LTC3: Lessons from Leading Through the Ebola Crisis

In this BSC podcast, Professor Matt Andrews and Peter Harrington interview Tolbert G. Nyenswah, MPH, who shares his lessons learned from leading the Incident Management Systems for the Ebola crisis in Liberia.

Read our Public Leadership through Crisis blog series

Transcript

Katya Gonzalez-Willette: Hello and welcome to Building State Capability at Harvard University's Podcast Series. In this BSC podcast, Professor Matt Andrews and Peter Harrington interview Tolbert Nyenswah, who shares his lessons learned from leading the Incident Management Systems for the Ebola Crisis in Liberia. 

Peter Harrington: We're very delighted to be here with Tolbert Nyenswah, who is a Senior Research Associate at the Johns Hopkins Bloomberg School of Public Health. And on the line with me, Peter Harrington, is Professor Matt Andrews from the Harvard Building State Capability Program. Tolbert, thank you so much for joining us. 

Tolbert Nyenswah: Thank you, Peter. It's a privilege to be with you today. 

Peter Harrington: I'm particularly excited to be having this conversation because I spent about six months back in Liberia in 2014-15 to support and help with the Ebola crisis response. And Tolbert had a very, very significant leadership role in that response, which we'll be hearing a lot more about in this conversation and which we're looking forward to learning from. So to start us off Tolbert, would you mind just giving us and giving the listeners a bit of a outline of your role and how you came into that role in relation to Ebola in Liberia? 

Tolbert Nyenswah: Thank you. It's again, a privilege. Peter did th introduction very well. I'm Tolbert Nyenswah, originally from Liberia, based now in the United States, I work for the John Hopkins Bloomberg School of Public Health. Before that I was in the Ministry of Health - I was the Assistant Minister of Health before Ebola struck in 2014 and then led Ebola crisis as the Incident Manager of the Ebola response in Liberia. The 2014 Ebola virus disease outbreak in West Africa was the largest epidemic of disease in history of Ebola. Before the outbreak was over, the W.H.O. declared the outbreak was about twenty eight thousand infections and eleven thousand deaths in the three most affected country Guinea, Liberia and Sierra Leone, and just imagine leading the Ebola response at that time. 

Peter Harrington: Absolutely. So you were essentially the chair of the institution that was set up to manage this in Liberia. 

Tolbert Nyenswah: Oh, yes. And then the most intriguing part of this was being in charge of the IMs system. I got in charge of the system come in very, very late in the early phase of the epidemic, when the epidemic was rising at an alarming rate and was recognized as a global crisis. The W.H.O. declared a public health emergency of international concern on August 6, and I was put in charge on August 11th when the outbreak was already out of control. So that's the kind of crisis management scale that is unique to COVID-19 as I see right now countries are struggling. When you're in a dire situation where people are in the streets, testing capacity is nonexistent, and you're setting up an incident management system at the same time reporting to the top and then to the bottom and distributing leadership. 

Peter Harrington: Can you tell us a bit about how that happened, how you were put in charge of this? Did you have, you know, the president obviously nominated you to this role, can you tell us a little bit about those few days around that moment when you were put in charge and what you were thinking, how you were feeling? You know, what was going through your head at that moment when, you know, when you were asked to take the lead and how that conversation went? 

Tolbert Nyenswah: Yes. The thing is, when crises begin like this, it's a time for sense making and meaning making before you really understand what the crisis is about, especially when information is scant and data, informatics - all of those things are difficult to deal with. And so Liberia was in a situation of desperation, fear, agitation, people dying in the streets. President Sirleaf was in a very, very uncomfortable position as a leader. In fact, political leadership were calling for the president's resignation, that the government should step down and turning over to response to the international community because the government could not handle such a situation with thousands of Liberians dying, hundreds getting infected with Ebola. If you understand what Ebola is at the time we were met with a situation where there was almost 60-70% of case fatality rate. For those who are not public health experts, it means the number of persons that got sick of the disease and those that would die from the disease. Today it is better because the world is still struggling between 2% to 3% of  fatality rate for COVID-19, which is completely different from Ebola. Ebola was a latent disease that was killing people rapidly. And the president reached out to me and said, look, "I think you have the skills. I need somebody in public health and need your leadership. I've got to know and heard about you. So, Mr. Neyswah, I'm putting you in charge of the response." And imagine I was the Junior Minister in the Government of Liberia. I wasn't the Minister of Health or Deputy Minister of Health. But leadership has nothing to do with the hierarchy and how senior you are, but leadership is to coordinate, coordinate and bring people together to work with. Teamwork is very critical. When I got this call and this had to do with lives, people were dying.People were getting sick. And so in my mind, was that, look, I was given a responsibility as a young man, I was not among the older folks and not one of the experts in the country, so people were doubting my ability, but I got home and said, "This is something you have to do for your country, for your people." And we stood up the Incident Management System that I led. It was terrifying. 

