-health-security-agenda">in 2015</a> to fight Ebola in West Africa would get replenished, that prompted these agencies to plan a retreat from 39 of the 49 foreign countries they were working in. </p>
<p id="qHRa14">Just one day after a separate Ebola outbreak was declared in the DRC last spring, the head of global health security on the NSC, Rear Adm. Tim Ziemer, <a href="https://www.huffingtonpost.com/entry/tim-ziemer-global-health-security-leaves_us_5af37dfbe4b0859d11d02290?ncid=engmodushpmg00000004">left the Trump administration amid a reorganization by National Security Adviser John Bolton</a>. That means the top White House official who would lead a pandemic response isn’t there to coordinate.</p>
<p id="j1ZI8K">The health security team <a href="https://www.washingtonpost.com/news/to-your-health/wp/2018/05/10/top-white-house-official-in-charge-of-pandemic-response-exits-abruptly/?utm_term=.89736bd4b9c6">Ziemer led was also dismantled</a>. (According to the NSC press office, Ziemer’s team has been “assigned to two different offices that have a direct relationship to their mission sets.”)</p>
<p id="reoFzE">When asked why the administration might not want to send people to DRC this time, especially since the US government operates in many active war zones, Morrison offered a few ideas — some political, some ideological. </p>
<p id="me2tP4"></p>
<p id="wViwsL">“There’s a fear of making a mistake and getting clobbered by Congress. There’s a fear of a Benghazi-type situation, that Americans might be targeted,” he said. “We’re looking at possible change of power in the House of Representatives in another 14 days.” (In 2012, an Islamic militant group attacked US government facilities in Benghazi, Libya, leading to the deaths of four Americans.)</p>
<p id="9GBlVM">The broader Trump administration ideology — prioritizing American interests and letting others lead abroad — may also be a factor, Morrison said. </p>
<p id="BWqAhD">“I’m a believer the US should be leading on the response; we have exceptional capacity to lead and we’ll bring others with us,” said Morrison. “We’re losing the game there and at risk of a much bigger outbreak. And if there’s a much bigger outbreak and we are hanging on the sidelines, we will be blamed.” </p>
<p id="IhqoKc"><em>Got a tip? Contact Julia Belluz securely via </em><a href="https://keybase.io/"><em>KeyBase</em></a><em> at jbelluz and Alex Ward via </em><a href="http://flowcrypt.com/me/alexward"><em>FlowCrypt</em></a><em>. </em></p>
<p id="BQwhhv"></p>
https://www.vox.com/2018/10/25/18015780/ebola-outbreak-2018-drc-congo-security-trump-cdcJulia BelluzAlex Ward2017-05-12T13:05:01-04:002017-05-12T13:05:01-04:00Ebola: an outbreak has been confirmed in the DRC. Here’s what you need to know.
<figure>
<img alt="" src="https://cdn.vox-cdn.com/thumbor/_sK2ZrO_m28AsyEdXiqnj3Rq6Ps=/0x107:2560x2027/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/54758349/14712446017_fbcd9d9547_o.1494607444.jpg" />
<figcaption>Scanning electron micrograph of Ebola virus. | <a href="https://www.flickr.com/photos/niaid/14712446017/in/photolist-oq68Cn-qKXxK3-oq5muj-oNktc9-nYbmbJ-oDe3A2-oHimQn-q6Jsbe-q6vBxC-pAdmdm-oq5wzY-oBmFNn-mxvLjF-pzVgqd-omJEd1-pBoeo6-98T49w-phbmfo-rbG7Yg-pvFRMh-pCYRsM-UdD6tW-UdD7Jw-quXEJF-pgaDi6-Gp9WmY-owpGda-eVGUe-pCXwKU-pL5egG-rdxR6k-pZC72k-qydASR-pfjrAR-qBDDRV-pCXwAA-qTWRGv-pQU8yE-5XstF7-njTPDT-oyMrH5-qVYPFs-pzfgiq-pj8ofq-q8hp8x-pAMwko-q6cKqu-qK6qsU-qMiYX3-wU48io">NIAID / Flickr</a></figcaption>
</figure>
<p>Nine cases of fever, three deaths, and one lab-confirmed case of Ebola virus. </p> <p id="WyDtj2">Health officials in the Democratic Republic of the Congo have <a href="http://www.afro.who.int/en/media-centre/afro-feature/item/9602-ebola-in-drc-en.html">confirmed</a> one case of Ebola in what appears to be the first new outbreak of the deadly virus since the massive epidemic that hit West Africa in 2014-’15. </p>
<p id="TT3s7w"><a href="https://www.washingtonpost.com/news/to-your-health/wp/2017/05/12/new-ebola-outbreak-declared-in-democratic-republic-of-congo/?utm_term=.767201a30b5a">According</a> to reports, nine people in a very remote part of the country recently fell ill with a hemorrhagic fever. The World Health Organization <a href="http://www.afro.who.int/en/media-centre/afro-feature/item/9602-ebola-in-drc-en.html">reports</a> three have died, but only one so far has tested positive for Ebola. </p>
<p id="lZQNV8">Eugene Kabambi, a World Health Organization official, <a href="http://news.trust.org/item/20170512142109-rpurx/">told</a> Reuters that the confirmed case occurred “in a very remote zone, very forested, so we are a little lucky. We always take this very seriously.”</p>
<p id="Ua7cJL">Ebola is a virus known to circulate in populations of chimpanzees, gorillas, fruit bats, and a few other animals in the rainforests of West and Central Africa. But occasionally it infects humans who come contact with those animals’ or fellow infected humans’ bodily fluids, causing intermittent outbreaks. The fever is associated with vomiting and blood loss, and <a href="http://www.who.int/mediacentre/factsheets/fs103/en/">kills around half of all the people it infects</a>.</p>
<p id="HPoeCF">The WHO is <a href="http://www.afro.who.int/en/media-centre/afro-feature/item/9602-ebola-in-drc-en.html">currently deploying</a> health care workers to manage the outbreak and do surveillance to track it. “‘The first teams of epidemiologists, biologists, and experts in the areas of social mobilization, risk communication and community engagement, and also personnel specializing in water, hygiene and sanitation, are scheduled to reach the affected area today or tomorrow,” the WHO <a href="http://www.afro.who.int/en/media-centre/afro-feature/item/9602-ebola-in-drc-en.html">reporte</a>d Friday. </p>
<div id="5anpJf">
<blockquote class="twitter-tweet">
<p lang="en" dir="ltr">On 11 May 2017, the Min of Health of the Democratic Republic of the Congo notified WHO & partners of a lab-confirmed case of <a href="https://twitter.com/hashtag/Ebola?src=hash">#Ebola</a><a href="https://twitter.com/hashtag/DRC?src=hash">#DRC</a></p>— WHO (@WHO) <a href="https://twitter.com/WHO/status/863022054223773697">May 12, 2017</a>
