The Anatomy of Surprise

The World Health Organization's (WHO) handling of the Ebola outbreak in West Africa was  called into question by Peter Piot, the Belgian virologist who discovered it decades ago. In recent interview in the Guardian, Piot asks, "why did WHO react so late?" He answers the question himself.

it was because their African regional office isn't staffed with the most capable people but with political appointees. And the headquarters in Geneva suffered large budget cuts that had been agreed to by member states. The department for haemorrhagic fever and the one responsible for the management of epidemic emergencies were hit hard. But since August WHO has regained a leadership role.

The accusation was amplified by an article in NDT, citing Medecins Sans Frontieres officials who say the regional WHO response was absent. "In all the meetings I attended, even in Conakry, I never saw a representative of the WHO," said Lugli, deputy director of operations for MSF Switzerland. "I didn't see it the first three weeks and we didn't see it afterwards."

Politics was at the heart of the problem, according to unnamed sources. "Insiders say the WHO is amongst the most politicized of U.N. agencies, with governments holding sway over its regional operations. The director of its regional African bureau (AFRO) based in Brazzaville, Congo, is appointed by governments and has access to locally raised funds, allowing autonomy from Geneva." It didn't help that WHO Director-General Margaret Chan of China unduly deferred to local governments even when it was clear they were phoning it in.

Peter Piot, a former WHO official who co-discovered the Ebola virus in 1976, said the delay in doing this was a crucial factor in allowing the epidemic to reach unprecedented levels.

"It took another five months and 1,000 deaths before the WHO declared this a public health emergency," said Piot, director of the London School of Hygiene and Tropical Medicine

For its part, AFRO claimed they were in the dark because their subordinates  had suppressed the bad news.

WHO officials say the epidemic raced ahead of efforts to control it from the start because Guinea took more than three months to notify the agency of the disease.

Only on March 13 did Guinea notify the WHO, which sent a team to the southeast the next day. Samples dispatched to a laboratory in France showed on March 21 what many feared - Ebola had struck a completely unprepared region.

"It was way too late," said AFRO's [Dr. Luis Gomes] Sambo, "Hundreds of unidentified people were already infected."

It is all too often the first instinct of bureaucracies to maintain the appearance of control, even when -- often especially when -- they are dealing with the unknown.

MSF warned as early as March 31 that the geographic spread of the outbreak made it "unprecedented". It received a strong rebuttal from a WHO spokesman.

"A few days or a week after our statements, there was always WHO saying 'no, it's not true'," said MSF's Lugli. "Except later they confirmed it."

In early August 2014 "Ken Isaacs, a vice president with Samaritan’s Purse, a North Carolina-based Christian humanitarian organization," warned that WHO was low-balling the figures.  What's the harm in a little delay?  As it turns out, a great deal of harm, because when diseases expand at a nonlinear rate "too late" comes very quickly. Scott Gottlieb, writing in Forbes, says it must now be accepted that it can break out of West Africa. "The decisive risk to the U.S. will emerge in a few months. If the virus continues to spread in West Africa at its current pace, much larger global outbreaks will become likely."

And if Ebola does decisively break out of West Africa, we may be unable to control the spread of the disease solely by conventional public-health tools of infection controls, tracking and tracing sick contacts, and isolating the ill. If this happens, we may face a global pandemic early next year.

Tom Friedan asked, 'how did Ebola spin out of control'?  In the usual way, with the block being a second behind the arrival of the punch. In the time honored way. The collapse of a complacent bureaucracy in the face of an emergent threat usually goes through 3 phases. Denial. Confident half-measures. Panic. These psychological phases are remarkably constant throughout history.

Take Julia Pierson of the Secret Service, who maintained the facade of being in control all the way until the moment she submitted her resignation. "When Omar Gonzalez vaulted the White House fence ... he shattered the idea that the White House is a sacred civic space, protected by the world’s most impenetrable security force," wrote the New York Times in an article titled "The Collapse of the Secret Service". ISIS similarly went from being a "jayvee" team to an existential threat in the relative blink of an eye.  From G-Man to "gee, man".

