All language subtitles for D D S01E06 Pandemics 1080p AMZN WEB-DL DD2 0 H 264-playWEB_track3_[eng]

Mother Nature’s
stealthiest killer

is the pandemic.

A worldwide spread
of infectious disease,

it is a natural disaster for
which we have some forewarning,

but this only makes it
all the more terrifying.

With an ever more mobile
world population,

potentially growing
to 11 billion people

by the next century,

public health experts agree

that the possibility
of a cataclysmic disease

spreading to all parts
of the globe

is more likely now
than ever before.

So, what makes
pandemics different

from normal infectious diseases

is they’re generally
new diseases

into human populations.

They emerge from,
typically, wild animals,

through humans coming into
contact with those animals.

And something critical
needs to happen.

Those viruses,
typically viruses,

are not well adapted to humans.

They mutate.

And then when
that mutation happens,

they have to start spreading
within the human population.

The outbreak needs to get
to a certain scale,

and then it really takes off.

What happens when the amount
of disease in a community

rises above the expected level
for the population?

When there are more cases
of infections in hospitals,

the regional authorities
and also on the national levels

you have emergency plans to,
essentially,

come up with ways to cope

with these increased numbers
of people

who turn up
at the hospitals.

A pandemic
is a whole different thing,

and the main difference
is that the virus strain

that hits the population
in a pandemic year

is radically different
from the virus strains

that had been circulating
in the previous years.

The consequence of this
is that the population

has no prior immunity

acquired through
the previous exposure.

And therefore, the infection
rates are just much higher,

and, uh, the number
of infected people

that turn up in a hospital
is much higher as well.

Among the most devastating
pandemics in history

was the Black Death,

which killed
at least 75 million people

throughout the 14th century.

By 1400,

it had killed more than 34
million European inhabitants,

or up to 50 percent
of the entire population

on the continent.

It would be a mistake to
believe that the modern world

isn’t susceptible to a similar
kind of widespread outbreak.

With the advent of jet travel,

disease can be spread
quite easily

and with terrible rapidity
throughout the globe.

But it wasn’t always
like this.

At the time
of the Agricultural Revolution

roughly 10,000 years ago,

man turned from nomadic life
as a hunter-gatherer,

and settled
into large communities.

This caused the way
that viruses interacted

with the human population
to change dramatically.

Agricultural revolution
essentially meant

that it became easier
to produce food.

And when you can
produce more food,

you can have more people
living in the same space.

That means the population
density goes up, and, um,

this is wonderful
for infectious pathogens.

For a virus,
it is extremely important

to have a sufficient number
of potential victims around.

In a way,
the Agricultural Revolution

made it much easier
for infections

to go round and round
and round and round

in populations in a way
that wasn’t possible before.

So it was only when
human societies

started having
large groups of people,

after we could make our own
food through agriculture,

and we started
to have towns and cities,

that you got
enough people together

to really sustain
these sort of epidemic diseases

of the type
we’re talking about.

One of the diseases

which has most frequently
caused pandemics

to sweep the globe
is influenza.

This is because the virus
that causes the disease

regularly mutates into a form

for which
the general population

has no natural immunity.

Historically,

a new mutated strain
of the influenza virus

has appeared three
or four times a century,

or roughly
every 30 to 40 years.

In the last hundred years,

there have been four
deadly flu pandemics.

The Spanish Flu pandemic,

occurring between 1918
and 1919,

may have killed at least
50 million people worldwide.

Astonishingly,

more soldiers
died from the 1918 flu

than were killed
in the entire war.

Adjusting for population growth,

the number of dead
from the Spanish Flu

is equivalent to about
425 million people today.

The most recent
influenza pandemic

was the global outbreak
known as swine flu,

which occurred
between 2009 and 2010.

The viruses that have mutated
and caused these pandemics

typically originated
from animal influenza viruses.

It is believed
that they are bred

as a result of the interaction

between diseases
among humans and animals.

In North America and Europe,

seasonal flus occur
each autumn and winter.

As the majority of people

will have been exposed
to these viruses

in previous seasons,

the symptoms
are typically mild.

However,
every 20 to 40 years,

the flu virus undergoes
a dramatic mutation.

Viruses are parasitic.
They’re not alive themselves.

They’re little chunks
of genetic material

which modify the cells
in our body.

