The End of Ebola - podcast episode cover

The End of Ebola

Nov 02, 201936 minSeason 1Ep. 28
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Episode description

The Ebola outbreak in The Democratic Republic of Congo is slowing down, and a new Ebola vaccine is likely to get approved by the European Commission. Leading Ebola researcher Pardis Sabeti reflects on what she has learned from fighting a disease that may soon be vanquished. 

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Transcript

Speaker 1

Pushkin from Pushkin Industries. This is Deep Background, the show where we explored the stories behind the stories in the news. I'm Noah Feldman Today some good news. The Yubola outbreak in the Democratic Republic of Congo seems to be coming to an end finally. Since the outbreak started in August twenty eighteen, over two thousand people have died, but now infection rates are measurably slowing down. Plus, in other good news, a vaccine for yubola is likely to get approved by

the European Commission very soon. That means that there is now a potential prospect of substantial reduction of future outbreaks. To learn more about these important developments, I spoke to Pardisa, who's a cutting edge biologist at Harvard and at the Broad Institute. Partis was actually in West Africa during the twenty fourteen Ebola outbreak researching the disease, on which she's made important scientific contributions. I started by asking her exactly

how the ebola vaccine works. Ebola as an RNA virus, so some viruses are made of DNA and some are made of RNA. RNA is a less stable sort of the thing that makes copies of it is has more mutations in it. So RNA viruses mutate faster, and flu and ebol are both RNA viruses, but then those are

even within them those there's differences. You know, HIV and flu are really hard to develop vaccines for because they have a lot of different versions of themselves and they change, you know, quickly, and ebola is not quite like that. It's actually not as difficult to develop a vaccine for. And that's sort of why we've seen such early, really good success. We're seeing really good, promising success of the vaccines. And why also, you know, so Murk has a lead

vaccine that's being used in the DRC right now. A number of other companies like Johnson and Johnson and GSK had one. A lot of people are developing vaccines because they know that it's likely to be effective. Was there a single breakthrough or development over the last five years that made it possible for multiple companies to develop vaccines here? I mean, obviously was not really in contemplation when the disease was still poorly understood and when just basically characterizing

it was still the name of the game. Is the process sort of what we should expect that over a course of five years there was time or is it more that there was some particular intervening event or discovery that made it possible to develop these vaccines. No. I mean the vaccine that Murk is using right now is based on VSV, which is a particular type of raptivirus

that is really easy to engineer. And essentially what they do is they take another virus that's less dangerous and they put a protein of a bowl of virus that is presented to the immune system into that virus, and so it allows basically this other virus to bring in a piece of a bowl of virus that will allow our immune system to get a chance to see it

and develop immunity to it. It's a pretty well understood way of developing a vaccine, and other groups like Johnson and Johnson I think, have one that are based on an adenovirus as well as another virus. So they have got some other things that they're doing to try to make vaccines even better. But even the very simple merc based vaccine that's based on just one virus engineer to carry a protein from e bowl is working very well.

So I don't think that this is an instance like HIV or flu, where we need to do something very fancy to get it to work. This is really more of a situation in which there was no need to invest that kind of money. I mean, I think one of the really big issues that we have in vaccine development in general is that there's no incentive for big companies to put in a lot of effort to develop vaccines for anything that might possibly be an outbreak. No

financial incentive. You mean, there's a there's a strong humanitarian incentive, but you mean that there's not. There are for profit companies and there's just not enough money to be made in a crisis. In a simplest term, Yes, but you know, but you could also say, well, we don't we don't know what the next big outbreak is, so we can't

necessarily build vaccines for everything that might be possible. You know, before the West African outbreak, it wasn't like a lot of people were worried that people was going to be something that would infect them. So there's definitely not financial incentive. But there was not even necessarily of the universe of many viruses that you might want to be worried about and create a large scale vaccination program. People would one might argue which of these viruses are the ones to

go after? So that's sort of really interesting because the point you're making, if I understand correctly, is that you know there's a cost benefit that goes into not only developing a vaccine, but also in spending all the money to go out and get people vaccinated. And to do that, you really need to think there's a relatively high probability

