Blog Series Featuring Jay Miller Aveska Program Manager

A time for resilience during COVID-19: Lessons learned in Liberia

June 19, 2020

I remember the headline, but I had to look up the date: May 9, 2015. The nation of Liberia had been ravaged by disease and desperation, but the World Health Organization finally declared the small West African country Ebola-free after 42 days—full incubation periods—without a case.

I was in the capital city of Monrovia that day, alone in my apartment, wishing I were more enthusiastic about this milestone. The news felt underwhelming. I had come to Liberia, to fight Ebola as a representative of the disaster relief organization, AmeriCares. After an exhaustive engagement, this was the moment we were working for—our collective global health workforce could claim victory.

There were no celebrations. By then the world had moved on, and with it, much of the financial support behind the response. At this point, we were in the “recovery phase” and my work primarily involved developing after-action reports and next step recommendations. I returned home to the United States soon after, moving into a different role.

Although Liberia was unfortunate to get a few imported cases over the following year, all of West Africa was declared Ebola-free on June 9, 2016. Getting this news seemed even more distant than before. Though for now, and like much of the rest of the world, I yearn for that feeling with COVID-19.

Roughly five years removed from this engagement, I found myself walking the halls of the Thomas P. O’Neill building in Washington, DC, where I serve as an on-site Program Manager with Aveshka, backstopping a large and talented team of public health scientists and emergency response professionals who support the mission of the Assistant Secretary for Preparedness and Response (ASPR).

ASPR’s stated purpose of “Saving lives and protecting Americans from 21st-century health security threats” saw our office engaged in the COVID-19 response from the very beginning. We took notice as the first cases appeared in Wuhan, China, and we scrambled to prepare as this novel virus brought a nation of nearly 1.4 billion people to a screeching halt. We witnessed Italy’s healthcare system collapse under the weight of this disease, forcing heroic nurses and physicians to make spirit-breaking decisions on who lives or dies, all while putting their own lives at risk.

Aveshka teams worked around the clock with ASPR counterparts to understand the situation, rerouting all of our relevant capabilities toward our nation’s fight against COVID-19. As this virus began spreading to every distant corner of the earth, people around the world braced for impact and this disease hit us like a tidal wave, breaching our protections and overwhelming our hospitals, our economy and our greatest cities.

Panic set in quickly as many of our neighbors began to fight over everything from public policy to toilet paper. As the world searched for answers, those deemed essential were leaned upon, and the vast majority of us were asked to do our part by staying home and practice the novel concept of “social distancing”.

Consider Liberia. From an epidemiological perspective, COVID-19 and Ebola Virus Disease (EVD) are drastically different. Ebolavirus Zaire was the causative agent behind the West African outbreak of 2014-2015, killing roughly 40% of those cases reported infected during the event. COVID-19’s agent, SARS-CoV-2, has struck at the heart of our fears because of its capacity for rapid global spread and its danger to vulnerable populations. Regardless of their differences, these pathogens share a capacity for disruption causing problems with few solutions.

When the first cases of EVD reached the capital city, it sparked fear. But not change. Citizens largely resisted the public health messaging and social distancing recommendations from the government and the international community. A war of information ensued and rumors propagated wildly. Some believed Ebola was a conspiracy to fund intergovernmental organizations, others postulated a biological attack meant to cripple and exploit a marginalized yet resource rich economy. Regardless of anyone’s opinion, the virus began to spread rapidly, resulting in many casualties. At the same time, riots broke out and the nations’ fledgling healthcare system was exposed, prompting a global emergency. Liberia ploughed through its breaking point, but then I saw it start to heal.

“…it was the everyday resilience of the Liberian people and their willingness to trust the unfamiliar process of social distancing that played a key, if understated role in stopping the spread of EVD…”

Humanitarian aid eventually poured into West Africa from all parts of the globe, and a crisis eventually came under control through sacrifice and determination. There were many heroes during this period. Ultimately, however, it was the everyday resilience of the Liberian people and their willingness to trust the unfamiliar process of social distancing that played a key, if understated role in stopping the spread of EVD and fostering healing.

Of course, science and medicine ferried their load in advancing treatment protocols and developing medical countermeasures. However, without the members of the health community who took an all-hazards approach and chose to realize an invisible enemy by remaining vigilant, there is no doubt we would have experienced more dire straits. They aggressively endorsed personal responsibility through efforts as simple as hand washing and compliance with regular temperature checks. The road to recovery was long, boring, and frustrating at best, but the bottom line was, Liberia got there.

Fast forward to almost seven months into the COVID-19 pandemic: we have made significant progress in the fight against COVID-19. An unprecedented global scientific response pushed hundreds of vaccine candidates into the fray. We are attacking this disease from every angle we can find, and some parts of the world have even claimed victory through control and elimination. But the United States is still reeling and scared—all with good reason. In a greater sense, health security and economic stability have been viewed as fait accompli by those of us fortunate enough to live in the developed world. Yet COVID-19 managed to take this confidence and these comforts from us.

Beyond this, and after enduring hardships, our lights remain on, our water runs, our infrastructure is intact, and we have taken various measures to adapt. Even as the country begins to reopen, we are asked to avoid non-essential travel and don masks when stepping outside. We muster hope as we watch industries limp back into the marketplace. Some are optimistic we are on the mend, while others remain panicked and realize things may get worse before they get better.

At the time of writing, we have more information but there is no definitive answer to COVID-19.  We learn more every day and promising pharmaceutical candidates are on the horizon. It may still be months before we see effective medical interventions in our healthcare centers, if we are lucky. Promising vaccines are currently undergoing human trials, with most experts agreeing that approval and distribution will take at least another year, if we are really lucky.

Regardless, we need to embrace resilience and an all-hazards approach as we crawl towards our “new normal”. We can do it. It is going to be hard, but it has been done before.

By Jay Miller, Aveshka Program Manager, BARDA & SPPR