Death defying decisions
The Democratic Republic of Congo is facing one of the greatest health crises of its history. In August of this year, its Ministry of Health declared a new outbreak of the Ebola virus; in November, a World Health Organization (WHO) official warned that the outbreak could last at least another six months. More than 200 people have already died.
When should public health officials declare a global health emergency?
In a case study on the start of the last West African Ebola virus epidemic (2014–2016), my colleague Gilles Hilary of Georgetown University and I wrote about life-and-death decision making in the management of a global health crisis. We looked at two organizations – Médecins Sans Frontières (MSF or Doctors Without Borders) and WHO – and how each group approached the data and other information from the earliest points of the outbreak. Despite nearly identical levels of expertise and access to data, the two organizations reached radically different conclusions about the seriousness of the outbreak.
We opined that indicators beyond the virus, its epidemiology, the number of cases, and its geographic spread were at play in their decision-making. Where MSF connected the dots to form a picture very specific to the region, the timing, and critical conditions, WHO benchmarked the outbreak against historical health events of similar size, even in far-flung regions. We believed that WHO, as the UN-authorized decision-maker, balanced the risk of declaring an emergency against acknowledging one – that is, the wrong assessment could yield potentially disastrous outcomes for the region’s economies.
With Saed Alizamir of Yale University and Shouqiang Wang of the University of Texas at Dallas, I explored this matter in greater depth. In our award-winning research – published as “Design of Public Warning Systems" – we conclude that even credibility plays a significant role in how organizations interpret and act on warning system policies. When agency credibility is low, risk is downplayed to improve credibility. In high credibility cases, the agency may exaggerate risk.
MSF declared the outbreak an emergency in March 2014; WHO identified it as such in August, five months later. In the end, based on more than just data, MSF was unfortunately proven the wiser. The Ebola outbreak resulted in more than 10,000 deaths.