Science advice during the Ebola outbreak
Reported by Victor Lovic, CSaP Policy Intern
The fifth season of CSaP’s Science & Policy Podcast is focussing on how science advice, data and evidence are used by decision-makers in government. The Centre’s Executive Director and Podcast Host - Dr Rob Doubleday – was joined by Sir Oliver Letwin, a former Cabinet Minister, Professor Melissa Leach, Director of the Institute of Development Studies at the University of Sussex, and Professor Dame Sally Davies, former Chief Medical Officer for England. All of them were involved in the science advice and decision-making process during the Ebola outbreak of 2014.
Listen back to the episode here:
The discussion began with Professor Leach providing some context and explaining what happened during the 2014 Ebola outbreak in West Africa. Ebola is an infectious disease with a high fatality rate, and in December 2013, a large outbreak occurred in Guinea. The World Health Organization (WHO) declared it a public health emergency of international concern in September 2014, by which time some epidemiological models were predicting millions of deaths. Sir Oliver Letwin said that he became aware of and concerned about the spread of Ebola though newspapers and media channels.
Professor Davies then explained about the Scientific Advisory Group for Emergencies (SAGE) which was called during the outbreak. The meetings are chaired by the Government Chief Scientific Adviser (GCSA), and the Chief Medical Officer (CMO) in cases when the emergency has a health component to it. She highlighted that relevant experts are then invited to the main committee, but SAGE also sets up sub-committees for further discussion and advice. Professor Leach joined the main committee and the Ebola Response Anthropology Platform that she co-founded with colleagues in Sierra Leone, and London became the social science sub-committee during the outbreak, bringing anthropological expertise and on-the ground knowledge of the culture, social, and political context in West Africa. She explained that initial health responses from governments and NGOs were being resisted by local populations: ditches were dug up on roadways to prevent access to villages. She said: “Patients were literally being stolen back out of hospital, because people were more frightened of the response, than the disease”. This underlines the importance of anthropology and social sciences in understanding how to tackle the Ebola outbreak, and more generally of integrating diverse disciplines and backgrounds to inform policymaking in emergencies.
“We knew that unless communities were to come onboard, that response would continue to fail, and that there was a role for anthropological science and understanding.” – Professor Melissa Leach
Letwin said that he did not actively receive information from SAGE meetings directly. Rather, Professor Dame Sally Davies and Sir Mark Walport acted as the intermediaries, summarising the detailed and disaggregated information produced by SAGE. Professor Davies further explained that the value provided by SAGE meetings was bringing together different perspectives and having a moderated debate between them. This develops understanding about the state of the evidence, so that they can then translate it for policy and decision-makers. She emphasised the particular importance of the perspective of the social sciences sub-committee during the Ebola outbreak. Professor Leach co-led this committee and saw her role as an intermediary, bringing in the insights generated by academics around the world, including on the ground in West Africa, and filtering them into the SAGE process.
Professor Leach described three particular innovations generated by the social science committee. First, was to establish and use small, community care centres, based on existing local facilities, rather than large hospitals and Ebola treatment centres. The idea was to make them more welcoming, and incentivise people to not hide Ebola cases, but instead to come forward. A second innovation related to burials: funerals were key events of increased transmission risk. The social science committee emphasised the importance of the co-generation of ideas for how funerals could be conducted that both respected social and cultural needs and norms, as well as minimising the risk of infection. Finally, the committee was able to aid in the development of accurate epidemiological models, by making model assumptions more realistic, using on-the-ground knowledge of how transmission was occurring.
“The big story from Ebola is that it was community learning and co-learning between frontline health workers and villagers that eventually bent the epidemic curve through bottom-up behaviour change.” – Professor Melissa Leach
Letwin said at the beginning of the UK’s response to the outbreak, he was very focussed on therapeutic solutions. He was surprised that in the end, sociological and public health efforts, as described by Professor Leach, turned out to be the primary means by which the outbreak was brought under control, although therapeutics did play a secondary role. One issue he identified is that Ebola was seen in the UK as something exotic and a problem in a faraway place.
Professor Davies concluded with the observation that the Ebola outbreak underlined the importance of strong public health institutions for dealing with health crises. She said Nigeria was able to cope with the Ebola outbreak much better than its West African neighbours, because of their public health infrastructure. Professor Leach agreed and said: “Preparedness for future pandemics has to be about strong and trusted health systems.”
Thumbnail Image Credit: Annie Spratt on Unsplash
Dame Sally Davies Image Credit: Bill Knight.