Thread by @RanuDhillon

In 2014, I was on a 'task force' convened by Guinea's President to forge a nat'l Ebola response

Cases were spiking, it was a polarizing election year &, though many efforts were happening, there was no overall strategy or unified response

Here's how we set up the response

1/15

The first step was to establish a clear chain-of-command leadership structure under the National Ebola Coordination Cell with Dr Sakoba Keita as its head

All partners (eg, WHO, MSF, other ministries) & all response activities had to go through the Cell

2/15

We then created an overarching national strategy that included all interventions (eg, testing, contact tracing)

This wasn't just a laundry list of things that could help but aimed to spell out the combo of measures needed to actually reach zero within a defined timeframe

3/15

Many aspects & especially timelines had to be periodically updated based on the trajectory of the epidemic but this strategy created an overarching framework for how & where to focus efforts with ending the epidemic as the goal

4/15

We then translated this national strategy into location-specific & timebound operational 'micro-plans' with 4Ws--who will do what where by when?--with the idea that each organization was assigned to what they uniquely did best (eg MSF led treatment, WHO/CDC contact tracing)

5/15

With that, we had an overarching nat'l response but the most important work was implementation at the local level. The 'ground game' defined whether or not we'd succeed

A similar structure was set up in each district to adapt strategies & coordinate day-to-day execution

6/15

Once main response structures & activities were in place, we investigated new cases to try to understand where gaps still remained or lapses in execution were occurring & used that info to improve execution

7/15

https://twitter.com/RanuDhillon/status/1263669198015717376?s=20

A major challenge we saw was misinformation & rational mistrust from communities who had for years been neglected or exploited (nejm.org/doi/full/10.10…)

To overcome this, we implemented an intensive & systematic community engagement strategy led by Cheikh Niang & others

8/15

Teams of anthropologists went village-by-village, neighborhood-by-neighborhood to listen to communities, understand their concerns & feed that back into how we did things, such as safe burials of those who had died from Ebola

9/15

This process--though painstaking--was essential & built trust over time

We also tried to engage politicians from both leading parties & empower religious and traditional leaders to push messages to their communities

10/15

In summary, we:
(1) set up unified leadership & coordination structure
(2) created a coherent national strategy
(3) translated overarching strategies into operational plans
(4) built up local level capacity & organization to execute

11/15

(5) used data to refine our approaches & implementation
(6) systematically & deliberately engaged & built trust with communities

All of this didn't happen seamlessly or even smoothly. It involved lots of local, national & organizational headbutting, politics & sheer grind

12/15

But many of the steps mirror with what we need to do now in the US

Broadly, we know the strategies to pursue but have to weave them into a coherent overall strategy ideally spearheaded by CDC

13/15

We then need to convert that into local action informed by local data ideally by adequately supported & funded state & local health departments

We also need to find a way to bridge political, ideological etc divides & get groups resistant to control efforts on board

14/15

All of this will be important to respond to the unprecedented 'supersurge' we're likely about to face, save lives until vaccines are ready & make sure they get deployed as efficiently as possible once they are

15/15

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