of some event occurring that would have bad consequences. I mean, I guess really what you want to do in a cost benefit is figure out not only the probability of an outbreak, but also the consequences of that outbreak, and then multiply the probability by how bad it would be and get an expected value, and then that goes into your cost benefit analysis. And you're saying that, really, it wasn't clear before the twenty fourteen West Africa outbreak that

ebola was that kind of a virus. Yeah, I mean, I mean, obviously it was that kind of a virus, But was it more that kind of a virus than machupo or judine or haunts of virus or lassa virus. I mean, if there is a vaccine that you would have a bigger that would kind of hit the buttons of being both a really big global sort of pandemic threat and also a public health crisis there where veloping vaccine now would also help a lot of people. Loss

of virus might be a better choice. And so it's not necessarily that one couldn't make an argument that they should have gone after ebola. It's just that there's I think of almost four hundred viruses that are known to infect humans, which one of those you would choose as hard to make a case for. And when you talk about the financials, so at least some of these vaccines were already developed when the West African outbreak hit, they just hadn't been tested in clinical trials. And that's really

the hard part. The cost of developing a vaccine may be relatively reasonable, and then reasonable it means millions within the millions of dollars, But once you go to testing the first the safety and then the efficacy of the vaccines through multiple clinical trials, you're getting up into the sort of tens to hundreds of millions of dollars. And so when you start to think about that, that's where

it becomes a whole different ball game. So in the when the West African outbreak hit, there were vaccines that could be employed, and one of the big things that was happening there. At first, people didn't even want to

do vaccinations because they considered that research. To me is sort of to say we're not going to try anything is wild that that was such a big deal to say we're going to try something when anybody who is on the front lines, if asked, would you take a vaccine, even if experimental, as long as it's known to be safe, you would absolutely do it. But it took a long time to even get the community to say we're going

to try some stuff. And it wasn't really until it sort of hit and probably hit Western individuals, that people said, okay, let's try these vaccines. And now now I think we understand more that we need to try things in real time. I want to unpack the many fascinating as you said

there party. So one is that actually, some of these vaccines did exist in twenty fourteen, and we're not used because they hadn't been properly tested in a randomized, controlled experiment, And that runs very much counter to what the ordinary person imagines from watching the movies, namely that you know, when people are dying in large numbers in the field, that's the moment when you say, Okay, we have this untested vaccine, but it has a chance of working, so

let's get out there and save some lives. I mean, there we have this sort of fantasy that when that happens, then emergency and measures kick in. And I hear you're saying that that's not exactly what happened, or at least not what happened. That's just not what happens. It's not what happened at all. I mean. And vaccines are kind of a you know, are one thing, which is they're preventative, and so one might argue, if you don't feel sure that it'll be effective, you might not want to take it.

What's more shocking is treatments. Once you have ebola, would you rather take your chances on riding out ebola or trying a treatment that is not completely well vetted but you know, is confident in given that the fatality rates early in the outbreak were about eighty percent, you would say, you know, I'll try anything. But even there, I think that was the place that it was really even more remarkable to see that even there a lot of the

international community wasn't willing to try treatments. There's some famous cases of places where there was battles over trying treatments on individuals that were infected, where organizations chose not to and the individuals died. They didn't do it until it was actually Americans that were infected that they said, well, oh now we'll try the treatments. But there were a lot of really prominent healthcare workers that were infected and they didn't even have it. They were not even given

the opportunity to take a experimental drug. So willingness to try experimental treatments was actually higher when it was Americans getting sick than when it was Africans who were getting sick. And that doesn't seem intuitive to me. I mean, you sort of imagine that if anything, you know, Western professionals, they're not all Western, but many Western professionals would be

more willing to try out something experimental in Africa. So what's the background to that, is that a case of bending over backwards to try not to appear to be ferimenting with an experimental treatment on people in poorer countries and then that's a kind of perverse reversal of our deep past and that leads to this kind of strange result. Or is it more a story of just valuing American lives more highly? Like what's you're deep inside this? So

