Lessons learned from past outbreaks can stop new epidemics

Editor’s note: Dr. Tom Frieden, director of the CDC from 2009-2017, oversaw responses to the H1N1 flu, Ebola, and Zika epidemics, is president and CEO of Resolve to Save Lives and a senior fellow at the Council on Foreign Relations on Global Health.

Precious Matsoso is the former Director General of the National Department of Health in South Africa and was the World Health Organization Director of Public Health Innovation and Intellectual Property. Precious Matsoso is the Director of the Health Regulatory Science Platform, a division of the Wits Health Consortium and Honorary Professor in the Department of Pharmacy and Pharmacology at the University of the Witwatersrand.


At the end of June this year, the health authorities in Ghana received some disturbing news: two cases of viral hemorrhagic fever were detected in the country. Blood samples from infected people tested positive for the Marburg virus, a fatal disease that can kill most of those infected.

The outbreak triggered emergency response efforts at all levels of government in Ghana. Almost 200 contacts were identified and interviewed. Healthcare workers were reminded how to protect themselves and their patients from Marburg infection. Non-medical community volunteers were trained to recognize signs of the disease, refer people with suspected Marburg infection to the appropriate authorities, and provide information to the community to help reduce disease threats.

After these efforts, no further cases were detected. After a conservative waiting period, the appearance was declared closed on September 16.

Why didn’t this story make headlines? It didn’t happen because it was an epidemic.

The public and the media tend to focus on what’s wrong: Covid-19, monkeypox, polio and now Ebola. But this focus obscures what’s happening every day: local and state public health workers and epidemiologists, or “disease detectives,” are stopping outbreaks and preventing epidemics around the world.

To celebrate these efforts, Resolve to Save Lives has released its second report, “The Epidemics That Didn’t Happen.” The new report details six outbreaks that were stopped in 2021, stories that might not otherwise make headlines, but provide valuable insight into what public health is doing right. Case studies show what is possible when local, state, and national communities mobilize a societal effort to prevent epidemics.

One lesson that stands out is that because outbreaks start and end in communities, well-coordinated action at the local level is essential. Rabies is almost always fatal, and after a tragic case in Tanzania, public health workers joined with community leaders to ensure that everyone else exposed was vaccinated, saving lives. Without sensitive community engagement, more children would die. When local efforts are supported by national and local governments, we can stop and prevent epidemics.

Another lesson is the high return on investment we can achieve by prioritizing and funding our preparation efforts. The 2014-16 West African Ebola outbreak killed more than 11,000 people and cost the world economy $53 trillion. To prevent another devastating loss of life and livelihood, Guinea coordinated significant improvements in health security at the national and subnational levels. It established a National Health Security Agency and a national and 38 district-level emergency operation centers. The country also recruited and trained public health doctors and others to respond to the outbreaks. Then, when an Ebola outbreak emerged in January 2021, the country was ready to coordinate a robust response. The outbreak ended with 23 cases as Guinea made sustained investments to prepare for the next health threat.

Finally, the coordination between local, state and federal agencies plays a crucial role in the prevention of the epidemic. After a 2018 Nipah virus outbreak in Kerala, India, that saw 18 cases — 17 of them fatal — state officials identified gaps in response efforts and improved them. When a case was identified in the state in 2021, officials from local, county, state, and national agencies immediately convened to plan and implement response measures. During these days, officials identified 240 contacts, tested fruit bats (repositories of the virus) in the affected area and carried out a risk communication campaign with citizens. This outbreak began and ended with a single index case.

These case studies demonstrate what can happen – and what won’t happen – when countries invest in and prioritize preparedness so that they are ready to act quickly and strategically when outbreaks occur. Offering a vision of what a public health renaissance might look like, they show what is possible when all levels of society work together to maintain a resilient health system built on the pillars of community trust and equity.

These are important lessons as we continue to strengthen preparedness for new diseases and as the World Health Organization considers the global pandemic treaty a tool to better prepare our world. A pandemic treaty instrument driven by this first-hand country and community experience and insight, and built on principles of solidarity and equity, has the potential to help countries greatly improve their preparedness for the next disease threat. And as our new report shows, preparation is not only possible, it happens every day. To protect us all, the global community must continually invest in preparedness and prioritize political and financial resources.