</blockquote>
<script async="" src="//platform.twitter.com/widgets.js" charset="utf-8"></script>
</div>
<p id="8BSYOp">In the 2014-2015 outbreak, more than 11,000 people died, mainly in Sierra Leone, Guinea, and Liberia. The DRC was spared the worst of the Ebola outbreak — with just 49 deaths. (The outbreak <a href="http://www.who.int/mediacentre/news/releases/2016/ebola-zero-liberia/en/">was declared over in 2016</a>, but the WHO warned of<a href="http://www.who.int/mediacentre/news/releases/2016/ebola-zero-liberia/en/"> occasional future “flare-ups”</a> of the disease.)</p>
<p id="XIUk7f">“One case of Ebola is an emergency,” Peter Piot, who co-discovered the virus in the DRC in the 1970s, <a href="https://www.ft.com/content/77c26d75-a296-39e2-8b84-fea533edd13b">told</a> the Financial Times. “All epidemics start with one case. You cannot take any risks and you should take all stops out to contain it.”</p>
<h3 id="y6ozal">The world is better prepared for an Ebola outbreak</h3>
<p id="XlyHtj">As Vox’s Julia Belluz <a href="https://www.vox.com/science-and-health/2016/12/22/14039628/rvsv-zebov-ebola-vaccine-trial-effective">reported</a> in December, health officials now have a potent new tool to prevent widespread Ebola outbreak: a vaccine. </p>
<blockquote>
<p id="UKAyb1">The vaccine was tested in a trial involving nearly 12,000 people in Guinea and Sierra Leone during 2015 and 2016. Among the 5,837 people who got the vaccine, no Ebola cases were recorded. By comparison, there were 23 Ebola cases in the control group that had not gotten the vaccine. </p>
<p id="IrpMne">"This trial, confirming the 100 percent efficacy of the rVSV Ebola vaccine, is a simply remarkable outcome," Dr. Jeremy Farrar, the director of the Wellcome Trust, said of the research. "We’ve shown that by working collaboratively, across international borders and sectors, we can develop and test vaccines rapidly and use them to help bring epidemics to an end."</p>
</blockquote>
<p id="x39FFu">When these results were published in December, Merck, the vaccine’s manufacturer, committed to ensuring 300,000 doses of the vaccine could be available in the case of an emergency. </p>
<p id="EF0dNb">But some questions about the vaccine still remain. Namely: How long does the vaccine last? It could be the case that it requires a booster dose a few years after an initial injection. We’ll know more with time. On Friday, the Gavi Vaccine Alliance — a public-private partnership that works to ensure global vaccine supplies — confirmed to Reuters that the vaccines <a href="http://www.reuters.com/article/us-health-ebola-vaccine-idUSKBN1881ZF">are available</a> to be deployed.</p>
<p id="wHL3oc">At least it’s an assurance: It’s unlikely a future Ebola epidemic will reach the horrific levels seen in 2014. </p>
<p id="9okXW2">And it’s the case that the DRC has a lot of experience dealing with Ebola outbreaks, as Stat News’s Helen Branswell points out. </p>
<div id="BNR4Sx">
<blockquote class="twitter-tweet">
<p lang="en" dir="ltr">There is an <a href="https://twitter.com/hashtag/Ebola?src=hash">#Ebola</a> outbreak in DR Congo. Key context: This is DRC's 8th Ebola outbreak in 4 decades. They have experience fighting Ebola.</p>— Helen Branswell (@HelenBranswell) <a href="https://twitter.com/HelenBranswell/status/863072281098153990">May 12, 2017</a>
</blockquote>
<script async="" src="//platform.twitter.com/widgets.js" charset="utf-8"></script>
</div>
<div id="UKSjSh">
<blockquote class="twitter-tweet" data-conversation="none">
<p lang="en" dir="ltr">Part of the problem in the West Africa outbreak in 2014-15 was it occurred in countries with no Ebola experience. Also, got into cities.</p>— Helen Branswell (@HelenBranswell) <a href="https://twitter.com/HelenBranswell/status/863072542801747968">May 12, 2017</a>
</blockquote>
<script async="" src="//platform.twitter.com/widgets.js" charset="utf-8"></script>
</div>
<div id="JTFtPA">
<blockquote class="twitter-tweet" data-conversation="none">
<p lang="en" dir="ltr">There is an <a href="https://twitter.com/hashtag/Ebola?src=hash">#Ebola</a> vaccine that could be used if DRC needs/wants it. At present, there's no reason to think this outbreak will be 2014 redux</p>— Helen Branswell (@HelenBranswell) <a href="https://twitter.com/HelenBranswell/status/863074023680487424">May 12, 2017</a>
</blockquote>
<script async="" src="//platform.twitter.com/widgets.js" charset="utf-8"></script>
</div>
<p id="Aii2T8">Overall: No need to panic here yet. But health officials do need to be vigilant. </p>
<h3 id="xyiAHO">Further reading: </h3>
<ul>
<li id="fIKa2s">Read Belluz’s <a href="https://www.vox.com/science-and-health/2016/12/22/14039628/rvsv-zebov-ebola-vaccine-trial-effective">report</a> on the Ebola vaccine trial, and the innovative strategy researchers employed to prove its effectiveness. “Researchers are calling this development one of the only positive outcomes of the 2014-2016 Ebola epidemic — the largest the world had ever seen,” she writes. </li>
<li id="67zpwy">She also explains the<a href="https://www.vox.com/2015/5/18/8621129/who-reform-ebola"> troubling trends</a> that have left the WHO “underfunded, understaffed, and underpowered” to combat outbreaks.</li>
<li id="ziLS1a">And an explainer: <a href="https://www.vox.com/2015/1/12/7532755/Ebola-epidemic-end">Why did the 2014 Ebola epidemic get so bad?</a>
</li>
<li id="IlRYBR">And one last thing to chew on: <a href="https://www.vox.com/2017/3/4/14803596/trump-pandemic-response-global-health-cdc">Public health experts are fearful </a>that President Trump won’t be prepared to respond to a global health crisis should one arise. (Consider how he has yet to appoint a new director of the Centers for Disease Control and Prevention.)</li>
</ul>
https://www.vox.com/science-and-health/2017/5/12/15630558/ebola-drc-congo-new-cases-world-healthBrian Resnick2016-12-22T18:30:01-05:002016-12-22T18:30:01-05:00We finally have an effective Ebola vaccine. The war on the disease is about to change.
