From Ebola to COVID-19 — the importance of trust in authorities and disease response

Stupefied. Admittedly so. That was the state of political punditry across the United States last week when former Vice President Joe Biden scored 10 Super Tuesday wins, propelling him to first place in the delegate count for the Democratic presidential nominee.

Joe Biden “shocks the world!” Unexpected! Unprecedented! Unparalleled! Historic! Joementum! The Thesaurus function for editors must have been on overdrive.

Since Tuesday, pollsters and campaign operatives have been crunching the numbers on demographics, trying to reckon with how a lack-luster campaign could rise like a Phoenix. But it’s not that complicated. It’s not about the campaign. It’s not even about Joe Biden. It’s about Donald Trump.

If you trust the polls, a clear majority of Americans do not support the current U.S. president, and for registered Democrats, it is with a raging fury. So as soon as Biden proved his viability in South Carolina, the electorate was drawn to him. It’s elementary human nature — when fear and hope fuse to propel behavior.

I saw this phenomenon play out in West Africa in August of 2014, at the height of the deadly Ebola virus outbreak, after the U.S. Centers for Disease Control (CDC) predicted a trajectory between 550,000 to 1.4 million cases by early the following year. And then — within just months — Liberia, the country hardest hit, was able to break the chain-of-transmission.

It started with an indignant declaration from then president Ellen Johnson Sirleaf when asked if she agreed with the CDC forecasts: “Absolutely not!” 

“I am waiting for the next projections, and I hope they will admit that they’ve just been simply wrong, that all of our countries are getting this thing under control,” Sirleaf said.

And with that avowal, coupled with a coordinated — albeit belated — national, regional and global effort, fear and hope merged: Behavior changed.

In May 2015, barely six months after the CDC’s grim prediction, Liberia was declared Ebola-free. While small clusters would continue to re-emerge for the next several months, the uncontrolled outbreak was over.

Like the Biden Super Tuesday win, it was equally unexpected, unprecedented, unparalleled and historic!

Notwithstanding its relative success, the toll on lives, livelihoods, the healthcare infrastructure and the economy was heavy: 28,600 cases and nearly 11,300 deaths were reported in Guinea, Liberia, and Sierra Leone with an additional 36 cases and 15 deaths outside the subregion, including seven in Nigeria and one in the United States.

But nothing like was predicted actually occurred, and the feared global pandemic was averted.

As America readies for its own battle with the Coronavirus Disease 2019 (COVID-19), with 430+ persons infected, and 15+ deaths, we can learn a lot from this small, post-conflict African country, despite the difference in the diseases, and the vast inequalities between the healthcare systems. 

“Nothing can substitute for political leadership in an outbreak response — But the political leadership needs to let the science and technical expertise rule,” Tolbert Nyenswah, the Incident Manager for Liberia who oversaw the multinational Ebola response team, told me in a recent interview. Nyenswah is now a senior research associate at Johns Hopkins Bloomberg School of Public Health.

He explained that while Johnson Sirleaf led the call for global resource mobilization — and travelled the country to enlist the population — it was the National Incident Management System (IMS) that had the authority for command and control. This allowed for an integrated rapid response to local disease clusters, in coordination with all partners — particularly so with the communities themselves.   

Even during the highly contested Senatorial elections, held at the height of the outbreak, Nyenswah explained that few dared to play politics with the healthcare emergency. The public would not tolerate it.

The second point that Nyenswah emphasized was the indispensable role of community engagement and community empowerment which allowed Liberians to break the disease transmission rate even before international support arrived in the fall of 2014. He suggested that the best-in-the-world disease response protocols would not have been effective unless they were locally owned and locally enforced.

Let’s remember that Ebola can fell the strongest and healthiest amongst us, and back then antiviral treatments and experimental vaccines were unavailable. As a result, two out of every three people who contracted the disease died.

Gyude Moore, a visiting fellow at the U.S. Center for Global Development (CGD), and former Minister of Public Works in the Johnson Sirleaf administration during the Ebola crisis, agrees with Nyenswah’s observation, but for him, Liberia’s success in eradicating the disease was grounded in something more fundamental — democratic values.

Moore said, “A democracy is based upon trust between government and the governed. And it is must be earned.” He explained that during the outbreak, the Sirleaf administration had to re-build trust, which had been eroded after early, and regrettable mistakes, including a forced quarantine of the most vulnerable. “It was critical that the communities felt empowered, and confident, that if they did their part, we would do ours.”

Moore’s point rang true to me watching the Democratic Republic of the Congo (DRC) close-out a nearly three-year Ebola outbreak, fueled — in large part — because of a complete breakdown of trust between the affected communities in the Eastern DRC and the central government.  

The same can be said of China and Iran.

China has struggled to contain the virus in no small part because of their sidelining of private charities, civic groups and other people-driven organizations whom the Communist Party considers rivals. Similarly, the Iranian government’s policies of regime preservation at-all-cost have bred deep distrust, sparked nation-wide protests, and triggered an uncontrollable spread of the virus, the second largest outside of China. 

In this context, how to do we create a phenomenon, where fear collides with hope to break the chain of transmission of COVID-19 in the U.S., and what can we learn from Liberia?

As with Biden’s Super Tuesday win, it’s not that complicated.

We remove the politics from the disease-response in the administration and Congress. We let the professionals direct the nation-wide mobilization. We give local healthcare providers what they need to do their jobs. And finally, we are transparent: We build trust and confidence, and let the American people do what they do best — hold their government and its institutions accountable.

K. Riva Levinson is president and CEO of KRL International LLC, a D.C.-based consultancy that works in the world’s emerging markets, award-winning author of “Choosing the Hero: My Improbable Journey and the Rise of Africa’s First Woman President” (Kiwai Media, June 2016). You can follow her @rivalevinson