Different viruses
target different cells.

So the influenza virus,
for instance,

targets certain cells,

basically in the lining
of our respiratory system.

And when it enters
through our mouth and nose

into our lungs, the virus
will attach itself to cells,

enter cells through a complex
set of molecular machinery

and then hijack
the cellular machinery

to start creating copies
of itself.

And those copies
will burst out of that cell

into the mucus of our lungs,

and through the process
of generating symptoms,

coughing, also gets expelled
and move onto the next host.

The flu virus
is highly contagious.

each time
a sick person coughs,

they expel some 2000
virus-laden droplets.

Sneezing or even talking,

can also generate
respiratory droplets.

If you inhale
or touch any object

infected with these droplets

and rub your nose
or eyes thereafter,

the virus can get through the
mucus membranes in your mouth,

nostrils or eyes,
and into your airways.

People can be infectious
24 hours

before they even feel ill,

and for five to seven days
after they become sick.

Once the flu virus
has gotten into your body,

it travels down your airways,

binding to the cells
which line the lungs.

When a virus infects us,

there is a whole arsenal
of countermeasures

that the organism has provided
and is able to provide.

And two very important ones,
called T cells

and the other ones, antibodies.

When we vaccinate people
that is what we try to induce,

so that you have already
T cells and antibodies

that are specific to a virus

that you may encounter
later on.

So this is what we want
from vaccines.

Most of the symptoms of the flu

are actually caused
by what your body does

to try and fight off
the virus.

It’s when the body’s cells
are under attack

that your immune system
kicks in.

Counteroffensive is led

by infection-fighting
white blood cells

called T lymphocytes.

T lymphocytes,
or T cells,

are often referred
to as soldier cells.

In the specific case
of the T cells,

one of the important mechanisms
to eliminate the virus

is to essentially
kill off infected cells.

There are ways to detect
that a cell is infected.

And then they go there,

and they have mechanisms
to kill off this cell.

This, of course, means there is
collateral damage,

because the cell
is now not there anymore.

We predominately feel
influenza symptoms

in the respiratory system,
in the lungs and throat,

because those are the cells
the virus targets.

Although the influenza virus
only stays in the lungs,

the symptoms of the illness
can be felt all over the body.

These include fever,
headache,

tiredness and aching muscles,

which is why the flu
can make us feel so very ill.

So there are multiple things
which cause symptoms

with an infectious disease,

partly it’s affected
by the virus itself.

Viruses, as they replicate,

they infect lots of cells
and cause damage to the person,

and fever is actually
an adaptive response

to help us clear infection
because most infections

are tuned to the body’s
normal temperature.

By making us hot,
the immune system

actually reduces how quickly
bacteria and viruses replicate.

The immune system is trying
to eliminate the virus,

the infected cells,
from the body.

And by doing that,
it damages us,

and that can generate
inflammation,

can make us feel even sicker,

can, for instance, for flu,
cause difficulty in breathing.

According to new estimates
published in December of 2017,

between 291,000 and 646,000
people around the world

are killed each year

as a result of catching
seasonal influenza.

While seasonal
influenza viruses

are detected year-round,

flu viruses peak
during the autumn and winter.

It is actually
surprisingly unknown

why we have seasonal peaks
of influenza.

There are a number
of thoughts,

but none of them
are completely clear.

One reason appears to be that

the drier and colder conditions
make the virus more stable.

Another probably very important
factor is that in winter,

we tend to huddle together
much more.

And that means, for a virus
that has infected one person,

it’s easier
to get to the next one.

During an epidemic
of seasonal influenza,

most of the terminal cases
will be the elderly,

while those
with severe complications

usually occur in people
with a variety

of pre-existing
medical conditions.

By contrast, a flu pandemic
can kill younger,

otherwise healthy people,

and cause many more cases
of viral pneumonia.

It seems when a completely
new virus comes along,

and that’s the situation
in a pandemic,

those who have
the strongest immune response

may be the ones
who suffer most.

And so that’s adolescents,
young adults,

and those with the healthiest
immune response.

The collateral damage
may be what kills you

in that situation.

If you have a really strong
immune system,

that gives you
a really strong response.

Then your collateral damage
may be really massive,

and that’s often
what kills you.