Matt Andrews: Tolbert, this is Matt speaking. And thank you very much for being on the line with us. It was terrifying, but it seems when I've read a little bit that one of the first things that you did was you started to constitute your own team around you. How did you choose the people that you wanted to work with in your kind of nuclear team that was directly around you? What were the attributes that you looked for in those individuals. 

Tolbert Nyenswah: Now the first thing is that the Incident Management System and we need to understand that it is the command and control system that Liberia and developing country, low middle income countries are not familiar with. It's a system that W.H.O. and the U.S. government, the U.S. CDC, had been using to manage crisis and response systems. And this is why while I'm based in the U.S. right now and am looking at how to COVID-19 crisis has been managed, I think of my days managing Ebola and working with the U.S. CDC folks who were coming out in Liberia. So the first thing was, the U.S. CDC folks, there were only a few and great epidemiologists that I worked with walked into my office in the Ministry of Health in Monrovia when I was appointed and came and said, "Look, we have to reinvigorate the task force or the incident management system is in place right now. And they brought a blueprint to me to look at the organizational chart of an incident management system that includes incident manager, deputy incident managers, thematic area of response, including one disease case management, contact raisers, people with epidemiology and surveillance, logistic management folks laborotory folks, race communication and social mobilization. And so I look with the existant team and scouted out Liberians with the technical capacity to make them the lead of the team. So our response when I organized it was led by Liberian technicians, technocrats and leaders that are put together, some of them to be my deputies, some of them were co-leads, some of them were were leaders of the thematic areas I described to you. But then we organize that around our international partners. So the international partners were co-leads to the technical leads that were Liberian. So if you were a case manager responsible for the case management team W.H.O. was co-chairing, if you were responsible for social mobilization, as the head UNICEF were cochairing the social mobilization team. And Peter, what may interest you is that we were dealing with a multinational response. And Peter knows how Liberia, Monrovia was flooded, with international partners, governments, people from the EU, the French government, Chinese, you name them, U.S. government, and everybody was coming in. And the only person that you needed to talk to was the Incident Commander, which was myself and reported directly to the President. And we organized a somewhat technical team around the President called the Presidential Ambassador Council for Ebola, PACE in short. And Peter is aware that part of the Tony Blair Foundation folks were working on the technical and supporting around our team. So form a team. Build a team. Top-to-bottom approach was the strategy from the very beginning and it was restricting people. Imagine one of the lessons was over 100 people were meeting and could not come to a solution. So I streamlined our team to a small team that was meeting 8 a.m. in the morning and then a team that was meeting 9 a.m. in the morning for the Incident Management System meetings. It sounds simple, but it was very huge. 

Matt Andrews: One of the things that's really interesting is just the amount of detail that goes into the model. You know, it's like you could say Liberia created the IMS, but you're saying no. There was a lot of kind of the design within creating the IMS that mattered. It was finding the right people. It was having Liberians as the leaders of the teams. It was then having partners from the international community. It was having the small 8:00 a.m. meeting before the bigger meetings. It was the connection that you had to the President. It wasn't just creating an IMS because I could imagine a lot of countries would say, let's create an IMS. But you guys really thought through the detail of creating that IMS. And if I could just connect up to the relationship that you had with the president, it sounds like the president really delegated a lot to you and didn't get involved in kind of all of the weeds. Would that be an accurate statement that she kind of trusted you, allowed you to do things? What kind of communication did you have with her? How regularly were you meeting with her? How much flexibility was she giving to you? 

