Michael Specter and Jerome Groopman on the Ebola outbreak

Summary

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Episode Overview

Podcast: The Political Scene | The New Yorker
Episode Title: Michael Specter and Jerome Groopman on the Ebola Outbreak
Date: September 19, 2014
Host: Dorothy Wickenden
Guests: Michael Specter (Staff Writer, The New Yorker), Jerome Groopman (Staff Writer, Chief of Experimental Medicine at Beth Israel Deaconess Medical Center, Boston)

Main Theme:
This episode explores the rapidly escalating Ebola outbreak in West Africa (2014), examining the political, economic, and public health ramifications of the crisis. The discussion critically assesses the role of fear, self-interest, the US response under President Obama, and the global scientific approach to viral pandemics.

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Key Discussion Points and Insights

1. The Ebola Outbreak: Scope and Political Context

• Ebola as an “unprecedented epidemic”
  • Michael Specter (01:25): “Ebola is now an epidemic of the likes that we have not seen before.”
• Obama’s US-led response and its timing
  • Dorothy Wickenden (01:29): References Obama’s remarks about the outbreak “spiraling out of control.”
  • Michael Specter (02:08): Questions why urgency emerged only after months of escalation; points to American fear as a driver:
    • “I’m not sure why he decided now was not the time to dawdle. Except that in America people are petrified about this, unreasonably so.”
• Self-interest as a motivator
  • (02:53): Discussion highlights that humanitarian action is often guided by self-preservation.

2. Why Did the Outbreak Get so Bad?

• Porous borders and rapid transmission
  • Jerome Groopman (03:20):
    • “I think there are very porous borders among the countries of the western African coast…this caused very rapid transmission…shifts in geopolitics within West Africa has resulted in part with the emergence of the epidemic.”
• Comparison to other crises
  • Groopman (04:05):
    • Draws a parallel to the political response to ISIS—crisis feels urgent once it directly involves Americans.
  • Memorable moment (04:06):
    • “Here, bringing the physicians who were on missionary…to Emory University, all of a sudden it became us. And then it galvanized the president.”

3. Public Health Threat vs. National Security Threat

• Dorothy Wickenden (04:18):
  • Notes how epidemics have become framed as security threats.
• Groopman (04:41):
  • “It boils down to economic disruption that then spills over into, quote, security threat.”
  • The World Bank’s involvement signals acknowledgment of broader consequences, including poverty, xenophobia, and resource conflict.

4. Health Infrastructure and the “Medieval” Challenge

• Wickenden (05:17):
  • Quotes Paul Farmer on “medieval level care to a 21st-century plague.”
• Specter (05:31):
  • Describes dire conditions: “If you find aspirin on the shelves in the dispensary, in a hospital, it’s a big deal. The doctors are fantastic, but often poorly trained.”
  • Previous outbreaks often faded in remote regions, but this time, urbanization multiplied the crisis.
• Role of fear:
  • Specter, citing World Bank (06:21):
    • “80 to 90% of the economic disruption…is based on fear…that’s what we have to combat even more than anything else.”

5. Diverging International Strategies: Urban vs. Rural Intervention

• Groopman (06:42):
  • Describes Jim Kim (World Bank president) and Paul Farmer’s alternative approach:
    • Warns against urban treatment centers that spur dangerous migration from rural areas, spreading disease.
    • Endorses soros-backed funding ($4 million pledge) for rural treatment centers to check epidemic at its source:
      • “Farmers contention for many years has been that the West dismisses the capacity to care…in rural Africa. And this will be a test of that hypothesis.”
• Cultural barriers:
  • Specter (07:53): Notes the importance of accommodating local burial customs and the role of education:
    • “Education is the key to this, but it’s a specific education. What works in New York City isn’t going to work in rural Sierra Leone, necessarily.”

