Following on from the Ebola blog Part I, here are some comments on 7 issues which surface from the case study. Each issue has a corresponding observations relevant for the BCM, crisis or security leader. However, these issues range from being positive to negative on a highly subjective scale and range from the strategic to the tactical (see diagramme below):
MORE POSITIVE ISSUES
Issue #1: Courage
• The outbreak has shown the most positive and the worst attributes of humans. The amazing people with courage have been seen to be the health professional, health workers working day to day with the victims and running massive personal risks. In Sierra Leone the countries’ sole virologist Mr. Umar Khan (can this really be true? – just one?) saves 100 people and then succumbs and dies. He is branded a national hero.
• The worst topic being the murder of the 8 person health education team in Guinea by local people in an affected district and the shooting of people in Liberia by authorities when enforcing movement control.
• The BCM consideration is that people can do amazing things and courage is found in many people, but they need leadership and support to deal with high hazard situations.
• Often individuals make the difference – so for BCM we need to identify the people capability and support the key people, as it is often a small number of people who really make the recovery happen. Find them in your exercises – the ‘Pareto’ principle 80% of the results come from 20% of the people.
Issue #2. Experience gained by world bodies of dread risk but thankfully not a fully transmissible infectious disease outbreak
• World bodies, national governments, medical, science advisors, charities and military have gained experience dealing with a ‘dread risk’. However, this is a limited transmissibility disease (maybe we will revise this assumption?) in that it is not airborne and as infectious as flu or smallpox.
• Normal risk and BCM process are still appropriate. Business impact analysis (BIA) will have identified minimum resources required and recovery strategies, but specialist hazard knowledge and travel systems will be needed to inform decision and mitigations. Crisis management and intervention will be needed.
• Techniques for uncertainty reduction can help e.g. scenario planning due to uncertainty. Pandemic planning can be referenced, however, much pandemic planning tends to be at the 1st level of maturity and not aligned to protect the core organizational strategy for weathering a national or international health crisis.
Issue #3. Mortality has been reduced but there are still major gaps in knowledge, science and health preparedness globally
• The Ebola outbreak has highlighted the weaknesses in national health care systems and the lack of real preparedness to provide vaccines for certain high mortality diseases. Gaps in knowledge, science and vaccination development illustrated.
• There is a false sense of security about what medicine and science can deliver at speed (this could be argued against the normal span of time and effort to bring new vaccine to market in non crisis times). However, Ebola was previously deemed to be a very high mortality disease and as it had been a regional disease in Africa the full weight of modern medicine had not been applied previously. In this outbreak as world resources have been applied, the mortality has lowered with supportive care from previously 90% fatal disease to a lot less. Over time it is likely that it will be conquered by vaccination. How long will this take is the question?
The BCM considerations
• The major positive is that engagement of world resources has happened to develop drugs and treatments and the precedent has been set for rapid ethic permission/process for a high mortality disease. However, the issues of the time taken to develop vaccine and then limited supplies will still be relevant.
IN THE MIDDLE – not sure if it is positive or negative – time will tell
Issue #4: Opportunity to learn when not a high transmissible disease
• There is a possible chance to learn and build better world systems to aid country weaknesses and to build better ‘normal’ health programmes.
• Learning must take place to capitalize on the lessons to be learned and preparation made of next more severe infectious disease outbreak.
Issue #5. Voluntary travel restrictions do not work
• Anecdotal evidence from news reports is that travel advice is not taken as mandatory and quarantine does not work if they are voluntary. The reproduction rate varies from disease to disease, but one report from the USA indicated for 1 person infected they were monitoring 84 other people, so even without an infection the effort is very large.
• There is a need to consider how to communicate effectively (risk communication) on the enforcement of quarantine and organizational policies. Given the experience of returning health workers and the success of not passing on the disease at home, then quarantine is still a valid concept in the absence of vaccination.
Issue #6. Society and customs trump science
• Low trust in politician/leadership and the authorities leads to more severe impacts. Local movement control and quarantine of districts is required if vaccination is not available. There is no other choice. This is not going to be an easy or pleasant duty and resolve is required.
• Enforcement of quarantine is very difficult and impacts normal life and the flow of essentials. National and local productivity impacts will linger on (debt, bankruptcy, interrupted business plans, orphans, social wounds, trauma etc. etc.) when the fire has been extinguished.
• How the communications of unpalatable measures is carried out is important. It is very difficult, where confidence in the authorities is already extremely low as in some African nations. Action needs to be based in the community and delivered in terms that are understood.
• Crisis leadership is required and resolve must be established and maintained.
Issue #7: Slow and ineffective intervention leads to poor containment and more-severe impact on society and development over many years
• Irrespective of your type of organisation, you need to realize that world bodies and governments are by reactive by nature and driven by politics. This prompts the need to have your own intelligence to detect, act and intervene effectively. This remains a core principle of effective incident and crisis management. If we detect a problem we must intervene to stop the escalation. This must be our aim so we don’t end up in crisis and ultimately disaster management.
With something as complex as the ebola outbreak I know I have only started to open up issues for this crisis. The impacts on GDP and the development index will be areas to watch to see what the impact really has been.
• People are at the root of capability. Even great people need leadership and development. How is your exercise programme assisting leadership to develop?
• Just because it is an infectious disease normal risk and BCM process still serve well but like other issues require specialist advice to assist incident and crisis management. Who are your specialist health advisors?
• New disease challenges take time to overcome, you must accept that there will be a drop in productivity until full response is organized. How does your risk management reflect new and novel hazards?
• Learning is central to a resilient organisation. What is your formal learning mechanism and is it credible or is it ad-hoc(might happen and might not)?
• What did you learn from previous infectious disease (SARs etc.) about the requirement for travel policies and mechanisms? How does you pandemic plan cater for this issue?
• How are you monitoring your people capital and absence rates to detect issues early on so that you can detect ‘not normal’ and act early?