Tolbert Nyenswah: There is no substitute for political leadership. The leadership in Liberia with the Ebola response was both top down and bottom up approach. As the IMS chair, I played a special leadership role  by organizing and creating the team. But the role that the President of Liberia played, I just described to you that I was not a senior government official then. In Liberia's governance system the bureacracy is everywhere. I see in the United States, where cities, states, federal government. There's a whole lot of bureaucracy. But in crisis management, you have to cut some of the bureaucracies in an attempt to reach the ultimate goal. And ultimate goal is to save lives and stop the outbreak. So President Sirleaf gave me the leverage and latitude. Once she knew that the right decisions were being taken, once she knew that you were getting results, because in the first three weeks and a month of my leadership, all of the dead bodies were not in the street anymore. We were building treatment units and we were were increasing the beds. Patients that were not fed in the Ebola Treatment Unit were getting food. Their cases were being tracked. Confidence was built from the international community. Liberia was moving, it was flattening the curve and bending the curve of the outbreak. And so her competence as a leader was already seen in the work that we were doing. So she gave me the latitude to have a phone call with her on a daily basis. She gave me the latitude to brief her at will anytime. And at any time the incident management system of the technical team was giving the communication to the public. And twice a week, we were having, from the beginning of the outbreak in August of 2014, I was briefing the President on a weekly basis or twice a week in office with the small group I describe called the Presidential Ebola Council. When we got to the point where we needed a president to make a statement on an issue that we were having difficulties with politically, that is when it came out to me, that she trusted me. For example, people did not believe that to stop Ebola was everybody's business. So we had a statement that we wanted the president to make, called "Ebola Must Go. It's Everybody's Business," and she came on the air. If we were dedicating an Ebola treatment unit or wanted a message out there, the president would come up and make that message. But the day to day briefing was done by the technician, because you have to explain the disease. You have to explain where the clusters of disease are. You have to explain why strategies are being used to curb the outbreak. Otherwise, you get confused with politicians coming in and giving mixed messages to the public about who to quarantine, how to do social distancing, when the disease will stop. Politicians don't stop disease. Diseases are stopped by the strategies and systems that you put in place, but the politicians have to be in the background to give you the support because you need the backing of the politician to do your job. That's what President Sirleaf did. 

Matt Andrews: So it sounds like she kind of convened you at the beginning and she authorized you, and when you needed her to provide that kind of motivational voice, she would do it, but she would do it almost when you guys asked her. So she trusted you guys implicitly enough to step back. And I guess that also allowed her to be able to do other aspects of her job. 

Tolbert Nyenswah: Exactly. 

Matt Andrews: She wasn't overwhelmed with this because she gave it over to you guys, which sounds like, you know, when I work with a lot of governments, it's it's something that I see politicians really, really having a hard time with. They want to hold onto this. And I see them getting in the way, getting in their own way. They can't get onto other things. And I think they almost exacerbate the crisis because the rest of their job kind of almost falls apart. And it sounds like she kind of worked out how to create a new mechanism to trust you guys, to let you guys work. And in a sense, you guys then took over the leadership role of identifying what was needed and going to her and saying what we need you to do is this. So as you say, it was almost leadership going bottom up and top down at the same time, which sounds amazing. 

Tolbert Nyenswah: Right. And let me tell you about some of the major decisions that we wanted the president to take and she took. Some of those where her own inclination, and she brought it to us for us to discuss then and make the decisions. For example, Liberia does not have a culture of cremation. We are people who love our dead. We bury our dead. We have funeral rights. We take people to a funeral home. Family will mobilize in a home. That's the culture and we'll have a lot of cultural rights. They are people who are familiar with burying the dead in Liberia. But there came a time when we needed to cremate bodies because people, were not allowing burials in Liberia. They were rejecting all of their bodies taken to the grave site. And so, President Sirleaf had to make one of the most radical and cogent decisions of burning people. So we did cremation. She took as a president as a decisive decision. Some of the other decisions were to suspend schools, to create a state of emergency, to raise money from the international community. Her voice was very strong in bringing international euphoria that came to Liberia to help. Community engagement, social distancing, in those things the President was very, very strong. But a day to day running of the IMS system and the task force to stop Ebola was done by myself and my team. 

