Ebola: Preventing the Next Pandemic

In twenty fourteen, a cluster of Ebola cases emerged in Guinea in West Africa. It was the start of what would become the largest Ebola outbreak on record. Ebola is one of the most deadly pathogens on Earth, and it started to move through densely populated cities at the time.

I might get Itbora, but my thinking is is better for me and a few orders to die and saved millions of people than be selfish and lefty. Disease spread and eventually paid a high price by seeing menials of people dying around me.

Today, on the show the twenty fourteen Ebola Outbreak and how the lessons we learned from that moment may help us prevent future pandemics. I'm Jacob Goldstein and this is Incubation, a show about viruses. First today is my conversation with Christian Happy. I talked with him about his work hunting viruses, and in particular about his role in fighting the twenty fourteen Ebola outbreak. Christian grew up in Cameroon and he

I grew up in the rainforest area and there was a lot of malaria there. I grew up knowing that my mother has lost two of my siblings to malaria. I think the day I met up my mind to become a scientist was when I was about eight nine years and I got one of the worst part of maya that I could ever remember, and my mom took me to the hospital. I got treated by nouns and then on the way back, she stopped under a tree and I was lying against a tree, and I do remember asking my mom, why was that sick?

Why is it that there's no.

Treatment or cure or anything to prevent this disease from hitting me this hard? And our response was I have no idea, And that day I remember telling her and when I grew up, I will find a cure.

Christian Happy did in fact grow up to study malaria and other infectious diseases that are common in West Africa. He got a PhD in molecular parasitology, and then he did a postdoc at Harvard. He was at Harvard when he met Pardis Sabbetti, the other scientist will hear from on today's show. In two thousand and eight, Christian started working on a disease called loss of fever. That experience laid the groundwork for the work he would do when

We find ourselves in a place where whole families have been wiped out by these virus. I realized that at that point that hospital is a nogal area. I'm being told that the place is called like a burier ground. When you go there, you get infected by this mysterious disease. There's no care for, it's almost impossible to diagnose, and then you die. And the first thing I did when I get to that place is to ask a lot of questions, and I realized, one, they don't have diagnostics.

Okay, you and parties, you set up this a lab at a hospital. It lets the people at the hospital diagnose loss of fever in patients there. What happens next.

We cut down the test fatality rate in the hospital from ninety percent to about twenty three point eight percent. Why because when they used to have disease outbreak, people will come from Germany or a team of researcher will come from Germany, take the sample to Germany and then they will have the result only about a month three weeks to a month after.

So there were people who had this potentially fatal disease in a hospital in rural Nigeria and in order to test for the disease, people had to take a sample from the patients from rural Nigeria to Germany and do the test.

Yes to Germany, Yes, and if you take about a month for them to have the result.

And would the person be dead by then.

By the time they get the result, ninety percent of those people were dead. But the introduction we brought the diagnostics by the patient bedside, that's really what our very first huge impact.

And so that's the just a simple, simple idea, which is like, if somebody might have a deadly disease, let's figure it out right here, rather than sending a simple to Germany.

That's the whole idea, normal senning simple to Germany, doing it within Africa, using the data within Africa to inform policy makers in real time so that they can use the data to respond faster.

So now let's jump forward to twenty fourteen and we have what's gonna become the biggest recorded ebola outbreak in history. Tell me about that.

The Ebola outbreak start in the remote part of Guinea and at that time, the world is looking away. The disease is crawling and the disease is killing people. And the first thing we did at the time is sit down and think about what we can do to support the response. Can we activate this This is so system that we were setting up through this epidemic, and we identify diagnostics as the weakest link of all of the things of the chain.

And the reason is being simple.

If you cannot diagnose a disease, it's going to be very difficult for you to contain it because you need to know what you're trying to contain.

You need to know who's got the infectious disease, and.

You need to go who has infection.

And we decided then to start training people in Syralllion because Syrillleon was neighbor to Guinea, and we train people in Nigeria because Nigeria being the most popular country in West Africa. But then the second thing is also the fact that we were already working in Syraleion on last fear. So those two countries where we're working, we prepare the ground by training people on how to diagnose a bowler. We also go quickly to develop a molecular diagnostics test

Of boler in Seria leone spreading out of Guinea.