what's your theory about how that that happened? Well, I mean, actually I was part of the conversations, and I would say although I didn't get to I would I did not get to witness. So the one the one that I got to witness the early conversations and then didn't get to witness what happened at the end was with doctor Humar Khan, who's a Shikumar Khan, who's the head of the clinical ward at Kennema Government Hospital in Siri Leone. That's where my lab had worked for many years before

the Bola outbreak hit. And he was very prominent, very heroic Siri Leone in doctor on the front lines of first loss of virus and then ebola and of yours and a friend of mine and he was he was infected and it was actually the first time that the international community said now, well, so we were actually banging down the doors trying to get experimental drugs and vaccines tested early in the outbreak, and that was sort of like there was just like not no discussion of that.

It was it was that was that no one even wanted to do it. And then finally actually when doctor Khn became ill and people recognize he was very prominent and this would be really devastating, there was discussions, but even there it was interesting. So I think a lot of it has to do with the fact that they want to be perceived as testing on Africans. A lot of it is see what if something goes wrong, what if he gets the drug and dies, would they blame

the drug? So I think a lot of us around that political perception, and some of it is this idea that this kind of paternalistic view of like we have to protect them, them being being Africans. Africans, yeah, they like you know, when I do ethical protocols in Africa, I've taken a lot of ethics courses. I got really invested in it because I wanted to under stand how are we doing these things and thinking about how to

do things ethically right. And there's a lot of like we must protect them or we must be you know, their vulnerable populations. We don't want to exploit them, but sometimes it's almost infantalizing the way we describe their ability

to interpret it. And in the case of doctor Khan, it was an extreme case of in fact, he's more informed than I am to make this decision than any than And you know, even though I have an MD as well, he's still probably the most informed person on the planet to make a really good decision as to whether or not he should take the start or not. It's like it is like the scenario for a movie,

isn't it. You know, like the person with the most on the ground clinical experience in the disease is now infected with the disease and who's going to make the decision about his treatment? Yeah, And so out of a lot of those conversations that seemed pretty obvious that he was the right person, it made a lot of sense, and this is the time to try it. You know, I wasn't in the situation room. I was just in the kind of pre conversations. But when it got to

the situation room, they got cold feed. And I think for these other reasons, these sort of like larger implications, And then that part that you asked before, Like I said, I want to speculate, but obviously things changed when it was Americans on the ground affected. And I think um parties before you tell us that what actually happened to doctor Khan. Oh, he passed away. He passed away. So they chose not they ultimately chose. I mean, I just want to make sure that we get the depth of this.

So he there, he was, and in the end, the relevant people in the room were not prepared to try the experimental treatment and he died. Yeah, And the experimental treatment was at the site, so there it was just you know, feet away Frore it was, he was, it was, it was there, it was ready, it could have been used, and it wasn't. And when they tried that treatment later on others they took that exact that exact dose, and they gave it to two Americans, Nancy Warble and Kent Brandley,

and they both survived. Wow. Wow. Yeah. So I mean, when you can never say with one hundred percent certainty, but there's very very strong reason to believe that had doctor Khan received that treatment that was right there in the in the building with him, he would have lived it. Definitely. That was the risk I'm sure he know, his family knows, and I know if he was never given the choice. If he was given the choice, he certainly would have

he would have ruled the dice with the drug. Can I ask because this is a bit opaque to the ordinary person. Definitely to me, And I'm not asking you to name any names, of course, but institutionally, who gets to make that call? You mentioned that you had only been in the preliminary conversations. But when the decision is ultimately being made. Are we talking about international organizations? Are we talking about local government? Are we talking about US government?

Is at the who like who is at the private companies that control these things? Who is in the room when the decision is made. In this particular case, it was the MSF, And they have talked about it themselves. That's the med Sandstone Frontier, the International NGEO, Doctors Without Borders. Yeah, and and they I have a lot of sympathy for them and their decision, So I often say it's not

the decision I would have made. But I do think, at least in the early conversations I was part of, they're being thoughtful, They're being mindful, and there's a number of things that kind of came into play, and they made a choice, and they certainly regretted that choice. So in that case, it was, yeah, it's this particular organization and they were in charge of his care and they are making a choice about what to do with his care.