<figure>
<img alt="ebola" src="https://cdn.vox-cdn.com/thumbor/VNv6uzjXhhkUe3OG_2FqaFE-j4M=/0x0:2040x1530/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/52432251/452620350.0.jpeg" />
</figure>
<p>A study confirmed that the new vaccine is 100 percent effective. </p> <div id="L9fB2J">
<div class="volume-video" id="volume-placement-315" data-volume-placement="article" data-analytics-placement="article:middle" data-volume-id="365" data-volume-uuid="f37973ffa" data-analytics-label="This Ebola outbreak is the worst we've seen|365" data-analytics-action="volume:view:article:middle" data-analytics-viewport="video"></div>
</div>
<p id="1QutnT">It took a major <a href="https://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/">Ebola epidemic</a> that led to more than 11,000 deaths, but we now finally have a successful Ebola vaccine candidate in development. If approved, the vaccine would vastly reduce the likelihood of ever seeing another major Ebola outbreak.</p>
<p id="DiZMNb">More than a year ago, researchers published striking preliminary results from a large trial on a vaccine called rVSV-ZEBOV in the <a href="http://www.thelancet.com/pb/assets/raw/Lancet/pdfs/S0140673615611175.pdf"><em>Lancet</em></a>. They showed that everyone who got the shot immediately after contact with an Ebola victim didn't get the virus.</p>
<p id="2Zzygq">Today, the same researchers — who hail from the World Health Organization, Guinea’s Ministry of Health, Public Health England, and other international partners — have unveiled <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32621-6/fulltext">their final results</a> in the<em> Lancet</em><em>,</em> and they’re just as remarkable. The vaccine was tested in a trial involving nearly 12,000 people in Guinea and Sierra Leone during 2015 and 2016. Among the 5,837 people who got the vaccine, no Ebola cases were recorded. By comparison, there were 23 Ebola cases in the control group that had not gotten the vaccine.</p>
<p id="IrpMne">"This trial, confirming the 100 percent efficacy of the rVSV Ebola vaccine, is a simply remarkable outcome," Dr. Jeremy Farrar, the director of the Wellcome Trust, said of the research. "We’ve shown that by working collaboratively, across international borders and sectors, we can develop and test vaccines rapidly and use them to help bring epidemics to an end."</p>
<p id="FIgpqi">One of the most fascinating things about the vaccine — beyond its apparent safety and effectiveness — is how the researchers studied it.</p>
<p id="koaFe8">When they launched the trial in 2015, the number of Ebola cases in Guinea had already declined, and there were too few cases to run a meaningful traditional randomized study (giving the vaccine to a randomly selected group and comparing it with a control group that doesn’t get the vaccine). So the researchers had to be creative. They decided to try something called "ring vaccination," a public health method used to eradicate smallpox in the 1970s. It involves immunizing the immediate contacts — friends, family, housemates, neighbors — of a person who falls ill with a virus to create a protective ring around them to stop transmission.</p>
<p id="WtduyQ">As soon as a new Ebola case was diagnosed, the researchers traced all their contacts for a total of 117 clusters (or "rings"), each made up of about 80 people. They then randomized the rings of people to get the vaccine either right after their friend or family member had been diagnosed or after a three-week delay.</p>
<p id="4KBNL7">Their preliminary results were so positive that the researchers changed the trial design so that everyone got the vaccine immediately, including children. A little more than half of those vaccinated (3,149 people) reported at least one side effect, but they were mostly mild (headache, fatigue, and muscle pain). Eighty serious adverse events were reported, but only two (a fever and an allergic reaction) were deemed to be related to the vaccine. "Adverse events data indicated no safety concerns in adults or children," the researchers concluded.</p>
<p id="sqpXV0">These results build on studies in non-human primates, which showed the vaccine was safe and completely protected them from Ebola.</p>
<p id="fIKa2s">Researchers are calling this development one of the only positive outcomes of the 2014-2016 Ebola epidemic — the largest the world had ever seen.</p>
<p id="r8RLYt">"The Ebola vaccine studies during the Ebola outbreak were one of the few successes of the collective international response," said John-Arne Røttingen, director of the division of infectious disease control at the Norwegian Institute of Public Heath, who worked on the study. "The world managed to plan and conduct more than 15 clinical trials in less than an year. And this ring vaccination trial, with its innovative research design, managed to demonstrate efficacy for one of the vaccines."</p>
<p id="m0LNGv">The vaccine was discovered by the Public Health Agency of Canada and is now under development by the drug company Merck. For now, Merck is doing additional safety studies on children and other vulnerable populations and will be seeking approval from a regulator like the US Food and Drug Administration by the end of next year. In case of an emergency, the company has committed to ensuring that 300,000 doses of the vaccine are available, so the vaccine won’t hit the market just yet.</p>
<p id="R3WnBJ">And questions about the vaccine’s long-term effectiveness remain. "One question that has not been adequately addressed, even in nonclinical studies with any Ebola virus vaccine, is with regard to durability — is the vaccine long-lasting?" wrote <a href="https://microbiology.utmb.edu/faculty/geisbert.asp">Thomas Geisbert</a>, an Ebola virus and vaccine expert from the University of Texas Medical Branch in Galveston, in an accompanying editorial. "Is it still protective, for example, 2–3 years after the vaccination?" Geisbert also wonders about whether the vaccine can be tweaked so that there are fewer side effects.</p>
<p id="YiqExF">There’s also the question of how to speed up the development of vaccines for deadly viruses like Ebola, which may seem like distant threats — until it’s too late. The virus was discovered in 1976 but mainly affected people in Africa until the 2014 outbreak in West Africa, which affected more than 28,000 people and killed more than 11,000. The <a href="http://www.vox.com/2014/8/4/5963751/the-real-cause-of-the-ebola-outbreak-its-not-what-you-think">Department of Defense</a> and other funders only started to pour money into Ebola vaccine development when the virus was deemed a biological weapon after the 9/11 terrorist attacks.</p>
<p id="ES8XuB">"Had a vaccine been available earlier in the Ebola epidemic, thousands of lives might have been saved," Farrar added. "We have to get ahead of the curve and make promising diagnostics, drugs, and vaccines for diseases we know could be a threat in the future." Farrar hopes this success story will inspire stakeholders to prepare for future potential epidemics — an important message at a time when the <a href="http://www.vox.com/2016/5/31/11638796/why-there-are-more-infectious-disease-outbreaks">likelihood of</a> global outbreaks is only accelerating.</p>
https://www.vox.com/science-and-health/2016/12/22/14039628/rvsv-zebov-ebola-vaccine-trial-effectiveJulia Belluz2015-05-22T03:00:02-04:002015-05-22T03:00:02-04:00When disasters like Ebola hit, the world turns to the WHO. And it’s failing.