6. Success Stories and the Power of Community Interventions

• Wickenden (08:29):
  • Notes Farmer’s success in Rwanda.
• Groopman (08:40):
  • Farmer’s model: empower local health aides, not just doctors, to perform key interventions.
    • “Interventions which could be performed by competent but not highly trained community leaders…to sort of stem the epidemic and nip it in the bud…”

7. Viral Mutation and the Reality of Pandemic Threats

• Wickenden (09:22):
  • Notes prior comments by Specter on pandemic threat.
• Specter (09:43):
  • Viruses mutate rapidly—but often, less lethal forms survive due to evolutionary pressures:
    • “It’s just a Darwinian evolutionary tactic to be possibly virulent, but less virulent in terms of our problems…”
  • Modern travel accelerates pandemic spread; scientific tools exist but aren’t always used effectively.
• Vaccine innovation needs:
  • Specter (11:02): Argues for shifting away from outdated vaccine production techniques: “Mostly what we’re doing is growing vaccines in eggs the way we did after World War II. And that has to stop…we don’t have time for that.”

8. Challenges to Vaccine Development

• Groopman (11:35):
  • Industry incentives are misaligned; vaccines less lucrative than drugs like statins.
  • Liability risks deter development.
  • Memorable quote (12:23):
    • “If you have a choice between developing a vaccine and developing the 11th form of Viagra, you’re going to go with the Viagra because you’re going to make more money.”
• Specter (12:23):
  • Advocates for government subsidies and public health systems to drive vaccine innovation.

9. Funding and the Road Ahead

• Specter (12:55):
  • UN’s call for $1 billion is “a nice down payment. I’m sure that 10 billion would be better.”
  • Emphasizes urgent support for comprehensive, rural, and educational interventions.

10. Prognosis for the Coming Months

• Groopman (13:18):
  • Predicts further rapid spread in West Africa, with probable new cases in Europe, the US, and Australia due to global travel.
  • Realistic and sobering outlook:
    • “It will take time…urban treatment areas or if Paul Farm is successful, the rural, but the educational and cultural interventions…So there’ll be a lot of bad before there’s any good.”

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Notable Quotes & Memorable Moments

• “Ebola is now an epidemic of the likes that we have not seen before.”
  — Michael Specter (01:25)

• On self-interest:
  — “Let’s not pretend that’s not what’s going on here.”
  — Michael Specter (02:54)

• On US perception changing once “it became us”:
  — “Here, bringing the physicians who were on missionary…to Emory University, all of a sudden it became us. And then it galvanized the president.”
  — Jerome Groopman (04:06)

• On fear and economics:
  — “80 to 90% of the economic disruption…is based on fear…that’s what we have to combat even more than anything else.”
  — Michael Specter (06:21)

• On global vaccine production:
  — “Mostly what we’re doing is growing vaccines in eggs the way we did after World War II. And that has to stop…we don’t have time for that.”
  — Michael Specter (11:02)

• On pharmaceutical incentives:
  — “If you have a choice between developing a vaccine and developing the 11th form of Viagra, you’re going to go with the Viagra because you’re going to make more money.”
  — Michael Specter (12:23, agreeing with Groopman)

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Important Timestamps

• 01:25: Specter introduces the crisis scale (“an epidemic of the likes that we have not seen before”)
• 03:20: Groopman explains rapid epidemic spread due to West African geopolitics and porous borders
• 04:41: Groopman differentiates health and national security threats
• 05:31: Specter discusses lack of health infrastructure, impact on epidemic control
• 06:21: Specter and World Bank on economic impacts driven by fear
• 06:42: Groopman explains World Bank/Farmer's rural-centric strategy
• 07:53: Specter highlights need for culturally appropriate education
• 08:40: Groopman outlines Farmer’s success with local interventions in Rwanda
• 09:43: Specter explains viral mutation and vaccine timelines
• 11:02: Specter and Groopman critique current vaccine production incentives
• 12:55: Specter on funding needs
• 13:18: Groopman predicts spread, need for long-term interventions

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Tone and Final Takeaways

The conversation is analytical, nuanced, and urgent, combining scientific insight with strong critiques of political and economic inertia. The hosts and guests press for culturally sensitive local interventions, highlight global interconnectedness, and stress the need for innovative, well-funded responses to pandemic threats.