So I wrote a book called Outbreak Culture, and it talks about sort of what can become a toxic culture that emerges amidst the crucible of an outbreak. And the reason I wrote it, and I wrote it with Lara Salahia journalist, a fantastic journalist, was that I'm not trying to blame a particular person. I have deep sympathy for MSF and deep respect for everything that they're trying to do. I'm trying to understand the different the kind of complexity

of considerations that these matter organizations have. It's the suspicion and paranoia and you know, perverse incentives that emerge in the middle of a completely banana situation. Is how do we make better decisions given the many, many complexities of an outbreak. In your book that you just mentioned, Outbreak Culture, you go through in a lot of systematic detail things that went wrong in the West African outbreak and in

the response to the outbreak. And I'm wondering, as you look at the responses that are happening right now in the Democratic Republic of Congo, which is obviously a different geographical location, different political circumstances, do you think to yourself, Oh, my god, here we go again. You know, here are the mistakes that I just pointed out in a book, you know, published just last year, you know, for everybody to see, like, don't do this wrong. People could die,

and then those things are happening. Or maybe there are examples where there are lessons learned that you pointed out that are being taken into acount WHI would be more optimistic, we're thinking better, or maybe it's both. I would really love to hear from your perspective, how are we doing this time relative to the last time. The thing is,

these books have been written time and time again. In fact, when Laura and I kind of talk about these are recommendations, we actually don't give specific recommendations because so many people have given them before. What we try instead to do is to give a framework of how we should think about responding to outbreaks, and specifically we talk about organizational justice.

You know, the idea of organizational justice is that people believe that there's due process, there's a meritocracy, there's cooperation, there's transparency, and you know there. I think we're getting better at recognizing that we need to work with the communities allow them to understand what we're doing. But I'd say that there's a move towards that being important, but not necessarily that we've learned how to do it right, because there's still a challenge of getting people vaccinated when

there's a lack of trust. A lot of the treatment centers are being burned down because we haven't effectively communicated with the communities in which we're working, and so we haven't given them a sense of organizational justice, even if we may be developing it ourselves. And how much of

that is dependent on the government that's in play. I mean, in the case of Democratic Republic of Congo, you're working in a place that has a history of serious civil war autocracy of a totalitarian type before the civil war disorder that arguably was even worse than the totalitarian dictatorship. It's not credible or realistic to think that the government would have popular legitimacy as delivering justice and in those

places definitely where the outbreak is occurring. So given that, is it at all credible to even imagine that local people will say, oh, well, you know that might be true, but this international health organization that's looking to help us, they're you know, full of justice. You know, absolutely agree, And I think that that's a major shoe is obviously that in a society in which there's always been corruption and injustice, it's really hard to get anybody to believe

in anything. At the same time, I don't like kind of pointing to that being in a shoe because it's so easy. We're so good at anthropomorphizing other cultures and sort of saying that's that's their problem, that's not us. That we don't look to see what we're doing, what we could be doing better, and essentially we kind of throw everything up to oh, those are corrupt governments, so you know, so there, But ultimately, like you know, I

witnessed it personally, we are bad actors ourselves. We can be what's an example of where you saw we in the sense by which I assume you mean the international community of scientists and healthcare workers who are trying to help What's an instance where you saw that that we being bad actors. Oh, I mean a million different ways. And again I'm not going to name any names, but I'll say that there are a number of people there

in the West effering an outbreak that we're all. I mean you, We actually saw public fighting between number of major international organizations. People were trying to throw the people out because they wanted to be the ones to like do the first diagnosis or get the first paper out or they We got kicked out of multiple sites. I got kicked out of participating. They said you have no

business being here. And so there you are on the ground, the person who's been doing the most groundwork in the field scientifically for the previous several years, and they're like, leave, we don't want you here. Yeah, my team was told to leave. They were told they were not to return. We had no business here. And you know, our colleagues