Matt Andrews: So if I can get back to just on this topic, think a little bit about the politics. One of the things that you mentioned was that when you took over, you were already in the crisis. Right. And that's one of the things why I think this interview is so valuable for many people, because, as you said, most countries are not in the preparation mode COVID-19. They're in COVID-19. You also said that it was not only that you had Ebola, you also had a lot of political pressure. You had calls for the president to resign. I can imagine that you had opposition parties who were very, very vociferous. I could imagine the media was all over this. How did you and the president and the team coming into this manage to craft the message that, "OK, we're doing something different now. WE'RE creating this new agency. We're bringing this assistant minister to run the program. How did that work? Because it sounds like a tremendously risky transition in the middle of all of this political kind of craziness. 

Tolbert Nyenswah: And this is where political leadership.. this is where it's very critical on decisions that the leader makes. At this stage, that decision to switch from the bureaucracy to a sustained crisis management team, technical team was a decision that President Sirleaf had to make. The pressure was on her as the leader that look the initial system from March to August was not running, Madam President. Liberians are losing their lives. We were dying on a daily basis. And so she needed a transition. She needs something completely new to do. And this is why I respect her leadership to come down from our office and say, look, "Folks in the Ministry of Health, please concentrate on restoring the health care system. We have to put in a completely separate structure to run the response." That was the first decision that that I think was critical for that. In two to three weeks she had gained the confidence and was now telling the political parties that "No, we have a new system in place. It is working. You don't see the dead bodies in the street." A leader takes credit based on the results. Even if the leader is not a person on the field to do it. But the kind of person the leader puts in place is giving the results to the leader, gives credit, legitimacy and credibility to what the leader does. And when the response changed, and all of the pilots were working very well - people were tested on time, contacts traced, community engagement was effective, the cases were now winding, we flattened and bent the curve in about a month. Liberians now rallied behind the government and political tension reduced because what people wanted to see was an effective response. And this is why we're back. 

Matt Andrews: So moving towards that strong, effective response was a key to this. But taking the decision and having the courage was amazing. I want to get to some of the personal aspects of this for you. What were the hardest things for you in that period of time? You said at one point that it was kind of frightening. What were the things that stretched you the most, that were the hardest as a leader, that you would think in your mind right now, people who are taking upon some of the roles in response to COVID-19 should watch out for and with the benefit of hindsight You may be able to give them some advice on managing yourself through this process. 

