Flash point: science meets policy

Flash point:
Science meets policy (photo–Leslie Willoughby)

The story of the world’s first Ebola epidemic burns at the flash point between science and policy, an enticing yet frightening intersection that can make or break a writer’s credibility.

During an after-dinner speech at the time when the outbreak is beginning to dominate the news, I grasp the value of health care policy and grapple with how to maintain my credibility as a scientist when writing about it.

By this Oct. 7 evening, as science writers meet for dinner in San Francisco, the 2014 Ebola outbreak has claimed 3,400 lives. Donald Francis speaks about how the current outbreak differs from earlier ones. Francis, a physician and epidemiologist who built his career as an AIDS researcher, was one of four Westerners to observe the first cases of Ebola in 1976.

 “We have this remarkable–I would say preventable– failure at this point where we have far more cases of Ebola now than we had for the past years and decades,” says Francis.

Previous epidemics struck in remote jungle villages where respected tribal leaders set rules for quarantine. Francis clicks to a chart that displays a dramatic decrease in cases within a given locality over time. “We get these massive outbreaks and then the next year you can see they get it down.” Francis says. Experience fighting the disease boosts the odds against it during later outbreaks.

“It’s very different now,” Francis says. “It’s like a fire. Control it early, it will stop; if you don’t, it gets out of control.” All we need to control Ebola is “old fashioned public health—find the cases and isolate them,” he says.

The total number of Ebola cases ever recorded had totaled 2,800 until adding 7,800 new cases this year. So why is this outbreak so much worse?

“It’s a terribly chaotic political situation in the area,” says Francis.  There was no public health infrastructure to let everyone know when the outbreak started, over a year before.

 In a blur of words, Francis sets the scene for this year’s urban epidemic, “getting out of a 50 year dictatorship…fewest beds per capita in the world…civil war that went on for 20 years…Sierra Leone has the lowest life expectancy in the world..and it’s all connected to the Liberian civil war.”

So there we have it. Ebola hits so hard this time because no one saw it coming in chaotic war-stricken urban areas; there are no respected leaders to enforce quarantine; and resources are stretched thin.

After the presentation, we science writers ask questions from our comfort zone, science.  We want to understand the biology driving the epidemic: different isolates of Ebola, the evolution of the virus, hydration, vaccinations and blood serum.

For us, Francis has one answer, “Aside from the social chaos there really is no evidence that there is anything different about this bug.”

For Africa, he has none. “I don’t know what ultimately you can do when you have outbreaks of this size,” he says.

For America, Francis offers two recommendations: that we make a long-term commitment to disease prevention and that we arm boards of health at the federal, state, and local levels with the legal authority to fulfill that commitment.

When Francis ends his talk, we science writers don’t stand and cheer; we silently walk away to think, to sleep, perchance to dream of writing at the flash point. If Francis intended to recruit us to support a long-term commitment to public health, it seems no one enlisted. But why should Francis, a doctor, attempt to persuade science writers to link public health policy with Ebola?

Moreover, why should I as a science writer risk my credibility–the foundation of my career–to link policy with science?

This question lingers and I have begun to find answers.  For me, one of the most meaningful goals of science writing is to help my readers and myself understand how a topic fits with the way we live in the world. And the way we live in the world often leads to, or responds to, government policy.

Eleven days after Francis’s talk, panelists  addressed the science/policy flash point at a conference for science writers. To maintain credibility, they advised that science writers avoid analyzing policy itself and instead explore how different policies affect people.  That sounded just right.

The next time I write about Ebola, I probably won’t urge my readers to support a government commitment to public health. I probably won’t prescribe what legal authority a board of health should have, either.  But both messages may be implicit  when I tell how respected leaders and an isolation policy continue to boost the odds of survival for tribal villagers in Africa.