In 2009,

the swine flu virus evolved

when a previously combined
human-bird-swine virus

underwent a further mutation
with a Eurasian pig virus

to form a new H1N1 super virus.

The 2009 swine flu
was a classic case

of a very new virus
hitting a population

that was immunologically
not prepared for it.

So there was no protection

from the viruses
that had been around before.

The outbreak first surfaced
as an epidemic

in the state
of Veracruz, Mexico,

where a 5-year-old boy
became ill

with a high fever
and typical flu-like symptoms.

It was discovered
that he had been infected

with a new kind of variant
influenza virus

previously seen
only among swine populations.

The boy went down in history
as boy zero,

the first person to kick-start
the swine flu pandemic.

He was lucky to survive,

though the same cannot be said

for the countless
other swine flu victims.

I’m just really scared

because I don’t know, um,
if little kids are getting sick

or if there’s a certain medicine
for little kids.

In March 2009,

I got a call from my friend
and colleague Nancy Cox,

who directs
the influenza division

of U.S. Centers for Disease
Control in Atlanta,

saying that they had just got

some test results back
from California

which indicated that two
children who’d been to Mexico

were infected with a previously
unknown flu virus.

That became public knowledge,

I think,
two or three days later.

We were already gearing up
to assist in London,

our colleagues
in the United States,

the World Health Organization
in London.

And we now know the virus
had probably been circulating,

at that point, probably
for five or six months,

without really being detected.

But of course,
initially,

what people saw were
the really quite sick people.

They saw
the tip of the iceberg.

People in hospitals in Mexico,
and in the United States,

and there was real concern.

We started seeing cases
appearing, being detected,

really, across the world in 20,
30 countries within six weeks

of the initial announcement.

And the virus spread
very fast.

The first confirmed death
from the swine flu virus

occurred at the Texas
Children’s Hospital in Houston.

It was a toddler
from Mexico City,

who had been visiting family
in Brownsville, Texas

before being air-lifted
to Houston for treatment.

The World Health Organization’s

Strategic Health
Operations Center,

known as the SHOC room,
was activated.

For the next few months,

the SHOC room would become
the center

of a worldwide battle

against the H1N1
swine flu virus.

On the 24th of April,

the Center for Disease Control

uploaded the complete
gene sequences

of the 2009 H1N1 virus
to a public influenza database.

Scientists around the world

could now use the sequences

and compare them to samples
from their own countries,

in order to more
rapidly determine

the spread of the virus.

On Saturday,
the 25th of April 2009,

the Director General of
the World Health Organization

declared the outbreak
a public health emergency

of international concern,

admitting that
the swine flu epidemic

could not be
successfully contained.

Most cases of severe and fatal
infections have been in adults,

in adults between the ages
of 30 and 50 years.

This pattern
is significantly different

from that seen during epidemics
of seasonal influenza.

The pandemic alert level
was raised to Phase 4,

indicating that the virus

was spreading abundantly
between humans.

On the same day,
officials in New York City

reported that
they were investigating

a cluster of influenza-like
illness in a local high school.

The Center for Disease Control

next confirmed
two infections in Kansas,

and another case in Ohio.

In the midst of a bourgeoning
public health emergency,

the U.S. began releasing
a stockpile of supplies

which could be used to protect
and treat the public,

including over 39 million
masks and respirators,

gowns, gloves
and face shields,

as well as 11 million doses
of antiviral drugs.

On the 28th of April,

it was suspected that the virus
had further spread to Germany,

with seven more cases being
reported from that country.

The following day,
the World Health Organization

raised its pandemic alert
to Phase 5,

signaling to the global community

that a pandemic
was now imminent.

As panic
about the virus spread,

draconian measures began
to take force around the world.

Egypt began a cull of all
domestic pigs in the country.

In Germany’s western state
of Saarland,

kissing was banned
as a form of personal greeting.

Eventually,
more than 70 countries

were reporting cases
of infection.

The W.H.O. were forced to raise
the threat level to Phase 6,

the highest categorization
on the pandemic alert chart.

I have, therefore,
decided to raise the level

of influenza pandemic alert
from Phase 5

to Phase 6.

The world is now at the start

of the 2009
influenza pandemic.

The world was now facing
a global influenza pandemic

for the first time in 41 years.

Throughout June and July,

Europe was experiencing
a steep rise in new cases,

with a whopping 11,159 people
infected in Britain alone.