were the only ones doing diagnosis. They had a you know, a diagnostic that was working, and they're the only ones doing diagnosis in a particular site, and an individual for a major organization kicked us out because they didn't want us. We were doing it for free. We weren't doing it for credit, but they didn't want us doing it, and our partner there and our African partner there kind of fought with this person and said, but you recognize that we're the only ones that can do it. If we leave,

there's there's nothing, and he said, I don't care. I want you, I want you out. And then the amount of libel that gets thrown out and everybody gets it. Like essentially, I had multiple ceases and assists. I had, you know, before my paper we got published in a major journal, got out, we had somebody send a basically a scathing letter to the journal to say that we were criminals. I mean, it's endless. It's literally eighty percent of my time during that time was fighting off attacks,

not actually doing positive work. I mean, that's it's genuinely astonishing. I mean, you know what, you and I have spoken about this a little bit before, and so I know a little bit about it. But what you're describing is something really really pervasive of competition under conditions about break for credit and for I guess the point of the credit is to get future funding. Yeah, to get future funding,

to get recognition. Now all of those things, I have to say, it's a depressing picture that you're painting, but depressing well. But the thing is, I mean it's not different from I mean, have you been seeing what's happening in Washington right now? I mean, ultimately everything is about that. I mean, I think the people, that's what people right. But the thing, the difference there is that people are in this instance that you're describing, people are dying of

disease in real time. Yeah, you know, I mean Washington is bad. I'm not defending it for goodness sakes, but by the same token, we sort of expect that. I mean, maybe it's to do with our expectations. I mean we sort of expect politicians to be politicians, but then here are scientists and public health workers and physicians. Almost everyone swore in the Hippocratic oath. You know, they're they've devoted their lives to do this and not to making billions

of dollars because they wanted to help people. You know, they're willing to take significant risks by being in country as you were, in the middle of an outbreak. I mean, we sort of expect. Maybe I don't expect everyone to be quite Albert Schwitzer, but we at least expect people to be better than Congress. Yeah, in that situation. Yeah,

I mean it's a low standard. But you know so, and and I should say, I want to make very clear there are some of those people there, right, you see the best of of humanity and the worst of humanity is what you see, right you see, I mean you see these frontline workers who are who are just doing everything they can anonymously, you know, just to help their fellow you know, fellow man. You see all of that. It's it's tremendous um. It's actually it's that so I

call it a crucible. It is truly a crucible. It's a melting pot of insane for upon you in which like all of these emotions happened. But two, the thing is people expect that suddenly we'd all behave really well. But even even when people make Hollywood characterizations of what happens during an outbreak, people are like punching each other in the grocery store for food. And I mean it's

a crazy environment. I mean, there are legitimate reasons to be just frightened, as suspicious and concerned, and so it definitely like amps up the paranoia level a lot that I can't believe I mean, I you know, it was not as extreme, but when I was in Iraq, you know, in the period of time immediately following the US invasion and occupation there, you could just sort of see the kind of amped up cortisol levels in everybody leads to

bad decision making. It leads to paranoia. One person shoots at you, and now you think everyone's shooting at you, right,

you know, there's no question that decision making. And I imagine that people who were on a battlefield, the literal battlefield, people soldiers serving in war, and that they do in their writing explore this same sort of idea that there is is you know, there are a whole series of forces that kick in and make it very difficult to exercise excellent judgment, to do things right, to look out for for anybody other than your team. Right, That's very

much what's going on there as well. I mean, the virus is actually just a backdrop to what's happening, the politics happening between people. It's like you, in a way, the virus is the thing that people are the least worried about. Um, they're really worried about who's slandering them,

who's trying to take them out of their position. Who's and it's kind of that's really people taking their eye off the ball, right, and and there's this huge existential threat, and everybody's just worried about you know, they're the office politics.