Tolbert Nyenswah: Now as a leader, you have to be focued, and when you're doing the right things, you must make sure you remain focused and do those things that would bring in an impact. Number two, you have to, for me and I was on the frontline, so part of what was in my mind was I could get infected. and infect my family. I knew that very, very well that that could happen any time because some of the doctors and nurses that were on the frontline were dying from the disease. Some of my colleagues that were in charge got infected. So one of the things was oppressing. I was in danger that any time I could get infected with Ebola. Because sometime I remember leaving my home for over two to three weeks because people have brought in infected dead body at my gate. The reason they did that was they could not get the dead bodies team and response team to go into their homes to get the dead bodies. People who have died in the community. And so since I was in the same community living with them, they brought those dead bodies in my home. I had to find refuge in a local hotel with a friend and all the people who were there to give me support. But yet my team, my family was with me at the time in Monrovia. Another decision that we had to take was there was a political crisis that was happening. Liberia in 2014 had a senatorial May 10 election. Those who were the senators that were already in the positions were saying the country was not safe to have May 10th elections. Those who wanted to compete with them were saying we have to have the election. And Monrovia was still having infections of Ebola. We had to put a system in place. I had to draft a policy paper, present it to the president to keep the population safe into an election. So during Ebola, we did have an election, those kind of political decisions and technical coordinating roles, those are some of the decisions that I remember. To get kids back to school, we had to prepare an entire hygiene case to get kids back to school at the same time when the infection rate was low. So those are the critical times of decision making. But working together as a team is very, very, very much important. So some of the major lessons that I learned specifically - Number one, there is no substitute for political leadership. Number two, to lead effectively, there must be a supporting cast, a team work from bottom to top, from top to bottom, distributed leadership. Number three, governments must take ownership of their response even if you have international partners coming in. It is important. And number four, it is critical that systems and infrastructure be put in place early. This is very, very important. Systems, infrastructure should be put in place very, very early. Let me tell you a story in February of this year I was at the Center for Global Development in Washington, D.C. and one of the questions was on whether teh world was prepared to deal with COVID-19. It was the early stage. Countries in Asia were those that were dealing with the outbreak. Yeah, it was not in Europe, neither in the United States. And one of the questions that were asked to me was, "How is developing country or low middle income country, from your experience of Ebola can get prepared? And one thing I said was countries need to have the testing capacity, the isolation capacity, and start with simulation of their system. Early preparation. And neither did I know that America would struggle testing of people, all of these ventilators, isolation units and surveillance system. So it is critical that systems and structure be put in place at the early stage by governments. Those are the things that are critical lessons that I learned. And then relationship with the international community - how to work within a crisis management is very, very much important because everybody has their own way agendas. 

Matt Andrews: Those are great points. One of the questions that I get from countries often is, "You know, our systems aren't ready. "And so I say to them, "I don't think anyone's systems are ready right now." And so the point is you have to build capabilities as you go. A lot of them don't have confidence that they can build capabilities as they go. Because I think a lot of the governance reforms they've had in their countries have taken 20 years and they've involved hundreds of millions of dollars. And people are saying, well, you're not telling us that we need to put systems and processes in place in a week or two weeks, because that's the time frame that you guys worked in. And we have to do them by ourselves so quickly. A lot of people don't have confidence that they can do that, given that they haven't done it before. What would you say to them? How do you move quickly like this? How do you manage to adjust your processes, put new systems in place, get new information so fast? What are some of those keys? Because I could imagine people saying, "Yes, we want to do that, but that sounds impossible."

Tolbert Nyenswah: It has to be driven by science and data. There is no if and and about that. It has to be driven by science and data, based on what you see. The strategy right now - and I'm not criticizing anybody - working, living, and being in the United States with COVID-19 - and this is not unique to the U.S., for other countries - people are preparing for the worst case scenario, which is fine. But the strategy right now is more draining for curative health systems. Curative, meaning people with chronic condition. We need ventilators. They are building things for the source of the number of cases. But what prevents a disease, they are not making use of those strategies that much. I don't hear much about surveillance system. I don't hear much about contact tracing. Which is very, very much important. If you test, you must trace the contact and isolate the sick people. So response strategies should be driven by evidence and data. When you see more dead people. It means there are more people who are still getting sick. So for you to reduce the number of deaths, you must reduce the number of people who are getting sick and to do that, it's the surveillance system. It's the contact tracing. It's the testing. And contact tracing is very, very much important. So some of the decisions we made were made by the meetings we were having in the morning and looking at the data on the map. That's it. Every map. and knowing where the clusters and cases were coming from and stuyding what was fueling those cases that we were dealing with. 

Matt Andrews: That sounds like a really, really important message. And when I read some of your papers, it also sounded like the processes and systems that you put in place were fairly simple. They were robust, but they were fairly simple and they involved a lot of local people. When I read about it, like a lot of the contact tracing, for instance, you were using local people, you were using the local capabilities that you had. This wasn't something that you went and kind of got from abroad or whatever. These were local people that you put into work with fairly simple guidelines on what they needed to do and with strong monitoring and oversight. Would that be a good description of of how you guys did it so fast? 