Germany followed
in second place,

with 2455 confirmed cases.

Throughout the world,
immunization was seen

as the only effective means

of stopping the spread
of the disease.

However, the new H1N1 vaccine
was in short supply.

In America, the CDC recommended

that initial doses be
administered to priority groups

such as pregnant women,

people who lived with
or cared for babies,

children 6 months
to 4 years old,

and health-care workers.

In the U.K.,
the NHS recommended

that vaccine priority go
to people over 6 months old

who were clinically at risk for
seasonal flu, pregnant women,

or households of people
with compromised immunity.

It was initially proposed that
two doses would be required,

but clinical trials
demonstrated

that adults were receiving
sufficient protection

after only a single injection.

But unfortunately,
the vaccine was still

in the process
of development,

and would not be ready for use
before the end of September.

By that time,

the first official death
on German soil was announced.

The country would see
further losses of life

throughout October,
including the deaths

of a previously healthy
5-year-old boy

and a 48-year-old
mother of four.

By November,

a total of 53,968
German nationals

had confirmed infections.

Thirteen people
had died as a result.

I think we were lucky
in the 2009 pandemic.

The virus
wasn’t very pathogenic,

because the rate by which
it spread was amazing.

And, um, had it been
a virus strain

that gave much more severe flu
than the seasonal strains,

then we would have been
in deep trouble.

And this was not predictable,
that was, if you want,

that was sheer luck.

But despite
these tragic figures,

the overall worldwide deaths

from the 2009
to 2010 swine flu outbreak

were fewer than in
previous influenza pandemics.

Research shows that as many
as 579,000 people

could have perished
from the disease,

with figures suggesting

that a disproportionate
number of deaths

likely occurred in
Southeast Asia and Africa,

where access to prevention
and treatment resources

is more limited.

The total number
of people infected

was probably about a third
of the world’s population

in the first 12 months or so,

but only a minority of those

would have showed
any symptoms at all.

Probably only about
10 to 15 percent

of the global population
showed symptoms.

Then there were later waves
of transmission,

which infected more people

and now, at this point,
probably most of them,

90 percent
of the world’s population,

have been infected
with that virus,

or its descendants.

For the most part,

it seemed that the world
had been largely spared

from the major horrors
some had predicted.

But it wasn’t long before
another highly contagious

and deadly viral disease

threatened to overwhelm the world.

That disease
was known as Ebola.

The outbreak of Ebola
between 2014 and 2016

was the largest and most
complex epidemic of the virus

since it was first
discovered in 1976.

It killed a staggering
five times more people

than all other known
Ebola outbreaks combined.

The outbreak began in Guinea,

before moving
across land borders

to Sierra Leone
and Liberia,

and eventually found its way
to Europe and North America.

There is an incubation period
for Ebola

of anywhere from two to 21 days

before the victim
will begin displaying

visible symptoms
of the disease.

For this reason,
the World Health Organization

will only declare
the conclusion of an outbreak

once 42 days have elapsed,

the equivalent
of two incubation periods

with no new infections
being reported.

On average,

roughly half of patients
who catch the disease will die.

Historically,
there have been outbreaks

where the mortality rate
was as high as 90 percent.

It’s a horrible infection
to have, frankly.

It causes a widely
disseminated infection.

The virus is in almost
every body tissue.

Early initial symptoms
are mostly gastrointestinal:

profuse diarrhea,
vomiting,

with very high-end levels
of virus shared.

It can also then cause
a hemorrhagic fever,

where you bleed from eyes
and other orifices.

It’s got a very high
fatality rate.

We think about 60 to 70 percent,

typically,
of people die,

usually from multiple organ
failure.

It’s one of the most lethal
viruses we know.

It spreads from person to
person through bodily fluids.

Typically, people caring for a
sick relative will get infected

because the fluids
are very highly infectious.

Early medical care,

combined with rehydration and
drugs to relieve the symptoms,

can decidedly improve
one’s chances of survival.

But as yet,
there is no licensed treatment

proven to neutralize
the virus,

although a range of blood,
immunological

and drug therapies
are currently being developed.

The Ebola virus will be
spread between humans

either through the blood
or bodily fluids

of an infected person.

Breast milk, saliva,
semen, feces

and tears are all
highly infectious.