We're primates, We like we worry a lot about hierarchy. Yeah, let's do I want to ask when you look at the upside of the current outbreak, you know, namely the successes least preliminary successes of the vaccine and preliminary successes of the treatments, do you think, Look, it took a

little while, but science broadly speaking is working. You know, we're getting to a place where when we hear about an ebola outbreak, we're no longer going to feel sitting here in the United States existential dread, you know, worry about a global pandemic. We're going to increasingly think, Okay, you know, like this is rough, and it's going to be difficult, and no doubt some people will die, but

this is going to be fixable and manageable. And if so, is that is that a win for really for science broadly, you know, a vindication of the kind of work that you've been doing. Yeah, I think that we have the technology and the technological capabilities to likely be able to respond to any virus that's circulating. You know, I feel pretty confident that we can, you know, even the really hard things like flu and HIV we're starting to figure out,

or hepatitis C, like, we're starting to see breakthroughs. The technology is there to be able to respond. I think the thing that's still looming is, you know, one of the reasons why flu is such a concern is that, you know, the Spanish flu of nineteen eighteen was able to likely you estimated to have taken out twenty five million people in twenty five weeks. We you know, we're still not moving fast enough where a significant percentage of the world's population might not die if a new outbreak

came out that we weren't ready for. And so it's one of those places where we actually have all the technological capabilities to make this move faster, but we just need to put the resources behind making it possible to move fast enough to be ready for any threat. It's why folks like Bill Gates are on the front line saying this is the thing I'm most worried about in the history of humanity. Infectious diseases have been one of the most major killers. They're really effective at doing what

they do. And we're not even talking yet about the fact that there's such a thing as suicide biobombers, there's such a thing as biothreats. There are You may have an index case who doesn't want to be found, and that changes everything as well. Right, So when we talk about bad actors, we're talking about bad actors who just want to paper. What about the bad actors who are actually trying to spread the virus and infect as many

people as possible. So we have to be ready for that, the rise of deviant culture and the power that we can give them. I heard two different messages in there, and I want to disentangle them because I hear an optimistic message that says, you know, we've really made scientifically, I should say you, but you know you the scientific community who work on this really have made huge strides

in studying and responding to viruses. And in that sense, it sounds like you're saying that the danger of global pandemic as sort of high on the list of things that could go very wrong for the world, which was certainly in the curriculum that I was taught as a as a kid is declining relative to some of the other threats, which say are still there, like global warming, which you know, with the topic for another day, but

we don't have all the answers there. But it sounds like you're saying in an optimistic way that when it comes to the threat of pandemic by virus, that we were actually in a way better place today than we were even a short time ago. But then at the same time, I also hear you saying that because of speed and the danger of terrorists intentionally spreading disease and a hiding index cases that actually that danger remains about as pressing as it ever was. So am I hearing

you right? Which is? Oh? I think it's I mean, I think both can be true. I mean, I think that's right. That the same science that made it possible for us to have a vaccine for ebola very very quickly and to be able to launch it and have it be very effective, is the same science that makes it possible for one to synthesize ebola and for you know, people to understand how it works and how it goes forth.

So we are in that point where we have the capabilities to do tremendous good, but we have to be very committed, and we have to be very collaborative, and we have to move forward so that we navigate very treacherous waters. I can only tell you that it makes me feel a lot better to know that you're out there working on that partdis So go forth, please and solve some more solve some more diseases while you're at it, and we'll all be extremely grateful. Pride, thank you so

much for your time. I really appreciate it. Thanks though it's always a pleasure to talk to you. The story of Ebola is going to go down in the history of medicine as a fascinating case study of how a very contagious, extremely dangerous disease can draw intense global scrutiny, can highlight tremendous inequalities, can emphasize the irrationality and difficulty of our attempts to treat disease, and yet eventually lead to important treatment interventions and potentially even a vaccine that

renders the disease obsolete. It's important to keep in mind, then, that the story of Ebola has two sides. It will have the side of the story, which we've heard about very clearly from Pardis, in which there are dysfunctional elements, unnecessary competition, the wrong incentives, even bias of the most fundamental kind that stand in the way of effective cures

and effective treatment. Some of those biases and problems might even have led to the deaths of researchers and medical care workers, to say nothing of ordinary people who contracted the disease. Yet nevertheless, the alternative story, the heroic story of how those sacrifices ultimately led to real improvements, is a crucial element of this tale. I hope and look forward to a day when we'll only hear the word

ebola in the history books. When that happens, those histories will include appreciation for the work of scientists like Pardis who've tried to use reason and logic in the attempt to address this deeply serious problem of disease. And now our sound of the week. Last night, the United States brought the world's number one terroist leader to justice. Abu Bakar Albeg is dead. That's President Donald Trump, of course.

