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Journalist-author provides insights on covering the next infectious disease outbreak Date: 10/02/18

Lara Salahi

By Bara Vaida

Health journalist and author Lara Salahi partnered with scientist Pardis Sabeti to write about the devastating 2014 Ebola outbreak in West Africa and define the phenomenon of “outbreak culture.”

In their book, “Outbreak Culture: The Ebola Crisis And the Next Epidemic,” which will be published in November 2018, the two describe outbreak culture as a collective mindset that can develop in the beginning stages of an infectious disease outbreak among those who are trying to respond to it. Initial reactions may be based on fear and an instinct to protect oneself, other people or an institution, or on the desire to exploit others.

This mindset has existed in past outbreaks — from Zika to SARS, to the AIDS epidemic in the 1980’s — and persists today. It has led to governments to collectively remain stuck in the current state of responding to each outbreak like it is a new crisis rather than seeing that outbreaks are inevitable and require preparation. That mindset can leave the world remains woefully unprepared for a potential pandemic.

At the end of their book, Salahi and Sabeti offer some concrete ideas to help the world can better navigate the next infectious disease outbreak. In an interview with AHCJ, Salahi discusses how she came to write the book and gives advice for journalists covering infectious disease issues.

Q: How did you decide to write this book?

A: I initially did not set out to write a book. In November 2014, during the height of the Ebola outbreak, I was introduced to Pardis. At first, I wanted to write a piece that included her. We continued our conversation and met over many months, and each time I kept thinking, the narrative was more than a news or feature story. Both of us wondered whether what she and her lab experienced was unique to them, unique to Ebola, or even unique to outbreak response. From there grew this idea for collaboration to conduct hypothesis-driven work. We wanted to research the perceptions of outbreak responders during the Ebola outbreak and of past outbreaks to see what, if any, shared experiences they had. I thought I could write one story based on the findings that could publish with a one-time stamp, or I could do something more. We grew from a reporter-source relationship to let’s collaborate and do research and have it inform how we move forward. That is what turned into this book.

Q: As journalists, I know that we often come across sources that we think could be the subject of a book. How did you go from a reporter/source relationship to collaborating? 

A: In some ways, the Sabeti lab “adopted” me to collaborate on original research. The type of research we conducted, while related to the Ebola outbreak, was unlike the scientific work her lab typically does. But there was a lot we all could learn from the work, myself as a journalist and her team of scientists – and eventually the public. And they agreed that it could be driven by the reporter. Soon after, I left the [Boston] Globe. Meanwhile, I began reaching out and reporting on the experience of other people and organizations that responded to the Ebola outbreak, and how their experiences compared in other outbreaks. We began seeing patterns in the responses that we received. We thought at first that we might publish the research in a journal like The Lancet. Based on the reporting, and as patterns emerged, we thought this was more than a study. We turned the work into a book. Multiple parts of the book and even an entire chapter make a case for collaboration during outbreak response. Collaboration between agencies, between responders, between governments, and even between journalists and scientists.

Q: Were you just working with Pardis, or were you still working in journalism?

A: While working on our research and the book, I was still working in journalism and teaching as a professor of journalism at Endicott College.

Q: How many years did you work on this book?

A: The book will be published almost four years since we began our collaboration. Before we started our study, we went through Harvard’s Institutional Review Board process and got approval. [It’s a process that all professional scientific research studies must undergo at academic institutions.] Meanwhile we combed through past research, news coverage, and even spoke to responders of previous major epidemics, like SARS and AIDS. Many described a culture among responders and others involved in the initial stages of a disease outbreak — it is what we have termed “outbreak culture.” This collective mindset has dictated how we [as an international community] respond to outbreaks.  

Q: In what you are seeing with the current Ebola outbreak in the DRC, have any of the lessons learned from the 2014-2016 outbreak been implemented?

A: There has certainly been a swifter response than what was seen in West Africa. It’s difficult to project the outcome of what is happening in the DRC, but it’s critical that we don’t underestimate how quickly this could turn into a major disaster. International agencies understand this. There was a period of time in 2014 early into the outbreak when Ebola cases declined and officials and responders left the region, but it wasn’t over and recommitting resources became an added disaster. Our book discusses how outbreak culture manifests differently depending on the region, size, and scope of the outbreak. The differentiating factor and added challenge in the DRC is that an outbreak has emerged in an active conflict zone.

Q: Why do we seem to keep repeating the same mistakes with outbreaks? What did you learn about why we seem to keep reacting to each outbreak with surprise, rather than preparing and preventing them?

A: Our book discusses the underlying principles necessary to prepare for the next epidemic. The critical point is the need for a shift in mindset. What we know is that the culture of outbreak response transcends any one outbreak and any single institution organization tasked to respond to outbreaks.

Q: What was a big obstacle doing this book?

A: Some aspects of the book touch on the politics of outbreak response, and it was challenging to find people would speak on the record on some of their experiences. Our aim was to be as transparent as possible so we did not include anything we could not attribute on the record. Some people wanted to share their perspectives but would only do it if they did not have their full name, or a pseudonym used. We only included sources and information with real and full names. The only exception here is the survey research, which allowed for respondents to share information without attribution to their identity. Because of our commitment to transparency, there were some extraordinary experiences from primary sources that we did not include in this book.

Q: What do you believe are the best sources for journalists wanting to cover global health issues, besides the obvious and official organizations like the World Health Organization and the Centers for Disease Control and Prevention?

A: There is no one person or one place that one can go to get all the information you need. What is important is to get different perspectives – among them, ProMed, the Council on Foreign Relations, the Wellcome Trust, The Lancet, PLoS, CIDRAP. It’s up to journalists to dig deeper beyond the basic information and find and “advance the story.”

Q: You note in the book that there is a strong likelihood of another large-scale epidemic in the future. What can journalists do better when that happens in terms of maintaining the balance of informing the public but not creating hysteria?

A: How news stories frame an outbreak has a lot to do with how the population responds. During some outbreaks, the scientific community is learning about the pathogen as the outbreak is unfolding. There can be a lot we don’t know. So often we as journalists look for “answers,” because the public is looking for answers. I think it is important for journalists to communicate uncertainty. We should not equate communicating uncertainty with incompetence. As journalists covering infectious diseases, we should also strive to build relationships with the scientific community — perhaps during the interepidemic period — and vice versa.

Transparency seems to be a growing challenge between officials (particularly in large agencies) and among journalists. This is going to cost us. Ebola and outbreaks before and after are clear reasons for transparency and better communication. Pardis and I can tell you; there is value when we work together. Again, the case for collaboration.

Lara Salahi is an award-winning multimedia health journalist and author. She is also an assistant professor of broadcast and digital journalism at Endicott College in Massachusetts.