Final message:
Only robust investment, education tailored for local realities, and a willingness to change entrenched systems (like how we produce vaccines) offer hope for preventing future crises of this magnitude.

Transcript

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[Dorothy Wickenden]

This is the Political Scene, a weekly conversation with New Yorker writers and editors about politics. It's Thursday, September 18th. I'm Dorothy Wickenden, executive editor of the New Yorker.

[Michael Specter]

Ebola is now an epidemic of the likes that we have not seen before.

[Dorothy Wickenden]

At the Centers for Dis Control in Atlanta. This week, President Obama announced a U S led response to Ebola, which he said is spiraling out of control in West Africa.

[Michael Specter]

If the outbreak is not stopped now, we could be looking at hundreds of.

[Jerome Groopman]

Thousands of people infected with profound political.

[Michael Specter]

And economic and security implications for all of us.

[Dorothy Wickenden]

Dr. Jerome Grootman and Michael Specter are talking with me today about the politics of the epidemic. Michael, I just read a piece that you've written for the New Yorker's website today and you talk about how self interest and fear are playing into the political discussion of Ebola. Talk about that a little bit.

[Michael Specter]

Look, I think it's great that we're sending a lot of money to Africa and the more that we can help them, the better. But when the President talks about this is not a time to Dawdle. Well, the annual per capita income spending on health care in Sierra leone is about $30. These countries have no health infrastruct. They have very few medicines and poorly trained doctors and no good roads and no clean water. Of course this stuff is going to happen. This isn't new. And in fact, this epidemic started in March and it's been going on for months and it's been getting worse and worse and worse. So I'm not sure why he decided now was not the time to dawdle. Except that in America people are petrified about this, unreasonably so.

[Dorothy Wickenden]

With their self interest.

[Michael Specter]

With their self interest. And it's fine to have self interest and it's fine to help others because you have self interest. Let's not pretend that's not what's going on here.

[Dorothy Wickenden]

Jerry, I want to ask you a quick question first and then get onto a slightly bigger one. Ebola was discovered in 1976 in Congo, which is 3,000 miles away from where the current latest outbreak started in Guinea. And I think there have been five outbreaks since then which have been contained. How did this one get so out of hand?

[Jerome Groopman]

Well, I think there are very porous borders among the countries of the western African American coast. And so the movement of people across borders, particularly infected people and then family members who are bringing sick individuals to presumably care or relatives, is what caused the very rapid transmission among different countries. And so I think the shifts in the geopolitics within West Africa has resulted in part with the emergence of the epidemic. I agree with Michael, also in terms of the self interest, in some ways it's analogous to the president finally doing something about isis.

[Dorothy Wickenden]

Absolutely.

[Jerome Groopman]

And here bringing the physicians who were on missionary in West Africa to Emory University, all of a sudden it became us. And then it galvanized the president.

[Dorothy Wickenden]

So this leads to my next question. Jerry. Obama isn't the first to describe an epidemic as a danger to national security in two the UN Security Council called AIDS a global security threat. And in 2005, George W. Bush described the bird flu in the same terms. You've studied AIDS for decades. How do you differentiate between a public health threat and a national security threat?

[Jerome Groopman]

I think the interface between the two, which is the argument made by the governments, has to do with economic disruption. It worsens poverty, it worsens xenophobia, and it can spark more internecine conflict, more fighting, basically because of competition over resources. The World bank recently has jumped into this just yesterday, and we might want to talk about that later. They're doing a parallel effort to what Obama is proposing in a very different strategy. So it really boils down to economic disruption that then spills over into, quote, security threat.