So the disease is spreading. It has started in Guinea. Now you've identified it in Sierra Leone, but it hasn't yet reached Nigeria. Yes, you are in Nigeria. Yeah, and a passenger arrives at Legos Airport with a suspected case of ebola, first suspected case in the country. You're there, Yes, what do you do at that moment? That day?

On that day, I got a call, a very strange call around eight four pm and that call is coming from one of the foremost virologists in Africa. He calls me and he says there is a suspectic case of a boler in Legos. There's a lot of argument about whether it is or it is not. But I've told the public health authority is that the only person that will give me a result, and I believe is Christian because I know his ability.

They're saying like we were one person in this country to do the test, and that person is.

You, right, I mean, the stexts are very high. And he tells me what do we do? And I told him that evening, I am driving from a house to the lab that they should send the sample. We'll meet in my lab and I'll collect the sample and then do the testing that night.

And what are you thinking. What do you think when you get this call?

Of course, it sends you chills in your vertebrate because this is a suspected case in a country of two hundred and thirty million people. So if this spread, the consequences are going to be very disastrous, not only for Nigeria, for Africa and then the rest of the world.

And this patient collapsed at the airport. The nightmare scenario.

He collapsed at the airport, He's taken into a hospital, He's probably been handled by people with are suspicion, and I am to face it. I was going to deal with the beasts, which means I may not come back home alive because we don't have a BIS facility, be.

A self force like the super safe High Security facility.

The super safe HAST best safety level.

Four and you don't have that. So you mean by going to do this test, you might get a bolder.

I might get a border.

But my thinking is it's better for me and a few orders to die and save millions of people. If it is confirmed, then be selfish and left the disease spread and eventually paid a high price by seeing millions of people dying around me. So I turn to my wife and I tell hell, this is a situation. I want to go do this. If I don't make it back home, take care of the children, it to be okay. And she said, I'll pray for you. You'll be back. I know this is what you've always wanted to do.

I'm sweating like a pig into the ppe.

My eyes and fast side is fuggy because you know of the heat.

Your safety goggles are fugging.

I'm wearing the safety goggle and that is fugging up and then I'm really looking through that and then working in the night very carefully.

And it's what, you have a blood simple I got a blood sample, yeah, okay, and ran the first test and then the first test turned out to be positive.

That really sends chills in my spine.

I mean, this disease is transmitted through blood, and you're sitting there working with the blood.

Yeah.

But my mind is like started running through the number of people that came across this guy. How many people are being exposed? You asked yourself many questions. I repeated the test just for confirmation purpose, and then that test actually the result is consistent, and were repeated it the tod time and then in the morning around like six o'clock the result turns out to be positive.

Then I know that while we got a problem in the country.

I do court the then Minister of Health and I told him that, sir, we have a baller in the country. I remember for about a minute when I told him this, the line was quiet. And then the question was how do we organize ourselves the reality that at that time were really not organized.

What do you and your colleagues do over the coming days.

We start saying Okay, when I know that this case is confirmed, we start thinking about who are the people that came in contact with this case.

So people are like going door to door, who are doing knocking on doors saying you need to come with me. You were exposed to a bowler.

Basically, that is exactly what im because we form immediately form an emergency operation center. Were actually create a group that is tracking down with these individuals, and that group is led by a general and we're getting people out of their homes. Once we tuck you down, you know we're in contact. We're taking them to a solution center. And this is how we're actually picking the cases much more earlier before the cases become serious and we start managing them.

So this is at this moment when there is this large outbreak in several countries near Nigeria. You have this first case in Nigeria. You're trying to do testing and tracing really aggressively in Nigeria. Does it work?

It works?

It works.

It works because we're able to issolate as many cases as possible. We're basically also providing the results the test result in the E real time and sharing these with public health authorities and guess what Nigeria comes out of it with only twenty cases and AED debt and in the country of two and tenty million, that is unprecedented.

It's unbelievable. But then it shows that it works.

We showed in the context of our program that you need two major things to contain an epidemic.

One is speed, that is.

Your speed of execution, your speed of response, your speed of characterizing the virus.

