Homeland Security Watch

News and analysis of critical issues in homeland security

January 29, 2015

Epidemiology of violence

Filed under: Biosecurity,Public Health & Medical Care,Radicalization,Strategy,Terrorist Threats & Attacks — by Philip J. Palin on January 29, 2015

About this time last year I first heard about a few cases of Ebola in the Guinea Highlands.  It was, I thought , a bit strange.  A long way from the Congo River basin, with which Ebola is usually associated.

But I was busy finishing a big project.  Infectious disease is not my specialty. The occasional human contraction of Ebola has typically produced a rapid and effective professional response.  As previously outlined, I also missed some other important connections that could have enhanced my attention.

I was not alone.

Fast-forward to today.  According to the most recent WHO situation update, in mid-January, 148 new cases of Ebola have been confirmed in Guinea, Sierra Leone, and Liberia. Compared to August and September this is good news.  At any other time and at any other place, this level of Ebola transmission would be the epidemiological equivalent of a three alarm fire.

This is not a disease we want to treat as a chronic condition.  We ought not allow it to become endemic.  It is too deadly. The current transmission cycle must be fully, wholly stopped.  Then we must each and all do better with early identification and elimination of future animal-to-human and the first human-to-human transmissions.

This is the way with networks and we are — technically and socially — increasingly a networked world.

It would be easy to move to measles or seasonal influenza.  But I want to try a more audacious analogy.

Last week Secretary Kerry spoke to the World Economic Forum.  The whole speech was better than the sound-bites I had been fed.  Following is the whiff of epidemiology I noticed in his remarks.

We have to do more to avoid an endless cycle of violent extremism, a resupplying on a constant basis. We have to transform the very environment from which these movements emerge. And that’s why we are committed to enlarging our strategy in ways that respond effectively to the underlying causes, as well as the visible symptoms of violent extremism. That’s why we’re developing an approach that extends far beyond the short term, and which cannot be limited to the Middle East or to any other region.

We need – all of us – to take these steps so that a decade or two in the future, when the economic forum meets and you hear from leaders, they’re not standing up here responding to a new list of acronyms to the same concept, but different players. We cannot have our successors come back here to face the same questions and the same challenge. The terror groups may have those different acronyms in the future and they may be targeting different countries, but if we don’t do what is required now, then I guarantee you the fundamental conflict will either stay the same or get worse.

We were very late, nearly too late, in the West African Ebola outbreak.  Thousands have — potentially will — die needlessly.  My too-simple — but not necessarily inaccurate — analysis:  When the usual professional methods were distracted and delayed, the contagion multiplied reaching an extent beyond the capacity of professionals alone.

Sierra Leone applied significant command-and-control techniques.  In retrospect, these were entirely ineffective.  Liberia — more by accident than intention — came to depend on an extraordinary network of neighbors working with neighbors. Eventually this whole community approach was adopted in Sierra Leone as well. This mostly spontaneous bottom-up engagement became the essential foundation on which current containment was achieved.

Professionals have certainly been needed at every stage.  Coordination, collaboration, communication, and clinical care have been built upon the foundation.  Spontaneous beginnings have been systematically reinforced. But until the community — really multiple communities — mobilized the deadly disease was quickly spreading.

This is the way with networks.

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8 Comments »

Comment by William R. Cumming

January 29, 2015 @ 9:35 am

Of first importance about the WEF–China attended for the first time.

Second, Kerry gives some good speeches even as WHO remains underfunded and under supported politically by the US.

Comment by Donald Quixote

January 29, 2015 @ 11:36 am

So true and so important, but will there be tangible results or achievements from this most recent public health scare? The consequences of immediately ignoring the lessons learned and unaddressed vulnerabilities for governments and other bureaucratic organizations shall be little over time. The same lessons learned and areas for improvement were identified in 2003 (SARS), 2006 (H5N1), 2009 (H1N1) and numerous other times after significant public health incidents with very few sustained achievements for the future.

Will the over five billion dollars approved by Congress for the national and international Ebola response establish and enhance critical infrastructures and networks or only replenish the government coffers where funds were borrowed for the Ebola Black Swan?

I believe that James Taylor may have a song for this occasion.

Comment by Ben

January 29, 2015 @ 1:01 pm

“Liberia — more by accident than intention — came to depend on an extraordinary network of neighbors working with neighbors.”

. . .

So many governments (including my own) think that only they have the resources to solve problems, but forget that their citizens are frequently far more engaged in the situation on the ground, and better able to take action rapidly.

Pingback by Prepper News Watch for January 29, 2015 | The Preparedness Podcast

January 29, 2015 @ 2:13 pm

[…] Epidemiology of violence […]

Comment by Donald Quixote

January 29, 2015 @ 2:27 pm

A Few Recent Examples of Lessons Learned or Lost

WHO Draft Resolution:

Ebola: Ending the current outbreak, strengthening global preparedness and ensuring WHO capacity to prepare for and respond to future large-scale outbreaks and emergencies with health consequences

http://apps.who.int/gb/ebwha/pdf_files/EBSS3/EBSS3_CONF1Rev1-en.pdf

Ebola crisis: World ‘dangerously unprepared’ for future pandemics

The world is “dangerously unprepared” for future deadly pandemics like the Ebola outbreak in West Africa, the president of the World Bank has warned.

Jim Yong Kim, speaking in Washington, said it was vital that governments, corporations, aid agencies and insurance companies worked together to prepare for future outbreaks.

He said they needed to learn lessons from the Ebola crisis.

http://www.bbc.com/news/world-31013636

WHO executive board approves Ebola reform proposals

The World Health Organization’s (WHO’s) executive board yesterday unanimously approved proposals for improving its ability to handle global health emergencies, such as West Africa’s Ebola epidemic, which includes a contingency fund and reforms aimed at improving logistics and staffing.

http://www.cidrap.umn.edu/news-perspective/2015/01/who-executive-board-approves-ebola-reform-proposals

Comment by Tom Russo

January 30, 2015 @ 3:17 pm

The lessons learned for the nation with our Ebola “dust-up” is that it tested those billions spent on capabilities believed to be ready for an emerging infectious disease outbreak.

Well, the exercise showed that institutions trusted for response stumbled. State and federal executives under threat and public pressure, signed quarantine orders in conflict with CDC authorities. Hospital protocols for isolation and protection of healthcare workers were shown to be inadequate while isopods were rolled out and captured the nation’s attention showing symptomatic patients rolled from transport vehicles to Ebola approved healthcare facilities.

Simultaneously, the nation’s hospital systems spun up their dated infectious disease protocols developed during those pandemic preparedness grant days.

In my research in preparation to speak to a community group, I see where BARDA with CIADM are gearing up for production of Ebola vaccine by using cell-based technology. EVD is grown in tobacco plants versus eggs used in traditional vaccine production technology.

Looks like we have one plus and three minuses!

Pingback by Homeland Security Watch » What is harder to defeat – Ebola or ISIS?

February 2, 2015 @ 2:49 am

[…] (in contrast to the thousands in West Africa), but Phil’s post this past Thursday on “Epidemiology of Violence” reminded me of Allison’s take on the same general […]

Comment by Donald Quixote

February 2, 2015 @ 10:35 am

You make an important point. What is the staying power for preparedness once the grants slow and the threat diminishes? Can we have adequate planning and preparedness along with a short attention span?

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