<figure>
<img alt="Medical staff remove the corpse of an Ebola victim from a house in Monrovia, Liberia." src="https://cdn.vox-cdn.com/thumbor/DeIp0kuNNzSUd0pcuZI1FIqckJI=/0x0:1800x1350/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/46374870/456344070.0.0.0.jpg" />
<figcaption>Medical staff remove the corpse of an Ebola victim from a house in Monrovia, Liberia. | (Photo by Pascal Guyot/AFP)</figcaption>
</figure>
<p dir="ltr"><span>This week, an annual meeting of the world's most powerful global health players is taking place in Geneva. It's called the</span><a href="http://www.who.int/mediacentre/events/governance/wha/en/"> World Health Assembly</a><span>, and ministers of health, heads of state, and civil society leaders are gathered at the United Nations' </span>Palace of Nations t<span>o set health priorities and policies for the entire world.</span></p>
<p dir="ltr">At the moment, they're focused on whether we're prepared for future deadly disease outbreaks — a question that's particularly urgent in the wake of the <a href="http://www.vox.com/cards/ebola-facts-you-need-to-know">Ebola epidemic</a> in West Africa. More than a year and 25,000 cases later, it's clear the World Health Organization and the countries involved weren't ready for that crisis. The world took too long to act, leading to avoidable suffering and long-term devastation.</p>
<p dir="ltr">The Ebola outbreak should have been predictable — in the sense that we know the next outbreak is always around the corner. Yet as <a href="http://www.who.int/dg/en/">Dr. Margaret Chan</a>, the WHO boss, said in her<a href="http://www.who.int/csr/disease/ebola/joint-statement-ebola/en/"> opening remarks</a> this week, "The Ebola outbreak shook this organization to its core."</p>
<p dir="ltr"><span>It wasn't just Ebola. We know the WHO has done a less than stellar job at </span><a style="font-size: 19.5px; line-height: 32.1749992370606px; background-color: #ffffff;" href="http://www.vox.com/2014/9/30/6843117/slow-ebola-virus-epidemic-response-WHO-after-brantly-Americans-infected" target="_blank">responding to outbreaks</a><span> in the past. </span><span>The organization was set up in 1948 with the ambitious mission of rallying countries around health problems. It's </span>supposed to be the key player for health around the world. But the organization has been struggling of late as it loses funding and influence relative to other disease-focused groups (like UNAIDS, which was set up in the wake of the WHO's failure to deal with the HIV crisis) and public-private health partnerships (like <a href="http://www.gavi.org/">Gavi</a>, which is <span>focused on financing vaccines)</span>. <br><br>In theory, the WHO still has a crucial role to play in responding to deadly disease epidemics; it's the only global body that can declare a pandemic and mobilize internationally in the face of health threats such as Ebola. But to do so, it will have to change radically.</p>
<h3><span>Why the WHO is struggling to respond to deadly outbreaks</span></h3>
<p dir="ltr"><span> <figure class="e-image">
<img alt=" " data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/3R0VFaklgD-AE0TsGOknI7FubTY=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/3705150/global%20health%20funding.jpg">
</figure>
</span><span></span></p>
<figcaption style="font-size: 13.5px; line-height: 17.1818180084229px; margin: 0px; color: #6f96a8; background-color: #f1f3f2;">
<p style="margin-bottom: 0px; font-size: 1em; line-height: inherit;">Development assistance for health 1990 to 2013. You can see WHO's relative influence in the global health landscape shrink over the past two decades. (<a sl-processed="1" target="_blank" href="http://www.healthdata.org/sites/default/files/files/policy_report/2014/FGH2013/IHME_FGH2013_Full_Report.pdf">IHME</a>)</p>
</figcaption>
<p dir="ltr"><br>Some of the most detailed explanations for why the WHO struggled to act on Ebola can be found in<a href="http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_25-en.pdf"> this interim Ebola response assessment</a>, released this month from an independent panel of experts convened by WHO's director general. The panel makes clear that the problem with the Ebola response actually mirrors problems with the WHO itself — how it's funded and organized.</p>
<p dir="ltr">Take the organization's financing. The WHO is supported by its 196 member states, each of which pay in for membership and gain a seat at the decision-making table. This structure is part of what makes the WHO special: every country has a seat, no matter how rich or poor.</p>
<p dir="ltr">Yet only one-quarter of the WHO's funding comes from these membership dues. That means the other 75 percent is voluntary, from wealthy countries and contributions of other players, most prominently the <a href="http://www.gatesfoundation.org/">Bill and Melinda Gates Foundation</a>. Essentially, the organization relies on donors to come forward and fund the bulk of its budget and projects.</p>
<p dir="ltr"><span>And that's created problems. </span>When pandemic threats emerge, the organization scrambles, waiting for the money to trickle in from donors before action can be taken. "That's not the way to run an agency," said <a href="http://www.hsph.harvard.edu/deans-office/julio-frenk-dean/">Dr. Julio Frenk</a>, dean of the Harvard T.H. Chan School of Public Health. "WHO should be seen as the instrument for member states to exercise their collective action in the face of common threats and to realize common opportunities."</p>
<p dir="ltr"><span>The WHO's culture is also problematic. The organization favors hiring health professionals over other types of skilled labor. As this </span><a href="http://www.publichealthjrnl.com/article/S0033-3506(13)00291-6/pdf">2014 study </a><span>points out: "While an impressive 43.8% of WHO's professional staff are medical specialists, only 0.1% are economists and only 1.4% and 1.6% are lawyers and social scientists, respectively." That makes the WHO a valuable source of health knowledge, but it can be an obstacle when it comes to navigating the informal rules of international diplomacy to get things done in an emergency. </span></p>
<p dir="ltr"><span>Meanwhile, critics have pointed out that the WHO suffers from a bit of an identity crisis. While it considers itself a technical body that provides expert advice, it's also a political body that works with world governments and helps coordinate other global health actors. And, at times,</span><span> </span><a href="http://www.publichealthjrnl.com/article/S0033-3506(13)00291-6/pdf">politics can trump scientific expertise</a>. T<span>he WHO took months to call the Ebola a public health emergency of international concern in part due to political wrangling. </span></p>
<h3 dir="ltr">There are plenty of ideas for fixing the WHO...</h3>
<p dir="ltr"> <figure class="e-image">
<img alt="ebola" data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/jZ79M6msFP8MET_n3rNqYsHlUF8=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/3718670/EbolaVsMediaInterest-1.0.0.jpg">
</figure>
</p>
<p>At this year's World Health Assembly, there's been lots of talk of learning the lessons of Ebola to fix the WHO. One idea that's been bandied about involves increasing the WHO's mandatory membership payments from countries. These payments have been frozen since the 1990s, not even fully keeping in step with inflation.</p>
<p dir="ltr">There's also talk of creating a well-funded emergency response unit within the WHO that would be ready to act when another outbreak sparks. Many attendees here in Geneva have pointed out that we have a humanitarian system that can kick into action in the face of natural disasters like the recent earthquake in Nepal, but no similar system for health emergencies.</p>
<p dir="ltr">Meanwhile, experts have wondered whether innovative insurance mechanisms could help countries respond more quickly to outbreaks. Right now, many countries have incentive to cover up diseases early on — for fear that announcing a health emergency would lead to trade or travel restrictions. So a special insurance program for countries to help compensate them for these losses might make them more willing to come clean about outbreaks. The problem? This sort of scheme could easily be abused.</p>
