As Americans’ fears are being stoked with around-the-clock coverage of the first diagnosis of Ebola in the United States, Dr. Larry Brilliant is calling for calm. The president of the Skoll Global Threats Fund has had a long career in global health policy and has experience fighting the spread of infectious diseases, such as smallpox. Ebola's unwanted arrival in America is an important issue, but mass panic needs to be avoided at this point, Brilliant says.
“If we’re going to see 24-7 Ebola on Fox and CNN, everyone is going to be apopolectic, and no one is going to go to a birthday party,” Brilliant told TakePart in an interview Wednesday. “And then Ebola has won, and we’re better than that.”
Ebola has killed more than 3,000 people in West African countries and has infected thousands more. Its spread has been largely unchecked because of unstable postconflict governments that have minimal medical infrastructure as well as rituals local cultures practice that involve touching the bodies of those who have died.
Here are the highlights of our interview, edited for length and clarity. (Disclosure: Jeff Skoll is the founder of Participant Media, TakePart's parent company.)
TakePart: What makes you so confident that Ebola won’t be a huge problem in the U.S., and why should Americans believe in your confidence?
Dr. Larry Brilliant: The first reason to be confident for me is that I was part of the eradication of smallpox. I was in India when there were hundreds of thousands of children dying and the rivers didn’t run because of the bodies. There were half a billion people. That’s 500 million people who all died from smallpox in the 20th century—and yet we eradicated it.
There are differences. We don’t have a vaccine against Ebola, but on the other hand, Ebola does not spread until you actually have the disease. Smallpox was spread by a respiratory means that was much worse, many times worse—for every person with smallpox, five or six others could be infected, and with Ebola that transmission rate is 1.1 to 1.2.
TakePart: But that’s a notable difference between smallpox and Ebola. What eradicated smallpox was, in part, the availability of a vaccine—and we don’t have an Ebola vaccine. Are they really comparable?
Brilliant: Oh, sure. You don’t need a vaccine if you can do the same work as a vaccine would do. What does a vaccine do? It reduces the density of susceptibles [people vulnerable to becoming sick through contact], hopefully, down to zero.
Our strategy for eradicating smallpox in the first instance was mass vaccination—vaccinate everybody in the room. Well, that didn’t work. If you’ve got an outbreak of smallpox in Toledo, Ohio, it’s not going to help you to go to Japan with vaccines. We have to vaccinate in the three or five miles around, and proximity is the key to stopping any outbreak. If you have the worst disease in the world, and it will infect a set of people near you, and there’s nobody near you, it’s not going to infect anybody.
A disease like Ebola is mild to moderately communicable; it’s not outrageously communicable. It’s not like influenza, which has another generation of cases between one and four days later. Ebola has seven to 22 days, probably about two weeks in the mean. How many secondary cases are there from the first case, and how quickly do we do it again?
TakePart: Of course it’s speculation, but having seen other incidents become outbreaks of communicable disease, are you confident there will be some secondary cases?
Brilliant: I am actually confident that Ebola will not stick [in the U.S.], will not become epidemic in other states. We have a couple of examples [of the American response to Ebola]—we brought three cases over; there were no secondary cases.
Now when you’re in an airplane and you’re traveling and you have symptoms and you’re contagious, that’s the height of the time that you’ll be getting lots more people infected because you’re essentially in a hermetically sealed container and you’re sick. This guy when he was on the airplane didn’t have symptoms, so he was incapable of spreading the disease during that time. There was a period of time where he both had symptoms and was not isolated. During that period of time it is likely that he will have infected someone. Not probable or certain but likely.
TakePart: What are the procedures in the U.S. that will spare us the consequences that have been seen in Liberia and West Africa?
Brilliant: We’re able to isolate in an almost perfect way once he enters into isolation, so we reduce the density of susceptibles down to zero. Either there’s nobody in the room with him, or people in the room are wearing space suits. If there are no suspeptibles around you, it doesn’t matter how bad the disease is once you’re in a room and there’s no one you can catch the disease from.
He didn’t know he had it. There were people around him who cared for him. Once he entered into the isolation room, it’s not possible for him to transmit the disease. So up until the time that he had symptoms to transmit in the room, once he entered the isolation chamber, he couldn’t transmit the disease. He could have transmitted the disease when he was at home. He could have transmitted the disease when he came to the hospital, you know—with a pen, when somebody drew blood from him for the first time—those are all very high-risk encounters. Now if you do get a secondary case from that, you’ll immediately know what it is because people are alert.
TakePart: That alertness can only be raised by the double-edged sword of media saturation on this subject.
Brilliant: Everyone in Texas is now on hyperalert, and we will now diagnose. They failed to diagnose Ebola, they diagnosed zero out of one. Over the next four weeks we will diagnose 1,000 out of zero. We’ll diagnose everybody with Ebola.
TakePart: So you expect a spate of misdiagnoses as a result of heightened fears, not an actual spread of Ebola?
Brilliant: Correct, of course. Looking at it as an epidemiologist, when you look at it as the branches and the leaves, that’s the way you look at this. You look at this as the case, the secondary cases, the tertiary cases. I’m very confident that any importation of Ebola that we get into the United States while it may lead to secondary cases will be rapidly contained and will not pose a public health crisis.
Why do we see it in Liberia and Guinea? Because these are the poorest countries in the world, and they are all post-conflict. Their public health systems and economies are in shambles, and in America, we don’t understand because for us, if you go to Canton, Ohio, California or New York, they’re all part of the United States. In these developing countries, there’s very little government outside the capital cities. That’s just kind of a political fiction. There were no public health officials there before the outbreak began. Our systems are obviously very different.