And then secondly is accuracy.

If you do this with accuracy, you should be able to contain any epidemic.

Thank you so much for your time. I really appreciate it.

Thank you.

Christian Happy is the director of the African Center of Excellence for Genomics of Infectious Diseases at Redeemers University in Ede, Nigeria. So for the next part of the show, we're going to talk to parties, yep. And I'm just curious to hear you talk about your friendship with her, your work with her.

I do call parties my academic betaph I will say it is a friendship that is transcending, you know, the RUSSA that we're doing, it will become family.

For the second half of today's show, I talked with Pardise Sabbetti. Partise is a computational geneticist. She has an MD from Harvard and a doctorate from Oxford and she runs a lab at the Broad Institute. And she says she and Christian have been through a lot together.

Well, Christian is like, you know, we call each other our academic better haves. That's what he always says. And I always calling my writer Di because we've been in situations where it's like, what are we even in? You know, We've been in some really banana situations together.

Parties and Christian's work on malaria and loss of fever and ebola has made them really world experts on how to prevent outbreaks. Later in the show, I'll talk to Parties about her book on culture and Epidemics, but we started by discussing this outbreak surveillance system that she and Christian have developed to reduce the risk of future pandemics. It's called Sentinel, and it grew out of the work that Christian and Parties did on loss of virus and

Sick we need detection of pathogens wherever they're occurring, because these pathogens all look the same and we don't know, you know, like what's brewing inside of us until it's pretty late. It's no coincidence that every time we identified a virus in the world it was when somebody had access to testing, right, Like, for most of these viruses, we don't see them, and so LASA viruses won't the one we started looking at, and everywhere we looked we

Were you setting up just just before that twenty fourteen Ebola outbreak.

We essentially set up the capacity to train individuals on the continent to do diagnostic testing and the tools to share that information and track pathogens. So it was basically a training program as well as the tools and technology to detect pathogens around West Africa at the time.

And then how did that play out as the Ebola outbreak emerged.

Honestly, our timing is kind of wild in that we were, you know, working and working and working to get the grant. We got the grant in like December of twenty thirteen, and we launched the program in March of twenty fourteen. And right at that moment, like literally the program launched, we're like meeting with the World Bank leadership, you know there, and that was when they identified Ebola and Guinea. We're like just hearing Ebolas here and we're there. The frustration

So what did you learn from that experience that led to this kind of next generation surveillance system that you are working with.

So, I mean the idea of Sentinel it is predicated on having these different technologies. So there's three kinds, Like there are these point of need tests, things that could be as sensitive as PC are tests that you know, you could run in villages at home that could pick up the pathogen everyone's worried about circulating or ones that

And as I understand it, some of these tests are using using a technology related to crisper to the genie editing tool. Tell me about that.

Sure people know about crisper as the technology to edit genes and how it might be changing gene therapy and designer babies and all that stuff, But what is crisper. It was actually originally discovered in nature as a bacteria's immune system to viruses. It was designed in nature to detect and to destroy viruses. So that's what it's good at. It's good at detecting viruses. And there's certain classes of crisper that have properties that make them really good for

Okay, so those are the point of need tests. And then there's this other category, which is the genetic sequencing machines that you were able to get into hospitals in West Africa. What do those allow you to do.

In the clinics when people come into the clinics or hospitals. You want to be able to test for like a patient comes in and you test for twenty things right at the same time, because it could be any of those things.

We don't know a lot of times.

Like in that instance, are you just like what are all the pathogens in this person's body right now?

Is that what you're doing in that Yes, that is the goal of it.

We're not there like we know everything, but we but it's getting close to that.

I mean, that's like the dream right then you can just say, like tell me everything that's there, Like that's the one that I thought you couldn't do.

Yeah.

Yeah, And you're saying you're getting there.

Well, you were getting there, yeah exactly.

Right now, It's like expensive and time consuming, but like yes, that would be the kind of holy grail, right, And so we've been building these like really super exciting tools that allow people to really in a very user friendly way, see you know what, all the different pathogens that they're detecting, where they're occurring, and start to really kind of make sense of all of that data.

And has there been an instance more recently when you were able to use this set of tools to you know, stam an outbreak?