<p dir="ltr"><span>The challenge is that any of these changes would require an overhaul to the structure of the WHO, or at least to the way in which it has always worked. And sweeping changes may be tough to make, especially now that the Ebola threat is fading. </span></p>
<p dir="ltr">"Once the media stops talking about pandemics, the pressure on politicians to do something goes down, and we forget until the next pandemic," says Harvard's Julio Frenk. "That's exactly what happened after H1N1 in 2009." Frenk knows: he was Mexico's minister of health from 2000 to 2006, and in the middle of his term he led that country's response to the global SARS pandemic.</p>
<p dir="ltr"><span>This helps explain why in Geneva, along with the urgency around Ebola, there's also a distinctive lack of confidence that anything will actually change this year. As a </span><span>senior member of the US delegation here</span><span> told Vox, "Are we sure [the WHO] can do better next time? No."</span></p>
<h3 dir="ltr">Why the WHO is still crucial to public health</h3>
<p dir="ltr">What's clear is that the WHO in its current form isn't set up to act fast in the face of a health emergency. And yet, as that same US official said, "The WHO fills a function no one else can."</p>
<p dir="ltr">The WHO is the guardian of global public health. It's the one international authority that can enact quarantines, declare pandemics, and coordinate disease responses. It remains the body the world looks to in times of health crisis. However imperfect the WHO may be, there is simply no other body that gives all countries an equal place at the table to rally around health.</p>
<p dir="ltr">Ebola will not be the last global<a href="http://en.wikipedia.org/wiki/List_of_epidemics"> epidemic</a> the world faces. MERS, leishmaniasis, and plague are just a few possibilities on the horizon.</p>
<p dir="ltr">That's why everyone in Geneva seems to want to see a stronger WHO. As another delegate noted, creating a new organization from scratch would simply be too difficult, and it's not clear it wouldn't suffer from the same challenges the WHO faces.</p>
<p dir="ltr">"What people realized this time with Ebola is that people do want the WHO," said Barbara Stocking, who led the independent review of the Ebola response. "It can't be dissipated. It [would be] bad for all of us in the world."</p>
https://www.vox.com/2015/5/22/8640607/ebola-WHO-reformJulia BelluzSteven Hoffman2015-05-18T13:20:02-04:002015-05-18T13:20:02-04:00One chart that explains why the WHO is actually in crisis
<figure>
<img alt="WHO Director General Margaret Chan." src="https://cdn.vox-cdn.com/thumbor/K2qEvYkvmgvKtHuNyhEnnWRHEo8=/0x750:2000x2250/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/46352018/GettyImages-456089036.0.jpg" />
<figcaption>WHO Director General Margaret Chan. | Andrew Burton/Getty Images</figcaption>
</figure>
<p id="5ue0wQ">Throughout the recent <a href="http://www.vox.com/cards/ebola-facts-you-need-to-know/what-is-the-ebola-virus">Ebola outbreak</a>, the World Health Organization has been <a href="http://edition.cnn.com/2014/10/18/world/who-ebola-response/">universally</a> <a href="http://www.slate.com/blogs/the_world_/2014/10/22/who_ebola_response_the_politics_and_economics_of_why_the_organization_was.html">admonished</a> for being too slow to respond to the crisis. And one of the key <a href="http://www.washingtonpost.com/news/morning-mix/wp/2014/09/16/why-the-who-has-failed-to-stop-the-ebola-outbreak/">reasons cited</a> for the delay is that the WHO is underfunded, understaffed, and underpowered.</p>
<p id="lQDubA">But as this chart from the <a href="http://www.healthdata.org/">Institute for Health Metrics and Evaluation</a><strong> </strong>shows, that's only part of the story. Though funding for the WHO has leveled off in recent years, that only came after more than 20 years of massive increases. Overall funding for development assistance for health also increased dramatically in the period.</p>
<figure class="e-image">
<img alt=" " data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/3R0VFaklgD-AE0TsGOknI7FubTY=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/3705150/global%20health%20funding.jpg">
<figcaption><p>Development assistance for health 1990 to 2013. (<a href="http://www.healthdata.org/sites/default/files/files/policy_report/2014/FGH2013/IHME_FGH2013_Full_Report.pdf" target="_blank">IHME</a>)</p></figcaption>
</figure>
<p id="1LnCJB">What changed, however, is the WHO's relative influence in the global health landscape. The organization's slice of the funding pie has been dramatically reduced over the past two decades — while other health organizations and bodies showed up on the scene and grew.</p>
<p id="sWmRRM">As the chart shows, in the 1990s the WHO (in dark blue) was one of only a few key players in global health, alongside organizations like the World Bank and other health-related UN organizations.</p>
<p id="fn3ZLg">Since then, American NGOs (the largest green slice) like the <a href="http://www.gatesfoundation.org/">Gates Foundation</a><strong> </strong>have stepped in. So have public-private partnerships (represented in purple on the chart) such as the <a href="http://www.gavi.org/">Gavi Alliance</a> (focused on expanding access to vaccines) and the <a href="http://www.theglobalfund.org/en/">Global Fund</a> (which finances treatment and prevention for infectious diseases like HIV/AIDs, TB, and malaria).</p>
<p id="38QDQl"><q aria-hidden="true" class="right">This increase from other players shifted the balance of power away from the WHO</q></p>
<p id="BSfx4D">The world's wealthiest nations — the US and UK (the "bilateral agencies" in red and pink hues) — have also prioritized funding for global health through their government agencies and departments.<br><br>This increase from other players shifted the balance of power away from the WHO — the only global health organization when it was founded 70 years ago. And in a world where the key players in global health are rapidly changing, the WHO's role in this new landscape is less clear.</p>
<p id="Wc8N9K">That's not to say the WHO isn't still hugely important. It has a monopoly on legitimacy, and is the normative body when it comes to health. That monopoly, for right now at least, just isn't being backed by dollar figures, and the organization is trying to find its way. Yet, as public expectations of the organization during the Ebola epidemic made clear, it's still the body the world looks to in times of global health crisis.</p>
<p id="1AC18H">That disconnect between perception and reality is something the organization is now grappling with.</p>
<p id="yjyLt5">Dr. Margaret Chan, WHO director general, <a href="http://www.who.int/dg/speeches/2015/68th-wha/en/">explained in an address at the World Health Assembly today </a>that the arrival of Ebola forced the conversation about internal reform and the organization's role in the world.</p>
<p id="RfjdOa">"The Ebola outbreak shook this organization to its core," she said. "This was a defining moment for the work of WHO and an historic political moment for world leaders to give WHO new relevance and empower it to lead in global health." Whether the organization remains the leader in global health — with Gates and other players rising — remains to be seen.</p>
<p id="HK2Im4"><strong>WATCH: Keeping Ebola in perspective</strong></p>
<div id="TV4dPn">
<div data-analytics-viewport="video" data-analytics-action="volume:view:article:middle" data-analytics-label="This Ebola outbreak is the worst we've seen|365" data-volume-uuid="f37973ffa" data-volume-id="365" data-analytics-placement="article:middle" data-volume-placement="article" data-volume-autoplay="false" id="volume-placement-903" class="volume-video"></div>
</div>
https://www.vox.com/2015/5/18/8621129/who-reform-ebolaJulia Belluz2015-05-12T07:20:01-04:002015-05-12T07:20:01-04:00Reporters got a lot wrong covering Ebola. We should do better next time.