The next phase is equally depressing. A surprised and embarrassed bureaucracy applies overconfident half-measures to staunch the insolent threat to the normal. The interruption is treated as a nuisance and the flunkeys are sent to deal with it so that the ballroom music can resume. Don't worry ladies and gentlemen, the scheduled programming will soon return to normal.

For example, President Obama authorized a limited response of airstrikes against ISIS which the Kurds now say aren't working.  He needs a bigger pinprick.

Isis units have edged to within two kilometres of the centre of Kobani, according to Kurds fighting a rearguard action inside the city. The jihadis, who this weekend generated further outrage with the murder of the British hostage Alan Henning, are simply too numerous to be cowed by the air assault by US fighter jets, the Kurds say.

“Air strikes alone are really not enough to defeat Isis in Kobani,” said Idris Nassan, a senior spokesman for the Kurdish fighters desperately trying to defend the important strategic redoubt from the advancing militants. “They are besieging the city on three sides, and fighter jets simply cannot hit each and every Isis fighter on the ground.”

When the half-measures don't work there is finally panic;  full-blown, shameless panic which either manifests itself in a bugout or in the demand by authority for absolute power to contain a crisis which only last week they declared did not exist. Now the very same WHO which low-balled the numbers is warning of catastrophe unless the 'world' gives it billions. Whether it is the Blitzkrieg in France or the Fall of Singapore or Black April in 1975 or ... perhaps today, the stages of a rout are frighteningly similar. Denial. Confident half-measures. Panic.

The man who the public debate misses most right now is the late Michael Crichton. His best selling novel Jurassic Park wasn't really about dinosaurs. Dinosaurs were merely used to advance his theme, which was the vanity of the elites who wrongly assumed everything was under control; that the world unfurled around them solely for their entertainment -- until emergent events show up to show them who's in charge.

"I believe my life has value, and I don't want to waste it thinking about clothing," Malcolm said. "I don't want to think about what I will wear in the morning. Truly, can you imagine anything more boring than fashion? Professional sports, perhaps. Grown men swatting little balls, while the rest of the world pays money to applaud. But, on the whole, I find fashion even more tedious than sports."

Dr. Malcolm," Hammond explained, "is a man of strong opinions."

And mad as a hatter," Malcolm said cheerfully. "But you must admit, these are nontrivial issues. We live in a world of frightful givens. It is given that you will behave like this, given that you will care about that. No one thinks about the givens. Isn't it amazing? In the information society, nobody thinks. We expected to banish paper, but we actually banished thought.”

But Crichton knew that nothing was given. Jurassic Park was about the Black Swans before the great Naseem Taleb wrote his book. Crichton made fun our claims to presume the future.

“They believed that prediction was just a function of keeping track of things. If you knew enough, you could predict anything. That's been cherished scientific belief since Newton.'

And?'

Chaos theory throws it right out the window.”

He described how Black Swans made a hell  for people who believed they were in control. Who thought a directive here, a talk show there, a message not to panic there fixed everything, little realizing that events have a mind of their own.

People were so naive about plants ... They just chose plants for appearance, as they would choose a picture for the wall. It never occurred to them that plants were actually living things, busily performing all the living functions of respiration, ingestion, excretion, reproduction---and defense.

What could go wrong with such god-like things as Washington and WHO?  Why what in the end went wrong in Jurassic Park.  “God creates dinosaurs, God kills dinosaurs, God creates man, man kills God, man brings back dinosaurs.”  We're so worried about Global Warming that we've forgotten to worry about ourselves.  What the Greatest Generation knew that our current princes have forgotten is that survival is not a given.

Let's be clear. The planet is not in jeopardy. We are in jeopardy. We haven't got the power to destroy the planet - or to save it. But we might have the power to save ourselves.”...

Because the history of evolution is that life escapes all barriers. Life breaks free. Life expands to new territories. Painfully, perhaps even dangerously. But life finds a way.

"Life will find a way". It would be the most tragic of epitaphs if some race of space aliens should come to earth and after years of studying our artifacts, databases and newspapers, left this sad inscription before blasting off. "Here lies a race that came to dominate the planet with its vitality. It expired when, in an outburst of pride, it put its fate in the hands of the one thing on earth capable of movement without life, speech without thought, power without a mind. In a world 'where life will find a way', it put its faith in dead bureaucracy. Humankind, R.I.P."


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