Last Sunday, describing a military operation that is arguably one of the most significant of his presidency, the one which led to the death of the leader of the Islamic State, Abubakhara al Bakhdadi, the self declared caliph of the organization that managed to conquer substantial amounts of territory in Syria and Iraq, and along the way combined an extraordinary capacity to murder, to rape and to kill with a remarkable ability to attract followers from around the Muslim world who

came to the Islamic State with the aspiration of participating in a millennial, idealistic and to them utopian community. What will happen to the Islamic State in the aftermath of Bahdadi's death and in the aftermath of the collapse of his caliphate. To understand how Islamic State is likely to develop, what's crucial to realize is that ultimately Islamic State turned out to be a very different kind of movement than al Qaeda, the terrorist organization from which it originally grew.

Recall that Al Kaieda defined itself globally as a movement designed to fight the jihad by Muslims against Western occupiers, those people who were perceived and in some cases actually were occupying Muslim lands on behalf of non Muslim countries. Those people who joined al Qaida were signing up to be, in their own minds, warriors, and in most instances they knew they would die. They engaged in terrorist activities all over the world, always with the theoretical aspiration of using

those terrorist interventions to make change in Western policy. But at no point in its history was al Kaieda effective for more than a few days in a few places at a time in actually achieving sovereign government over substantial amounts of territory. What made the Islamic State different from al Qaeda, and indeed unique in the annals of Islamic jihadi terrorism, is that the Islamic State did manage to conquer a large swath of territory in which they actually

created a functioning government. Using their reign of terror, but also using the ordinary bureaucratic tools of regular, everyday municipal governance, they manage to run the show. The end of Islamic State and the death of Baghdadi himself capture the reality that the Islamic State is no longer distinct or different. It does not govern territory in any meaningful way anywhere in the areas of Sirah and Iraq, where it had

its heart. It's true that in a few places around the world, various terrorists jihadi groups have used the brand name of Islamic State to try to claim for themselves the authority to govern in small enclaves. That will probably continue to be the case. It will probably still be the case that if you're the leader of jihadi group and you actually managed to grab some land and you want to legitimate what you're doing, you may say I

am the local branch of the Islamic State. But as that becomes rarer and rarer, and as there is no substantive caliphate of the Islamic State to which such an oath of allegiance could refer, what's going to happen into Islamic State, overwhelmingly likely is that it will gradually morph back into the organization from which it came in the

first place, namely Al Qaida. Ultimately, historians will look at the Islamic State and conclude that it represented a distinct moment where there was an attempt to instantiate in real life a set of old, indeed medievil ideas about utopian Islamic governance and that that effort failed. The death of Abu Bakhar al Baghdadi is therefore significant as a kind of endpoint to the aspirational ideal of the Islamic State

as a real world state. As a terrorist organization like al Qaeda, the Islamic State can continue to exist without a caliph, but in its character as a distinct aspirational caliphate trying to govern space, it can't do without a leader at the top, and in that sense, Bahdadi's death is historically significant. Deep Background is brought to you by Pushkin Industries. Our producer is Lydia Genecott, with engineering by Jason Gambrell and Jason Roskowski. Our showrunner is Sophie mckibbon.

Our theme music is composed by Luis Gara. Special thanks for the Pushkin Brass, Malcolm Gladwell, Jacob Weisberg, and Mia Lobel. I'm Noah Feldman. You can follow me on Twitter at Noah R. Feldman. This is Deep Background.

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