<figure>
<img alt="A Liberian health worker speaks with families in a classroom now used as Ebola isolation ward on August 15, 2014, in Monrovia, Liberia." src="https://cdn.vox-cdn.com/thumbor/OWdMeQH1gr4d3L-a4zlNt8oOXOA=/0x1:700x526/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/46314452/453646210.0.0.0.jpg" />
<figcaption>A Liberian health worker speaks with families in a classroom now used as Ebola isolation ward on August 15, 2014, in Monrovia, Liberia. | John Moore Getty Images News</figcaption>
</figure>
<p>We journalists often rush from one story to the next with whiplash-inducing speed — and sometimes without time to reflect. On Monday, however, a few of us paused. Just as Liberia was finally <a href="http://www.nature.com/news/liberia-is-declared-ebola-free-1.17513">declared Ebola-free</a>, I appeared on a panel organized by the <a target="_blank" href="http://www.one.org/us/">One Campaign</a> alongside colleagues from NPR, the Washington Post, Ebola Deeply, and the Centers for Disease Control and Prevention. Together, we looked back at how the media dealt with the epidemic. What could we have done better? What lessons did we learn? What were we most proud of? And where did our coverage go off the rails?</p>
<p>Since this outbreak won't be the last — and we can and should do a better job reporting on the next one — I wanted to share some thoughts.</p>
<h3>1) The low point of the media's Ebola frenzy</h3>
<p> <figure class="e-image">
<img alt="kaci" data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/gsoisru4zc8I-S9E6rZ-KyFwa70=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/3687926/458186348.0.0.jpg">
</figure>
</p>
<p class="caption">Kaci Hickox at her home in Maine. (Spencer Platt/Getty Images News)</p>
<p>When reflecting on the low point in coverage during this crisis, <a href="https://twitter.com/lara">Lara Setrakian</a>, founder of <a href="http://www.eboladeeply.org/">Ebola Deeply</a>, remarked that for her it probably came last summer: she was visiting Asia and saw 24/7 news footage of ambulances bringing American Ebola victims to US hospitals for treatment. She compared this to the now-iconic police chase involving <a href="http://www.latimes.com/local/lanow/la-me-ln-oj-simpson-white-bronco-chase-20140617-story.html">OJ Simpson</a>'s white Ford Bronco in 1994, except this time, the people in the vehicles — even more absurdly — were disease victims.</p>
<p>Of course, there were other cringe-worthy moments during the crisis. Last fall, when Ebola health workers <a href="http://www.vox.com/2014/10/30/7133511/just-let-kaci-hickox-have-a-pizza">Kaci Hickox</a> and <a href="http://www.vox.com/2014/10/24/7057535/the-new-york-ebola-patient-is-a-brave-and-heroic-doctor-stop">Craig Spencer</a> returned to the US after serving in West Africa, they were treated like social pariahs. Spencer fell ill with the disease, sparking panic in Manhattan, but even though Hickox had no sign of illness, she was put under a mandatory quarantine. A lot of the media coverage fed into the public fear and political fight over <a href="http://www.vox.com/2014/10/18/6994413/research-travel-bans-ebola-virus-outbreak" target="_blank">travel bans</a> by, for instance, tracing <a href="http://www.vox.com/2014/10/24/7057535/the-new-york-ebola-patient-is-a-brave-and-heroic-doctor-stop">Dr. Spencer's steps through Manhattan</a> or encircling <a href="http://www.vox.com/2014/10/30/7133511/just-let-kaci-hickox-have-a-pizza">Hickox's home</a>, wondering if she should be allowed to receive a pizza delivery.</p>
<p>While these journalistic nadirs were embarrassing, there was something much more dangerous going on: all of these stories took attention away from coverage at the epicenter of the outbreak in West Africa. They were distracting. They were frivolous. And, worst of all, they <a href="http://www.vox.com/2014/10/24/7057535/the-new-york-ebola-patient-is-a-brave-and-heroic-doctor-stop" target="_blank">denigrated and discouraged</a> the very people we should have been celebrating.</p>
<h3>2) The problem of portraying scientific uncertainty</h3>
<p> <figure class="e-image">
<img alt="Ebola virus" data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/UadqfOuD4mxSwegYR2DELl19jR0=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/2396094/453210018.0.jpg">
</figure>
</p>
<p class="caption">The now very recognizable image of the Ebola virus. (CDC/Getty Images)</p>
<p>One of the greatest challenges while covering the science of Ebola was trying to communicate uncertainty about the virus without freaking people out.</p>
<p>There is a lot we know about the Ebola virus and how it's transmitted. After all, it was discovered in 1976. But it's still a relatively rare disease, and until last year, had killed <a href="http://www.vox.com/cards/ebola-facts-you-need-to-know/what-is-the-ebola-virus" target="_blank">a total of about 1,500 people.</a> So there is a lot we're learning about the virus, such as how it <a href="http://www.nytimes.com/2015/05/08/health/weeks-after-his-recovery-ebola-lurked-in-a-doctors-eye.html?_r=0" target="_blank">affects survivors</a> in the long term, or how it mutates when it infects tens of thousands of people as it did over the last year. <br><br>Some reporters did an excellent job of conveying these uncertainties while being careful not to induce panic. <a href="http://www.washingtonpost.com/national/health-science/how-the-microscopic-ebola-virus-kills-thousands/2014/10/18/6e21bdec-561b-11e4-809b-8cc0a295c773_story.html">This piece</a> from Joel Achenbach and Brady Dennis at the Washington Post was masterful, as was <a target="_blank" href="http://www.thefreepress.ca/national/287297971.html?mobile=true">this one</a> from Helen Branswell at the Canadian Press.</p>
<p>Many of us were learning about Ebola on the fly, and we couldn't always get a hold of the then over-taxed experts in this rare disease. As Jana Telfer, associate director for communication for science at the CDC, noted during the panel, prior to this outbreak her agency had very few Ebola specialists and a rather limited knowledge of a disease that wasn't a priority in America.<br><br>Many of us also wanted to calm the public, and maybe we were afraid of creating space for fear by talking about unknowns — particularly amid <a href="http://www.vox.com/2014/9/19/6543157/ebola-is-unlikely-to-go-airborne" target="_blank">frightening rumors</a> that Ebola could go airborne. <br><br>Even so, the lesson here, perhaps, is that it's important to communicate that science is an iterative process — that it's <a target="_blank" href="http://www.vox.com/2015/5/13/8591837/how-science-is-broken">proximate by nature and not a collection of immutable facts</a>. It may be even more important to underscore that fact during panicked times, instead of creating a false sense of certainty that may later backfire.</p>