Studies have shown
that traces of Ebola

may even remain
in a man’s semen

for more than a year

after he has recovered
from the disease.

The virus can also survive

for several days
outside of the body,

so cleaning up body fluids
or touching the soiled clothing

of an infected person
can also lead to infection.

According to the W.H.O.,

health care workers are between
21 and 32 times more likely

to be infected with Ebola

than people in the general
adult population.

They must wear a face shield,

or a medical mask and goggles,

if they are to be
within one meter of a patient.

It is also necessary
that workers wear

a long-sleeved gown
and gloves.

Fifteen of our health workers

from this case management center
have passed away.

When somebody dies of Ebola,

that time the virus
is very virulent.

And in that case, we have
to handle that corpse very well,

in order not for us
to be infected.

Ebola infections are so deadly

because the virus
infects the cells

that line your blood vessels

and this leads
to massive leakage,

and essentially inner bleeding.

So it’s a very,
very virulent virus

that kills you
just quite rapidly.

Ebola virus is a virus

that is not constantly present
in the population.

So that means there is
no immunity in the population

due to having seen
the virus before.

If the virus manages
to be transmitted

from a patient or a victim
to a new person,

then it can
just very explosively expand

in the new person,
and, um, be deadly.

The standard methods
of treatment for Ebola patients

have remained the same
for many years.

It consists of oral
or intravenous rehydration

and electrolyte replacement,

coupled with drugs to decrease
vomiting and diarrhea,

as well as to mitigate
the symptoms of pain and fever.

Patients who are also at risk
of contracting malaria

are given anti-malarial
medication and antibiotics

so they don’t have to fight
both diseases at once.

There are drugs
being developed to treat Ebola

that stop the virus
from replicating.

Another treatment being studied
is the use of immunotherapy

by giving transfusions of blood
from survivors.

Further potential treatment

could be the mechanical
filtering of patients’ blood.

All the infections occurring in
the West African Ebola epidemic

in 2014 and 2015

can be traced back
to an 18-month-old boy

from the village of Meliandou,
in the southern part of Guinea.

According to the American Center

for Disease Control
and Prevention,

the boy is believed to have
been infected by a bat.

He died on the 28th
of December 2013,

followed throughout
the next month by his mother,

sister and eventually,
his grandmother.

On the 1st of February 2014,

a member of the deceased
child’s extended family

traveled to Conakry,
the capital of Guinea.

That individual died
four days later,

having by then infected
many other people.

The World Health Organization

opened an investigation
on the 13th of March

after the Guinea Ministry
of Health issued an alert

about the unidentified
infections,

which they suspected
was Lassa fever,

very common to the region.

Samples of the pathogen

were immediately sent to the
Pasteur Institute in France.

Within a day, they confirmed
that the patients

from which samples
had been taken

were infected
not by Lassa fever

but by Ebola.

The W.H.O. officially announced

that there was an outbreak
of Ebola.

At that stage, there were
already 49 confirmed cases

and 29 deaths.

It’s just amazing
how this disease

can spread so widely
and so silently

and then have such devastating
effects in the community.

So it is very important

to not give false hope
to anybody

that Ebola
can be treated now.

This is absolutely
not the case.

What we are relying on now

is proper implementation

of infection prevention
and control,

control tracing and quarantine
of people who have the disease,

quarantining of contact
to make sure

that they would be
under proper treatment

if they, indeed,
have the disease.

Between early June
and the middle of September,

the epidemic grew
exponentially.

National case numbers were
doubling every 16 to 30 days.

The United Nations Security
Council issued a statement

stating that they were
extremely concerned

about the Ebola epidemic.

They sought immediate help

from the international
community

to stop any further spread
of the virus.

On the 23rd of July,

the World Health Organization
confirmed

that there were now more than
800 Ebola cases in the region.

The Peace Corps
took the painful decision

to evacuate
its volunteers from Liberia,

Sierra Leone and Guinea,

because of concerns
for their health and safety.

The Center for Disease Control
in America

warned U.S. residents to avoid
all non-essential travel

to those countries.

By the middle of September,

there were 5000 reported
cases of Ebola

and almost 2500 deaths
across the globe.

At the special request of
the World Health Organization,

Germany began admitting
patients into the country

who required
immediate treatment.

German doctors admitted
a foreign patient

into a brand-new tropical
medicine unit in Hamburg,

which specialized
in the treatment

of contagious diseases.