[Dorothy Wickenden]

Paul Farmer, who is a professor at Harvard and the head of Partners in Global Health, he describes the challenge in these countries that are applying medieval level care to a 21st century plague. Michael, could you talk a little bit about that?

[Michael Specter]

If you go to these countries very often and you find aspirin on the shelves in the dispensary, in a hospital, it's a big deal. The doctors are fantastic, but often poorly trained. Everyone's dedicated, but they don't have anything like the level of technology that, you know, even 19th century Europe had. The idea that they could even contain one of these epidemics is foolish on its face. And I think we face some bad luck in the poorest borders that Jerry talked about. I think what's usually happened in the past and I think probably happened long ago with HIV is there were epidemics and they would kill people and they would die out in their local region and they would be forgotten. This one has gotten into urban areas. But the World bank report that just is coming out now makes a big distinction between the physical viral threat and the threat to the economy based by fear. And they say that 80 to 90% of the economic disruption, which can be tremendous and truly a security threat, is based on fear. It's on the fear of people not going places. It's on the fear of people not buying things. And that's what we have to combat even more than anything else.

[Dorothy Wickenden]

So, Jerry, what is the World bank strategy?

[Jerome Groopman]

It's very interesting. There was a meeting. Jim Kim, who was the president of Dartmouth and now the head of the World bank, was Paul Farmer's partner in. And they actually take a very contrarian approach to what Obama and the World Health Organization, the CDC proposed. He thinks it's a mistake to set up these treatment centers within major urban areas because what's going to happen is family members from the rural areas will bring their sick relatives and travel miles and miles and miles, contaminating themselves and exposing others along the route. So apparently Soros gave $4 million yesterday, pledged it. And then there were other pledges from philanthropists with the World bank gathering so that pharma would actually set up treatment centers in the most rural areas to try to stem the tide of migration into the urban areas. And Farmers contention for many years has been that the west dismisses the capacity to care for people effectively in rural Africa. And this will be a Test of that hypothesis.

[Michael Specter]

I think it's also true that one thing we ignore a lot are the customs of different places in rural Africa. A lot of these people feel very strongly about burying their own family members when they die. And that's a lot of what the transmission has been. And what that needs is education. There needs to be a clear understanding that if you do that, you're going to get sick and probably die too. And that understanding is not there in the rural areas. You know, as is the case here, as is the case everywhere else. Education is the key to this, but it's a specific education. What works in New York City isn't going to work in rural Sierra Leone, necessarily.

[Dorothy Wickenden]

And is that what Farmer has done, for instance, in Rwanda, which you would have thought would have been the most impossible country to get back on its feet again and now seems to have a functioning health care system.

[Jerome Groopman]

You know, the success that he has had in reducing transmission of HIV and also reducing transmission of drug resistant tuberculosis. Farmer did it basically by going into these rural areas, which he saw as the sort of catalysts of the epidemic and setting up through education again, as Michael emphasized, interventions which could be performed by competent but not highly trained community leaders, quote, nurses, health aides and others to sort of stem the epidemic and nip it in the bud through interventions which didn't require, you know, the equivalent of an icu.

[Dorothy Wickenden]

Michael, getting back to the fear factor, you've said before that virus pandemics pose the biggest threat to humanity of all. In the H1N1 outbreak, more than a billion people were infected. So talk a little bit about that and how viruses mutate relatively easily and how we can fight effectively against something we can't even yet see.

