1 00:00:02,000 --> 00:00:04,433 HARI SREENIVASAN: Next: After the containment of the Ebola outbreak, scientists are looking 2 00:00:04,433 --> 00:00:08,266 around the corner for the next serious threat to global threat. 3 00:00:08,266 --> 00:00:13,266 Judy Woodruff recently sat down with Liberian-Born Dr. Raj Panjabi at Spotlight Health in Aspen, 4 00:00:14,833 --> 00:00:17,833 Colorado, to discuss the challenges of preventing the next pandemic. 5 00:00:17,833 --> 00:00:21,166 Warning: Some of the images in this report may be disturbing. 6 00:00:21,166 --> 00:00:26,166 JUDY WOODRUFF: Dr. Raj Panjabi, thank you very much for joining us. 7 00:00:28,300 --> 00:00:31,133 What do you think the world learned from the last Ebola outbreak of just a couple of years 8 00:00:31,133 --> 00:00:35,066 ago, and do you think we're ready, the world is ready for the next one? 9 00:00:35,066 --> 00:00:37,166 DR. 10 00:00:37,166 --> 00:00:39,300 RAJ PANJABI, Last Mile Health: You know, I think there are many lessons that have been 11 00:00:39,300 --> 00:00:42,133 learned from the crisis and still are, but probably one of the most central, fundamental 12 00:00:42,133 --> 00:00:47,133 lessons is this basic notion that illness is universal and access to care isn't, and 13 00:00:48,766 --> 00:00:52,066 that that actually places all of us at greater risk. 14 00:00:52,066 --> 00:00:57,066 We have known this from even the first boy who died in the Ebola crisis, Emile, a 2-year-old 15 00:00:58,600 --> 00:01:01,733 in the rain forest in Guinea. 16 00:01:01,733 --> 00:01:06,733 He died after having vomiting, fever and diarrhea in December of 2013. 17 00:01:08,700 --> 00:01:11,333 It took three months for the world to realize that this was an outbreak. 18 00:01:11,333 --> 00:01:16,333 He lived in a forest community that -- in rural parts of West Africa where the forest 19 00:01:17,533 --> 00:01:19,700 is dense, but health workers are sparse. 20 00:01:19,700 --> 00:01:24,700 And so the virus spread during that time out of control, led to tens of thousands of people 21 00:01:26,233 --> 00:01:28,266 dying. 22 00:01:28,266 --> 00:01:30,933 JUDY WOODRUFF: One of the things you did was employ what you call community health workers 23 00:01:30,933 --> 00:01:33,266 to go out and do what you're talking about. 24 00:01:33,266 --> 00:01:34,733 What exactly did they do? 25 00:01:34,733 --> 00:01:36,800 DR. 26 00:01:36,800 --> 00:01:40,400 RAJ PANJABI: Well, community health workers are people from villages like Emile's where 27 00:01:40,400 --> 00:01:45,400 a middle- to high school-educated person would be trained for a matter of months and equipped 28 00:01:47,633 --> 00:01:51,066 to provide medical care door to door to their neighbors. 29 00:01:51,066 --> 00:01:55,100 Those workers are critical, in addition to nurses and doctors, because nurses and doctors 30 00:01:55,100 --> 00:01:56,533 are concentrated in cities. 31 00:01:56,533 --> 00:01:58,033 They don't reach rural areas. 32 00:01:58,033 --> 00:02:00,400 When I first came back, I grew up in Liberia. 33 00:02:00,400 --> 00:02:01,966 I fled during the civil war. 34 00:02:01,966 --> 00:02:04,100 I came back as a medical student. 35 00:02:04,100 --> 00:02:08,100 And what I found is that there were just 51 doctors for four million people. 36 00:02:08,100 --> 00:02:12,266 It would be like the city of San Francisco having just 10 physicians for the entire city. 37 00:02:12,266 --> 00:02:16,233 So, if you got sick in the city, you might stand a chance. 38 00:02:16,233 --> 00:02:18,300 But, in rural areas, you didn't. 39 00:02:18,300 --> 00:02:23,166 So, community health workers have been critical to providing health care, where doctors don't 40 00:02:24,366 --> 00:02:26,666 reach, and linking patients to care. 41 00:02:26,666 --> 00:02:30,733 What we did, for instance, when an outbreak happened in a rural part of the country, was 42 00:02:30,733 --> 00:02:35,733 to train and equip health workers from those communities to go door to door to work with 43 00:02:37,666 --> 00:02:40,033 doctors and nurses to find the sick and get them into treatment units. 44 00:02:40,033 --> 00:02:43,433 JUDY WOODRUFF: We have been hearing about community health workers for a long time. 45 00:02:43,433 --> 00:02:47,400 What's different about how they work now, the role that they play? 46 00:02:47,400 --> 00:02:49,966 DR. 47 00:02:49,966 --> 00:02:53,400 RAJ PANJABI: I think what's new now is a recognition that this is perhaps one of the most undervalued 48 00:02:54,600 --> 00:02:57,333 labor assets in the health work force. 49 00:02:57,333 --> 00:02:59,633 Long-term, they have been treated as volunteers. 