Staff members of the facility
assured the press

that the critically ill patient

posed no significant risk
of spreading infection.

He would be treated
in a special isolation ward

behind three separate
air locks.

Within the isolation unit,
no liquids, gases,

or particles in the air

could possibly reach
the outside world.

This extraordinary safety
measure was put in place,

despite how unlikely it is
for Ebola

to spread through the air.

The W.H.O.
said that the patient worked

in an Ebola testing
laboratory in Sierra Leone.

He arrived at Hamburg airport

on the 27th of August
in a specialized plane,

which had been modified
to transport patients

requiring isolation.

From there,
he was transferred

to a special
isolation ambulance,

accompanied by a convoy
of police cars on its journey

to the University Hospital
Hamburg-Eppendorf.

When news
of the patient’s arrival

was released
to the public,

reactions were mixed.

Some expressed concern

that allowing such a contagious
person into the city

could pose a genuine
public health risk.

Others felt that the need
to help this desperate person

far outweighed
any potential for danger.

They also contended
that the treatment

could aid and advance
medical research.

On the 3rd of October,

Germany accepted
yet another Ebola victim,

this time to a hospital
in Frankfurt-am-Main.

They were flown in on a medical
flight from West Africa

and transferred
to the isolation unit

at Frankfurt
University Hospital,

all under deep cover.

The patient
was a Ugandan doctor

who had been working with Ebola
patients in Sierra Leone

before falling ill
with the virus himself.

Though two of his patients

responded positively
to treatment,

both he and a third patient
had not been so lucky.

This third patient had been
a U.N. employee from Liberia

who landed in the northern
German town of Leipzig,

200 kilometers
southeast of Berlin,

in the early hours
of the morning.

There, they were met
by a medical team

wearing biohazard suits

and taken immediately to
St. George hospital in Leipzig,

which had a tropical disease
clinic with six rooms

where the patient
could be treated

under the strictest
quarantine.

Sadly,
despite their best efforts,

the patient succumbed
to the disease.

The first individual to die
of Ebola on German soil.

On the 24th of November,

it was also confirmed

that an Italian doctor
who had been working

for a medical charity treating
Ebola victims in Sierra Leone

had, himself, become infected
with the disease.

He was flown back to Rome

where he was successfully
treated.

On the 29th of December 2014,

the United Kingdom was also
drawn into the epidemic

when the first case of Ebola
was confirmed in the nation.

The victim was a female nurse

who had returned
from voluntary work

at an Ebola treatment center
in Sierra Leone.

This case was concerning,

because her journey
from Freetown

had taken her
to several major global cities.

First, to Casablanca
in Morocco.

Next to London, in England.

And finally,
to Glasgow, in Scotland,

her ultimate destination.

After suffering from fever
and headache,

she was admitted
to a specialist unit

for infectious diseases

at the Gartnavel Hospital
in Glasgow,

where she was kept
in strict isolation.

The patient was displaying
no symptoms of the kind

that would lead
to onward transmission

and put other people at risk

before she had reported,
this morning, as being unwell.

A day later,
she was transferred

for specialist treatment
at the Royal Free hospital,

where the facilities,
staff and systems

were in place
to ensure the safest care.

Public health authorities

began to investigate
possible contacts

that the nurse may have had
with other people in Britain.

It’s important to stress

that the risk to the general
public remains very low,

but we are contacting
the passengers

who were on the flight
with her.

There’s a special dedicated
help line for them to call,

so that if they have
any concerns at all,

they’re able
to communicate easily.

As well as liaising

with the World Health Authority
in Morocco,

where the victim
had changed flights

on her journey
back to the U.K.

She has since
made a full recovery.

As of April 2015,

there were 176 organizations
in Sierra Leone,

Guinea and Liberia,

all conducting
emergency programs.

Liberia was initially
declared Ebola-free

by the World Health
Organization

on the 9th of May 2015,

after more than
4000 people had died.

But Ebola was not yet beaten.

On the 12th of May 2015,

an Italian healthcare worker

who had been treating
Ebola patients

in Sierra Leone
for nearly three months,

fell ill three days
after returning back to Italy.

He was taken to the infectious
diseases ward

at the hospital
of Sassari in Sardinia,

where he tested positive
for Ebola.