[Michael Specter]

Well, viruses mutate rapidly and easily. It is important to point out something that isn't often pointed out, which is that when viruses mutate and there are exceptions, and those exceptions can kill us, they tend to go from more powerful to less powerful forms. And there's a simple reason for that. Because a virus needs a host in order to survive. And if it kills off all its hosts, there's nowhere left for it to live and it dies too. So it's just a Darwinian evolutionary tactic to be possibly virulent, but less virulent in terms of our problems with something like H1N1. It turned out that H1N1 was not as deadly even as most flus were, but a billion people were infected. And if we didn't have antibodies that were effective, that thing would have killed tens or Hundreds of millions of people. Because it's not 1918 where, you know, the flu traveled by train. Things zip around instantly around the globe. We actually have tools to deal with this. We can understand the molecular basis of a virus, we can look at the DNA, and we can in theory create vaccines rapidly. But mostly what we're doing is growing vaccines and eggs the way we did after World War II. And that has to stop because we don't have the time for that.

[Dorothy Wickenden]

Elaborate on that a little bit.

[Michael Specter]

Well, what you do is you figure out the culture, you figure out what's in the vaccine, and then you take the antibodies, you grow them and in eggs. And I think there are large farms in Pennsylvania where tens of thousands or more chickens are dedicated to this process every year for the flu. Now you could actually make this stuff in a lab. You could synthetically create the vaccine. You can make them rapidly and you can also change them rapidly as you see what the DNA mutations change. And that's got to be the future of vaccines.

[Dorothy Wickenden]

What about that, Jerry?

[Jerome Groopman]

Well, the problem with the whole vaccine landscape first of all has to do with incentives and money so that a lot of the big companies that were focused on vaccines have moved away. Vaccines are not nearly as lucrative as say, making the next statin its business. And they go where the maximum profits. The other has to do with liability. Even if there's a minuscule risk of reaction to a vaccine, there's concerns about lawsuits, malpractice. So there needs to be clever ways to address what has been a decades long problem, which is no real financial driver to make vaccines with the kind of new technology that Michael just emphasized.

[Michael Specter]

The fundamental thing Jerry said is absolutely true. If you have a choice between developing a vaccine and developing the 11th form of Viagra, you're going to go with the Viagra because you're going to make more money. And so we need some sort of subsidy system for that. I mean, that's theoretically why there are public health systems in the world. And it isn't going to get done without some sort of governmental help.

[Dorothy Wickenden]

The UN Security Council is holding a meeting today to discuss the epidemic. And the UN has already said that a billion dollars is needed to fight the outbreak. Does that sound right?

[Michael Specter]

It's a nice down payment. I'm sure that 10 billion would be better. But yeah, it's going to need a lot of money and it's going to need a lot of money fast. Because these things we've been talking about, education and getting people on the ground and getting people on the ground in rural localities. They take a lot of support and a lot of money and a lot of time, and we need to do that now.

[Dorothy Wickenden]

Jerry, how do you see this all playing out over the next six months or so?

[Jerome Groopman]

I think the epidemic will initially spread in a rather rapid way through the West African countries. It's quite likely that because of travel, as Michael emphasized, these microbes move around the world with the speed of planes. We will see cases in Europe, the United States, Australia, and so on. It will take time and it will take many months to set up the not only these urban treatment areas or if Paul Farm is successful, the rural, but the educational and cultural interventions which we talked about to really make headway. So there'll be a lot of bad before there's any good.

[Dorothy Wickenden]

Okay, thank you both. Jerome Grootman is a staff writer and chief of experimental medicine at the Beth Israel Deaconess Medical center in Boston. Michael Spector, also a staff writer, has reported widely for the New Yorker on diseases in the developing world. This has been the political scene from the New Yorker. I'm Dorothy Wickenden.

[Jerome Groopman]

You can subscribe to this podcast and other free New Yorker podcasts in the iTunes store. The weekly audio edition of the magazine is [e-mail] New Yorker subscribers can access the digital edition for tablets and phones at no extra charge from the App Store or from Google Play.

[Katie Drummond]

I'm Katie Drummond. I'm Wired's Global Editorial director. I'm Michael Colory, Wired's Director of Consumer Tech and Culture.

[Dorothy Wickenden]

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[Katie Drummond]

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[Michael Specter]

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[Michael Specter]

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[Michael Specter]

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