Guest blog written by Peter Harrington
As the world grapples with the first truly global pandemic, a crucial struggle is emerging between different ways of seeing the current coronavirus outbreak. On the one hand, it is a virus that medical science can tell us how to combat. On the other hand, it is a complex social challenge to which human behaviour and norms are the key. In truth it is both, but if we fail to understand this, and understand that it requires adaptive learning to overcome, far too many will die.
Five years ago, I worked alongside the late statistician and epidemiologist Hans Rosling in Liberia on the Ebola epidemic sweeping the country and its neighbours. I had gone back to Liberia having previously spent three years in the country with the Africa Governance Initiative, working in the office of President Sirleaf. Like many, including Rosling, I came out of a sense of duty. Looking back on that experience, it holds powerful lessons for how we respond to coronavirus today.
Rosling said something memorable in 2014, that ‘Ebola is both a biological and a social phenomenon’. In other words, beating it was as much about behaviour as beds, as much about trust as treatment. The huge spike of cases in Liberia – which at one point threatened to collapse the country – peaked around November 2014. Privately, many of the foreign epidemiological experts in Liberia admitted it is unlikely that the (belated) influx of beds, logistics, money and aid workers explains the decline in new cases around the country after that.
So what happened? It is actually really useful to look at what happened as an exercise in mass problem-driven iterative adaptation (PDIA). The headline problem was abundantly clear – an out of control epidemic with a mortality rate of over 50%. And the country lacked the capabilities to handle this epidemic. What followed was a mass learning process, encompassing many actors. Starting with the authorities: they had to learn how to set up an Incident Management System, the name for a completely new institution dedicated to the eradication of the outbreak, to avoid overloading the Health Ministry and other existing institutions. They had to learn to set up emergency response phone numbers, special burial teams, to build special Ebola treatment Units (ETUs), set up and run testing labs, mobilise mass logistics to distribute these resources, all without abandoning those in need of other healthcare.
At the same time, the stampede of outside organisations wishing to help had to learn too – to take their ‘expertise’ with public health, epidemics, logistics and communications and translate that to the local context. Some organisations – like the American CDC who came with ears and eyes open – proved very good at that. Others like the WHO proved very slow indeed. The difference was the willingness to learn. Continue reading Seeing Pandemics as Complex Adaptive Problems