Several small outbreaks
reoccurred in Liberia,

with a cluster of six new cases
confirmed in June 2015.

On the 3rd of September 2015,

Liberia was again
declared Ebola-free

before the emergence
of an additional three cases.

I came on the beach today
to celebrate Ebola

because Ebola
has left Liberia,

and we are going back
to our normal activities.

I just came on the beach to
enjoy myself because I’m alive.

Ebola did not take my life,

and none of my family alive
were taken away by Ebola.

So I came on the beach today
to enjoy myself.

Guinea was declared Ebola-free

on the 29th of December,

with Liberia to follow
on the 14th of January 2016.

This was now its third
official declaration

of complete inoculation,

only this time,
things stayed that way.

People should not remain
complacent.

It was the same complacence

that led to the second round
of the virus emergence.

And people should continue
to observe the practices

to ensure that
they can remain safe.

Once Sierra Leone
was given the all clear,

all three
West African countries

had officially
become Ebola-free.

The World Health Organization

lifted the Public Health
Emergency

of International Concern
related to the epidemic.

The W.H.O. reported that there
had been around 28,000 cases,

with more than 11,000 deaths
due to the epidemic.

But the true human cost
of Ebola was much higher.

It has been estimated
that over than 30,000 children

were left orphaned
by the disease.

According to Médecins
Sans Frontiers,

also known
as Doctors Without Borders,

it is impossible to be sure
how many people died

as a result
of the Ebola epidemic.

In addition to those deaths

resulting directly
from the Ebola virus,

there followed
a dramatic increase

in latter mortality rates,

due to an increasing lack
of basic health care.

This can be demonstrated by
the fact that as of March 2015,

over a million fewer children
were vaccinated against measles

than prior
to when the epidemic began,

which undoubtedly led to more
deaths from that disease.

There was also an increase
in the number of people

who lacked food security

as a result
of the 2014 Ebola epidemic.

This was estimated to be
in the hundreds of thousands.

The health of pregnant women
in West Africa

was also drastically impacted
by the Ebola epidemic.

Pregnancy appeared to make
women more vulnerable

to the effects
of the Ebola infection.

It particularly increased
their risk of hemorrhage.

There was also evidence
suggesting that the virus

was able to cross
from the placenta

into both the amniotic fluid
and the developing fetus.

Tragically, the pregnancies
of women infected with Ebola

all ended through either
a spontaneous miscarriage,

stillbirth, or death of the
newborn baby within a few days.

On top of the dangers
Ebola presented to the mother,

healthcare workers assisting
the delivery of babies

were at extreme risk
of infection.

The fear of health workers
treating women

from areas known
to be high in Ebola cases

led to a lack of maternal care
for pregnant women.

The United Nations
Population Fund

estimated that
the Ebola epidemic

could have either directly
or indirectly

resulted in as many
as 120,000 maternal deaths

by the end of October 2015.

The psychological well-being
of the survivors of Ebola,

as well as the families
of patients

and victims of the disease
became a major concern.

I’ve met some people
who have had Ebola,

and they described it
in first-person terms to me.

And it’s not--

You wouldn’t wish it
on your worst enemy.

In July 2014,

the first case of Ebola was
diagnosed outside of Africa.

This meant that the outbreak
could no longer just be viewed

as a humanitarian crisis.

It had become a palpable
security threat

to countries
all across the globe.

Due to the rapid
interconnectedness

of the modern world,

leaders could no longer ignore

urgent health crises
in distant countries,

as they would be putting
their own citizens

at a greater risk
of infection.

The lessons we learn,

particularly from the Ebola
epidemic in 2014/15,

which affected some of the
poorest countries in the world,

was that if we don’t improve

the ability of the poorest
countries to respond now,

we’re going to be left,
as the wealthy countries,

having to intervene later,
and spending a lot more money,

a lot more people dying,
a lot more risk to ourselves,

than we would if we had
invested to start with,

and helped those countries
develop the capacity they need.

As a result of this epidemic,

several influential figures

have called
for a renewed focus

on international
public health issues.

Microsoft founder Bill Gates
has spent billions of dollars

working towards the eradication
of global diseases.

He has advocated for building
health organizations in most,

if not all,
countries around the globe,

which could function

as an international
early alert system

for potential new outbreaks.