50 00:02:59,633 --> 00:03:02,700 So, in other words, they don't get paid to do their work. 51 00:03:02,700 --> 00:03:06,833 Most are underequipped and many have been barely trained. 52 00:03:06,833 --> 00:03:11,833 What's different now is the recognition, as in the case of Liberia, after the Ebola crisis, 53 00:03:13,800 --> 00:03:17,433 taking a former volunteer community health work force and upgrading it, hiring those 54 00:03:19,466 --> 00:03:22,900 workers, employing them, training them, equipping them with the right gear and medicines to 55 00:03:24,100 --> 00:03:25,500 go door to door and provide health care. 56 00:03:25,500 --> 00:03:28,600 JUDY WOODRUFF: A larger question of epidemic pandemics. 57 00:03:28,600 --> 00:03:33,500 It seems we pay a lot of attention to them when we're in the middle of the crisis and 58 00:03:33,500 --> 00:03:35,933 it's on everybody's mind, people are dying. 59 00:03:35,933 --> 00:03:36,933 It's a very visual thing. 60 00:03:36,933 --> 00:03:38,233 But then we quickly forget. 61 00:03:38,233 --> 00:03:39,233 We move on. 62 00:03:39,233 --> 00:03:41,333 Our attention span is short. 63 00:03:41,333 --> 00:03:46,000 How confident are you that the world is truly prepared for the next pandemic and the one 64 00:03:46,600 --> 00:03:47,466 after that? 65 00:03:47,466 --> 00:03:49,500 DR. 66 00:03:49,500 --> 00:03:52,133 RAJ PANJABI: Well, we have done more to become prepared after the Ebola crisis. 67 00:03:52,133 --> 00:03:55,600 We're not yet close to where we need to be to be prepared for the next epidemic. 68 00:03:55,600 --> 00:03:57,600 The data shows this. 69 00:03:57,600 --> 00:04:02,500 We know that the cost of inaction is larger than the cost of action; $6 trillion is the 70 00:04:04,466 --> 00:04:08,266 estimated potential economic loss of a pandemic. 71 00:04:08,266 --> 00:04:13,266 But we're only spending 50 cents per person per year in providing surveillance and preparedness 72 00:04:15,800 --> 00:04:17,866 against preventing the next epidemic. 73 00:04:17,866 --> 00:04:22,733 JUDY WOODRUFF: We know that this is one of the things that funding by the United States 74 00:04:24,066 --> 00:04:24,833 can make a big difference, as to your point. 75 00:04:24,833 --> 00:04:25,833 DR. 76 00:04:25,833 --> 00:04:28,333 RAJ PANJABI: Yes. 77 00:04:28,333 --> 00:04:30,566 JUDY WOODRUFF: The legislation that is moving through the Congress right now, or what appears 78 00:04:30,566 --> 00:04:34,600 to be moving through the Congress, could make some significant cuts in that area. 79 00:04:34,600 --> 00:04:35,600 DR. 80 00:04:35,600 --> 00:04:36,800 RAJ PANJABI: Yes. 81 00:04:36,800 --> 00:04:37,600 JUDY WOODRUFF: What effect would that have? 82 00:04:37,600 --> 00:04:39,600 DR. 83 00:04:39,600 --> 00:04:41,633 RAJ PANJABI: Well, I think, make no mistake, the cuts would be devastating. 84 00:04:41,633 --> 00:04:45,466 And one of the untold stories of U.S. foreign aid is that it's had such a dramatic impact, 85 00:04:48,300 --> 00:04:53,300 largely because of investments in health care systems like Liberia's and poor countries. 86 00:04:55,200 --> 00:04:58,333 If there had not been an effort to invest U.S. foreign aid before, during and now after 87 00:05:00,433 --> 00:05:04,433 the Ebola crisis, you wouldn't have been able to surge front-line local health workers who 88 00:05:05,866 --> 00:05:07,866 went door to door to find the sick and get them into care. 89 00:05:07,866 --> 00:05:12,533 At that very moment when the CDC told us that there could be as many as 1.4 million cases 90 00:05:14,500 --> 00:05:18,433 of Ebola in Liberia and Sierra Leone, in the country I grew up and the one next to it, 91 00:05:20,433 --> 00:05:23,633 that very week, in Dallas, Texas, America diagnosed its first case of Ebola. 92 00:05:26,066 --> 00:05:28,900 So it's not a theory that epidemics that happen to people across the world can impact us at 93 00:05:33,066 --> 00:05:35,166 home quite literally. 94 00:05:35,166 --> 00:05:39,733 So I think this is the real story about foreign aid is, it's actually not aid. 95 00:05:39,733 --> 00:05:41,066 It's investment. 96 00:05:41,066 --> 00:05:42,766 It's a win-win. 97 00:05:42,766 --> 00:05:46,466 It saves lives abroad and it keeps us safer at home in America. 98 00:05:46,466 --> 00:05:49,600 And that's something we should all be proud of, actually, as Americans. 99 00:05:49,600 --> 00:05:53,800 JUDY WOODRUFF: Dr. Raj Panjabi with Last Mile Health, thank you very much. 100 00:05:53,800 --> 00:05:54,800 DR. 101 00:05:54,800 --> 00:05:54,933 RAJ PANJABI: Thank you, Judy.