Definitely?

Well, yeah, I mean the funny thing about the kind of work we do is like when we're successful, you don't know about it, right, yes, right, right, Yeah.

I don't know all of the pandemics. We didn't, Yeah, because of that's it.

Well, and so we we have lots of great successes. The fact that when COVID hit, we had working COVID diagnostics in serri Leone, Senegal and Nigeria our main sentinel sites before any US hospital, like any that's sort of like what you don't hear about.

So okay, so that's your work on this, you know, very small scale, right, genetic screening looking for molecules in patients. I want to sort of go up many many orders of magnitude here make a big turn and talk about your work on thinking about outbreaks at the scale of society, at the scale of country in the world. You actually co wrote a book about this side of things. It came out before the COVID pandemic in twenty eighteen. It was called Outbreak Culture. Tell me about that.

Yeah, So Outbreak Culture was kind of born from conversations I had with a journalist, Laras LAHI just kind of processing what we were in.

Like, I think I said that, you know, the bowl outbreak was really like a lot. I mean a lot. You know.

Obviously now people know the kind of a lot that pandemics can be from COVID, but it was different because it was like it was extreme and nobody else seemed to know about it, about us, but there was this group of people that were like just deep in it, and we just saw a societal breakdown, you know. So I often say that viruses expose and exploit the cracks in our society. They prey upon us and the division

The virus is like the backdrop, you know, it's what does that mean? It's so proper between people.

It's a political battle, you know, and the virus is the thing around it, but it's actually about who's in charge. You know.

There's so much politics, and I think ultimately the most that.

Is wild foreshadowing, right, And like, yeah, I mean you you wrote about this and the book came out in what twenty eighteen or something, and like when you talk about that, when you say, what everybody starts talking about is politics, like that's like, you know, chills down my spine.

Yeah, right, I had a lot of people who were like, thank goodness you wrote this book, because then I just knew what was happening during COVID.

There's a really deep human nature thing that happens, right. I mean, that's the interesting piece of the book. In a certain way. It's like it's not because some particular politician is craven or something right as you describe it. It's just like, this fundamental thing that.

Happened doesn't have to happen by the way. It doesn't. I thought out the places where people were doing it the right way. Early in the outbreak. I was like advising everybody in their mother and you know, kind of just around talking to people, and I stumbled upon this like really just interesting place at Colorado Mesa University in Grand Junction, Colorado.

They had, you know, a.

Community that was very diverse politically, ideologically, ethnically, and they were trying to figure out how to work through it. And they didn't have money. They couldn't just throw money the problem and test everybody, so they had to figure out how to be creative. And that's where we brought our data analytics system to them, and we brought some of our support to help them be like smart about it.

So we are at this place now where the whole idea of pandemics and epidemiology is is weirdly politicized, and it seems like we would be screwed essentially socially politically if there were to be another outbreak. What do we do about that?

I think that we need to be way less toxic in the way we talk about it. You know, we have to basically decharge how we think about these things together, and we have to use every like mini event as an opportunity of like building better systems. When RSV is going through the schools, we can help parents think about basically just really think about what are the parents' incentives, right, Parents who don't want their kids vaccinated, they're just scared parents.

At the end of the day.

We need to tell them about how to keep their kids safe. And that's what's important, you know. And we should be showing value at every point and respecting autonomy where we can and trying to you know, support that conversations.

Is there anything we didn't talk about, anything else you want to talk about?

I guess the thing I just don't express to you is the joy that we have in Sentinel. You know, when I think about Sentinel, why it matters to me, right is as somebody who's a nerd at the heart, you know, I love math, and I love computer science, and I love building things, and I love it. But I also just want to say it's joyous and the joy that is important responding to outbreaks, Like you will not respond to an outbreak by walking around with your

Thank you for your time. It was great to talk with you, Kate, to talk with you too. Partis Sabetti is a professor in the Department of Immunology and Infectious Disease at the Harvard School of Public Health. She is also an Institute member at the Broad Institute of MIT and Harvard. Thanks to both my guests today, Christian, Happy and partis Sabbetti. Next week on the show, Epstein Barr the first cell for Christ's say Somebody's on his side,

Thanks for listening.