When Ebola swept through eastern Congo in 2018, it was difficult to track cases. Doctor Billy Yumain, a public health official, recalls constant flows of people crossing the border into Uganda while others hid sick family members in their homes because they feared the authorities. It took at least a week to get test results, and health officials struggled to isolate sick people while they waited.
It took two years for the country to bring this epidemic under control and more than 2,300 people died.
A similar disaster threatened Congo in September 2021. One family in North Kivu province fell ill with fevers, vomiting and diarrhoea, one after another. Then their neighbors also fell ill.
But it triggered a series of measures that Congo put in place after the 2018 outbreak. Patients were tested, cases were quickly confirmed as a new Ebola outbreak, and immediately health workers Health traced 50 family contacts.
Then they deployed to test potential patients at health centers and checked people at busy border crossings, arresting anyone showing symptoms of haemorrhagic fever. Local labs that had been set up following the previous outbreak tested more than 1,800 blood samples.
It made a difference: this time Ebola only killed 11 people.
“These people died, but we limited it to 11 deaths, whereas in the past we lost thousands,” Yumaine said.
You probably haven’t heard this story. You probably haven’t heard of the deadly epidemic nipa Neither does a virus that a doctor and his colleagues stopped in southern India last year. Or the rabies epidemic that threatened to spread through nomadic Maasai communities in Tanzania. Quick-thinking public health officials slammed it after a handful of children died.
Over the past two years, headlines and social feeds have been dominated by outbreaks around the world. There was Covid, of course, but also mpox (formerly known as monkeypox), cholera and the resurgence of poliomyelitis and measles. But a dozen other outbreaks flashed, threatened – then were snuffed out. Although it doesn’t seem like it, we’ve learned a thing or two about how to do it, and sometimes we’re successful.
A report from the global health strategy organization Make up your mind to save lives documented six disasters that were not. All emerged in developing countries, including those like Congo that have some of the most fragile health systems in the world.
While cutting-edge vaccine technology and genomic sequencing received a lot of attention during the Covid years, the interventions that helped prevent these six pandemics were decidedly unglamorous: building community trust in the local healthcare system. Train local workers on how to effectively report a suspected problem. Make funds available to dispense rapidly, deploy contact tracers or vaccinate a village against rabies. Increase laboratory capacity in areas far from urban centres. Priming everyone to act quickly at the first sign of potential calamity.
“Outbreaks don’t happen because of a single failure; they happen because of a series of failures,” said Dr. Tom Friden, CEO of Resolve and former director of the US Centers for Disease Control and Prevention. “And epidemics that don’t happen don’t happen because there’s a series of barriers that will prevent them from happening.”
Yumaine told me that a key step in stopping the Ebola outbreak in Congo in 2021 was to train health officials in each community on the response. The Kivu region has experienced decades of armed conflict and insecurity, and its population faces an almost constant threat of displacement. In previous public health emergencies, when people were told they should self-isolate due to exposure to Ebola, they feared it was a ruse to move them off their land.
“In the past, it was always people from Kinshasa who arrived with these messages,” he said, referring to the country’s capital. But this time the instructions on lockdowns and isolation came from trusted sources, so people were more willing to listen and be tested.
“We could give local control to local people because they have been trained,” he said.
Because labs had been set up in the area, people with suspected Ebola could be tested in a day or two instead of waiting a week or more for samples to be sent over 1,600 miles from Kinshasa.
In the southern Indian state of Kerala, Dr. Chandni Sajeevanchief of emergency medicine Kozhikode Government Medical College Hospitalled the response to an outbreak of Nipah, a virus carried by fruit bats, in 2018. Seventeen of the 18 people infected died, including a young trainee nurse who treated the first victims.
“It was a very scary thing,” Chandni said. Hospital staff took a crash course in intensive infection control, dressing in the “moon suits” that seemed so alien to the pre-COVID era. The nurses were devastated by the loss of their colleague.
Three years later, in 2021, Chandni and his team were relieved when the bat breeding season passed without infection. And then, in May, in the depths of India’s terrible COVID wave, a 12-year-old boy with a high fever was brought to a clinic by his parents. This clinic was full, so he was sent to the next one, then to a third, where he tested negative for Covid.
But an alert clinician noticed the child had developed encephalitis. He sent a sample to the national virology laboratory. He quickly confirmed that it was a new case of Nipah virus. By then, the child could have exposed several hundred people, including dozens of health workers.
The system that Chandni and his colleagues had in place after the outbreak of the 2018 outbreak: isolation centers, moonsuits, testing anyone with a fever for Nipah as well as COVID. She held daily press briefings to quell rumors and keep the public on the lookout for people who might be sick – and away from bats and their droppings, which litter the coconut groves where children play. Teams have been dispatched to catch bats for monitoring purposes. Everyone who had been exposed to the sick boy was quarantined for 21 days.
“Everyone, ambulance drivers, elevator operators, security guards – this time they knew about Nipah and how to behave not to spread it,” she said.

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