<h3>3) Viruses live in people and communities</h3>
<p> <figure class="e-image">
<img alt="ebola" data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/z0EshcMoRWBMuX1CrqSodbXw2SQ=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/3688724/453646640.0.0.jpg">
</figure>
</p>
<p class="caption">A mother and child in a classroom now used as an Ebola isolation ward in Monrovia. (John Moore/Getty)</p>
<p>All the reporters on the panel seemed to derive the most satisfaction from covering the stories of people whose lives were changed by this virus. These were also the stories, we felt, that most resonated and moved readers. But if you looked at the early media coverage, it could sometimes be read as dehumanizing — a collection of data and statistics about cases and deaths, a virus moving around the world separate from actual people.</p>
<p>There were other ethical questions about the coverage. The CDC's Telfer noted that many reporters working in West Africa disclosed patients' names and took pictures of them in a way they would generally never do while covering disease victims in America.<br><br>The challenge of being respectful, compassionate, and not exploitative while reporting was one we all felt.<br><br>To address that very issue at Vox, we launched this set of <a href="http://www.vox.com/a/living-through-ebola">oral histories of Ebola</a>. Many other news outlets had their own incredible — and very human pieces — such as this wonderful <a href="http://apps.npr.org/life-after-death/">interactive project</a> from NPR and the <a href="http://lens.blogs.nytimes.com/2015/04/20/daniel-berehulak-the-ebola-crisis-earn-photography-pulitzer/?_r=0">award-winning coverage</a> from the New York Times.</p>
<p>But I think we were mostly rather late to these projects: many launched in the late summer or fall, already halfway through the outbreak. So the lesson here is that we need to put people first from the beginning — and do so with empathy and respect.</p>
<h3>4) When health stories lack context, they do our readers and subjects a disservice</h3>
<p> <figure class="e-image">
<img alt="ebola" data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/IZ_sSzpj6pWDhs4O1123p8CkSaY=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/3688734/453480820.0.0.jpg">
</figure>
</p>
<p class="caption">(Sean Gallup/Getty Images News)</p>
<p>Some of the worst reporting came when we forgot to give readers context. For example, we covered the fight to get ZMapp, the experimental Ebola treatment — or <a href="http://www.cnn.com/videos/world/2014/08/04/newday-intv-gupta-ebola-secret-serum.cnn">"secret serum,"</a> as it was called in the early days of the outbreak — to patients rather than looking at the fact that strengthening <a href="http://apps.npr.org/life-after-death/">health systems</a> would sustain many more lives.</p>
<p>Other times, we exoticized the subjects in our stories, focusing on their supposed penchant for "bush meat" or their strange religious rituals — instead of covering them, as NPR's <a href="http://www.npr.org/people/365257508/nurith-aizenman">Nurith Aizenman</a> noted, just as they are: people like you and me.</p>
<p>Again, the lack of context diverted attention from the actual causes of the pandemic, and it had an othering effect on Ebola's victims.</p>
<h3>5) Calming people down can be difficult — but not impossible</h3>
<p><a target="_blank" href="http://www.washingtonpost.com/people/lenny-bernstein"> <figure class="e-image">
<img alt="ebola" data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/fwbxvbEH8KYG7OIHAzNLIeGCjNQ=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/3688728/doyouhaveebola_revised.0.0.0.png">
</figure>
</a></p>
<p>Lenny Bernstein, one of the Washington Post's intrepid health correspondents, noted that one of the reasons his newsroom was a little delayed in diving deeply into Ebola reporting was because of fear of the virus: people with children, for example, were hesitant about going to West Africa, should they get sick or need to be quarantined for a long period. So even the most educated — and, perhaps, audacious — among us were infected with fear and panic.</p>
<p>While many of us — myself included — covered the absurdity of the panic over a virus that's actually quite difficult to catch, we sometimes failed to fully think through <i>why</i> people were feeling this way.</p>
<p>Why did this particular virus invoke such fear? Why were airplane passengers in a panic? Answering these questions might have gone a long way in calming people, ourselves included. As the CDC's Telfer pointed out, you need to meet peoples' emotions with emotions — and you can't do that unless you first acknowledge how they feel.</p>
<p><i>Correction: An earlier version of this post misstated the year of the O.J. Simpson car chase. </i></p>
https://www.vox.com/2015/5/12/8587843/ebola-reporting-lessonsJulia Belluz2015-04-28T17:16:00-04:002015-04-28T17:16:00-04:00The tragic love story of America's first Ebola patient
<figure>
<img alt="" src="https://cdn.vox-cdn.com/thumbor/GkkcdB-gtfhkpDRiDw8-VwLVF-U=/99x0:1179x810/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/46225482/456806986.0.0.0.0.jpg" />
</figure>
<p>A lot of <a href="http://www.vox.com/cards/ebola-facts-you-need-to-know/what-is-the-ebola-virus">Ebola</a> reporting, especially in the early days of the recent outbreak, focused on cold body-count calculations and faceless victims, as if the virus wasn't moving through individual people and their families. This couldn't be truer than for the panicked coverage of the first Ebola victim in the US, Thomas Eric Duncan. Last September, the Liberian national flew to Dallas and soon discovered he was sick with the <span class="st">hemorrhagic</span> fever. <br><br>By September 30, 2014, the Centers for Disease Control and Prevention announced Duncan was the first patient diagnosed with Ebola in the US — sparking an <a target="_blank" href="http://www.nytimes.com/2014/10/14/opinion/roger-cohen-ebola-denial-fear-and-panic.html?_r=0">epidemic of fear</a>.</p>
<div class="align-right">
<p> <figure class="e-image">
<img alt="duncan" data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/yRrispGebOUUpO0fGMMVPOueRyM=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/3650170/AP779034289650.0.0.jpg">