Some of those same kinds
of preparations

of having lists of volunteers

and knowing that people are
trained and really practicing

for something
very challenging,

that’s probably
one of the lessons

out of this Ebola epidemic.

A flu pandemic
poses the biggest challenge,

in terms of responding quickly,

because flu spreads very,
very fast.

It’s about two, three days

between one person
getting infected

and them infecting
the next person

and the next person.

So we know how to make flu
vaccines against flu pandemics.

The challenge is that
we’re in a race against time

against the virus itself.

So back in 2009, it took us
about five, six months,

and we were doing well,

to make large amounts
of the vaccine.

And that was already too late
for much of the world.

There is enormous effort now,
in the intervening 10 years,

to speeding up that process.

We’re not quite there yet,

but there is the potential
of new technologies

allowing us to mass produce
enormous quantities of vaccine

on a much faster timescale.

And I would envisage
that in the next 10 years,

those-- Those new technologies
will come to fruition.

The 2014 Ebola epidemic
in West Africa

highlighted major deficiencies

in the ability of the
international public health

and scientific communities

to respond to infectious
disease emergencies.

It also provided a stark
reminder of the consequences

of not investing
in the development

of healthcare infrastructure
in developing countries.

The world kind of woke up
to the threat of new epidemics,

really, with the SARS
epidemic in 2003/4,

followed by avian influenza.

The wealthy countries
in the world

then started investing
significantly,

both in research,
but also in preparedness.

And that is...

First of all, in health systems,
better surveillance.

Picking up diseases
at the earliest possible stage

in an epidemic, so you have time
to do something about it.

Improving our ability
to make vaccines,

for instance,
against flu viruses.

Also, now,
just in the last few years,

starting to actually
develop vaccines

against some of these viruses,

even before
they become a pandemic.

And then there’s,
of course,

much of the world
is not wealthy enough

to put enormous amounts
of money

into epidemic preparedness.

But even there, there has been
the increasing investment,

by particularly, like the U.K.,
Germany, the United States,

in helping countries develop
healthcare infrastructure,

which enhances surveillance,
more generally,

enhances their ability
to respond

to that sort of emergency.

There is, however,

still an issue.

Companies are focusing

on the development of drugs
and vaccines

to tackle the chronic diseases

which predominately affect
people in the developed world,

and not the diseases which are
more likely to cause epidemics.

If we are going to prevent
future pandemics,

we must be
continually developing

powerful new vaccines.

When it comes to flu, one of
the things that’s interesting

and quite stunning
are the recent efforts

to develop a vaccine that does
not require prediction anymore.

These are called
"pan-influenza" vaccines.

The idea is you find a way
to vaccinate people

against any flu strain
that is out there.

I think, we are relatively far
away from this,

but if that worked, of course,
that would be amazing.

Certainly, it’s true,

that we have an ever-present
risk of a lethal pandemic.

And if we’re talking about,
for instance,

a virus similar in lethality
to the 1918 pandemic,

even with modern
medical technologies,

that could easily cause
30 million deaths worldwide.

We must also do our best
to address changes

that are occurring
in the Earth’s climate,

which can affect the spread

and reach
of infectious diseases.

We know from malaria,
for instance,

the limits of malaria infection
in the world

are dictated by the mosquitoes
that can transmit it.

The limit there is that they
have to survive the winter

so that the parasites
can develop in the mosquitoes

and then come back next year.

Now, with global warming,

these mosquitoes can extend
much more to the north

than they did in the past.

There are similar developments
for viruses

that use mosquitoes
to transmit.

One example is the West Nile
virus in the U.S.,

which didn’t exist there,

but now is there because it can
be transmitted by mosquitoes

that didn’t live there before.

So global warming

clearly plays into
the distribution

of infectious diseases.

The Ebola outbreak
clearly demonstrated the risk

that increasing accessibility
to air travel

can pose
to infection control.

As well as the spread
of disease,

there is also the panic
that can ensue

when infected people
are moving freely and quickly

across international borders.

It is clear that within an ever
more interconnected world,

the threat of diseases

spreading rapidly
around the globe

has become
more probable than ever.

And if a global pandemic does,
indeed, become our reality,

it won’t matter who you are,
or what continent you live on.

No one on this planet
will be truly safe

if Mother Nature unleashes

her most inescapable
deadly disaster.