</figure>
</p>
<p class="caption">The photo of Thomas Eric Duncan that was widely circulated during his illness. (Wilmot Chayee, AP)</p>
</div>
<p>Duncan died nine days later. At the time, what the public knew about him mostly focused on how he contracted the virus, whom he may have infected, whether his case would spark an outbreak (it didn't), and that he was America's first Ebola diagnosis and death. <br><br>What we didn't hear about, however, was the tragic love story behind his visit to America: Duncan was here to meet with Louise Troh, a Dallas nurse, his longtime love, and the mother of one of his children, a 13-year-old son named Karsiah. The couple had been planning for Duncan to come to the US since 2013, but it took months for them to secure a visa and raise enough funds for his first trip here.</p>
<p>In a new memoir, <a href="http://www.amazon.com/My-Spirit-Took-You-In/dp/1602862893"><i>My Spirit Took You In</i></a><i>, </i>Troh writes a personal tale of immigrating from Liberia to the US, leaving Duncan behind in Liberia, how Ebola eventually tore them apart after their brief reunion, and the quarantines and media circus that ensued.</p>
<p>In a <a href="http://www.vanityfair.com/culture/2015/04/my-spirit-took-you-in-louise-troh-excerpt">Vanity Fair</a> excerpt, Troh recounts seeing Duncan in Texas for the first time last September:</p>
<blockquote>
<p>He hugged me. When I sat down he sat next to me, put his arms around me, and pulled me close to him. It felt so strange to be with him at last. I knew him from so much talking on the phone, and the sharing of so many dreams. I hid Eric’s love at the center of my life for many years. For so many years, he was only a voice talking from so far away, many times talking about how fine our son was becoming ...</p>
<p>On his way to Dallas — and to me — Eric called from each airport where he landed on his journey. In Liberia as he was about to leave, he rang to say, "I am on my way at last, sweetheart."</p>
</blockquote>
<p>You can read the rest of the excerpt here in <a href="http://www.vanityfair.com/culture/2015/04/my-spirit-took-you-in-louise-troh-excerpt">Vanity Fair</a>.</p>
<p><b>Read more:</b><span> </span><a href="http://www.vox.com/a/living-through-ebola" target="new" style="font-family: 'Alright Sans', sans-serif; font-size: 1.15em; line-height: 1.65; background-color: #ffffff;">Living through Ebola — stories from the people who are witnessing the virus firsthand</a></p>
<p><a href="http://www.vox.com/cards/ebola-facts-you-need-to-know/what-is-the-ebola-virus" target="new">13 things you need to know about Ebola</a></p>
https://www.vox.com/2015/4/28/8507727/duncan-ebola-memoirJulia Belluz2015-04-13T12:10:01-04:002015-04-13T12:10:01-04:009 of the 11 Ebola treatment centers built by the US have never seen an Ebola patient
<figure>
<img alt="A holding center for suspected Ebola patients in Liberia. " src="https://cdn.vox-cdn.com/thumbor/P8phkDHnFjYLzlf0UhPWLZ78EH0=/0x12:4868x3663/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/46110350/456595082.0.0.jpg" />
<figcaption>A holding center for suspected Ebola patients in Liberia. | John Moore Getty Images News</figcaption>
</figure>
<p>A must-read roundup<b> </b>by Norimitsu Onishi in the <a href="http://www.nytimes.com/2015/04/12/world/africa/idle-ebola-clinics-in-liberia-are-seen-as-misstep-in-us-relief-effort.html?_r=0">New York Times</a> on the impact of the American Ebola response included a fact that perfectly sums up the wrongness of our approach to global health:</p>
<blockquote>
<p>"Only 28 Ebola patients have been treated at the 11 treatment units built by the United States military, American officials now say. Nine centers have never had a single Ebola patient."</p>
</blockquote>
<p>So: the United States built 11 treatment units in Liberia, drawing from the $1.4 billion allotted for the Ebola mission. Eighty percent of those units have never seen a single Ebola patient.</p>
<p>This may seem shocking, but it actually shouldn't be.</p>
<p>The timelines of global health and short-term-ism of politics are usually not aligned. World leaders <i>react</i> to global health crises slowly (instead of taking a <i>proactive</i> approach), and they prioritize politically expedient (read: ineffective but sexy) fixes over real fixes.</p>
<p>If the world truly wanted to address Ebola and its root causes, the focus of the Ebola response should have been on things like training more health professionals, building up health systems and disease-surveillance networks in the country, and working with countries to prioritize health in their national budgets — all efforts that could take decades and wouldn't immediately produce results for bragging rights.</p>
<p>Many of the investments that would most help West Africa deal with diseases like Ebola wouldn't go to health care at all. They'd go to boosting education (the single biggest predictor of health) and literacy, and building infrastructure (so that people can get to hospitals and clinics when they need to).</p>
<p>These efforts are long-term, less tangible, and a lot more difficult to measure than passing out medicines or building treatment units. But they would undeniably save more lives and drastically improve health.</p>
<p>In an interview with Vox in March, former US Ebola Czar <a href="http://www.vox.com/2015/3/3/8134789/ebola-czar-ron-klain">Ron Klain</a> — who, incidentally, bragged about building those treatment units — also shared his very astute views on the wrongness of the current approach to global health crises and how it will eventually catch up to us:</p>
<blockquote>
<p>"This constant pattern of responding to these things after the fact is going to result in a disaster, a horrible disaster well beyond Ebola at some point in time in the future. There eventually will be a fast-spreading highly lethal flu that will get out of control and the world won’t have the time we had on Ebola to try to bring it back under control. We’re either going to get that message before it comes or learn after."</p>
</blockquote>
<p>This is something <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1502918">Bill Gates</a> and <a href="http://www.slate.com/articles/health_and_science/medical_examiner/2015/03/global_public_health_development_goals_paul_farmer_on_who_lives_and_who.html">Paul Farmer</a> — two of the biggest heavyweights in global health — have also echoed for years, long before the current epidemic. Now the world just needs to listen before the next one.</p>
https://www.vox.com/2015/4/13/8402613/Ebola-US-responseJulia Belluz