Tolbert Nyenswah: Definitely. And the reason local capacity was important is that we don't have the kind of sophistication that the West has in Liberia. Difficult. No outlets. No roads. Houses are not marked to say this is the house number. There are no telephone lines or landlines in homes. Cell phone coverage is very difficult in some of the rural areas. So we're recruiting thousands and thousands of people who were not trained epidemiologists, but giving them the skills that if you go into a home - ask whether they had contact. When people are sick, take down their names, report that. How many of the contacts where you able to reach on a daily basis? Was it 90 percent.? Was this 80 percent? If it was 70 to 80 percent of the contacts that were traced, that is inadequate. I wanted to see a 100 percent contact tracing and those people were tested to make sure, iff you were developing fever, we moved you into isolation to do your test and start treatment. 

Matt Andrews: Just sounds so interesting to me because one of the things we say to countries is, you know, your capability to do this is probably greater than you think it is because you have a lot of latent abilities. But you need to introduce new systems and new processes so that you authorize people in different ways and you empower them in different ways. And it sounds like you guys really did that. And that message, I think, is a very strong one from Liberia. That our latent capability is there, but we need to awaken it and we need to structure it and we need to mobilize it. 

Tolbert Nyenswah: Definitely.

Matt Andrews: Tolbert, this has been a wonderful interview, and I have one last question and I'm gonna hand it over to Peter to sum up, but the last question is directly to you - One of the things that we find when we teach public servants is that people have a motivation that causes them to work in these difficult places doing amazing things. And you did an amazing thing at an amazing time. What is it that motivated you through that period? Why did you join public service in the first place? And why in this period when the president came to you in this tough period of time, facing all the risks, facing the danger that you did, facing all the time that you would be away from your family, etc.. Why did you say yes? What is it that motivated you? 

Tolbert Nyenswah: And the thing is public leadership is being a servant and my dealing with the number of colleagues that was on the incident management system was that we were serving humanity. And leadership comes from within, but opportunities to lead come from the outside and that's what I saw. The leadership was there. Serving humanity was there. But then the opportunity came and the president was able to tap on that that we were able to lead Liberia under the worst Ebola epidemic ever in human history, that overstretched local, national and global capacities from everywhere. And so it's sometimes is born within and comes out and you want to serve humanity. But at the same time, support from other people can make you succeed. And that's what I saw in the Ebola crisis. 

Matt Andrews: Thank you for all that you do. Thank you for all that you are sharing with the world right now. Really appreciate it. And let me head over to Peter to wrap up with some final questions. Thank you, Matt.

Peter Harrington: Tolbert, It's been really fascinating to listen to you. I've just got a couple of final questions. The first one, as you mentioned earlier, this kind of message in Liberia that stopping Ebola is everybody's business. How important in today's crisis is the messaging, communications, especially around behavior, especially about people's role? Can you reflect on that for us for a minute, just in just in the context of what's happening today. 

Tolbert Nyenswah: I would say the same thing today. Stopping COVID-19 is everybody's business. If we all keep the social distancing that everybody is talking about, then the virus will die a natural death. If it cannot find a host, then there is no virus because viruses survive in hosts. That's what we did with Ebola. We got the last case. We traced the contacts. We separated contacts. And that was the end of Ebola. Since 2016, it was declared over in Liberia. I've not seen a case up to date. So for us to stop COVID-19, IT depends on every one of us to take all measures, preventive measures seriously. And people need to get very, very simple and consistent messages. When the messages are not simple and consistent, we are all in trouble. Everybody should use masks. Other people are saying it is not necessary to use masks. Other people are saying that only health care workers are supposed to use masks. The message must be consistent. And sometimes it's difficult because you have to get the science right to curate the kind of message to get out there to people. So some disease response evolves based on new information that comes out, but one works to be communicated effectively. 

Peter Harrington: Thank you. You mentioned distributed leadership during this conversation. What are the strengths of distributed leadership? Is it that it enables space to learn and adapt? Did the IMS in the Liberian Ebola response, did you adapt over the course? Did you change course, change strategy based on what you are learning as things went along for that?

Tolbert Nyenswah: Definitely. Yes, that's correct. And the distributed leadership model stems from the fact that not only top and forgetting the bottom, but it was bottom and top. As communities were moving along in their response, there were local people, traditional leaders, religious leaders, cultural groups that were doing things differently. So we moved to the community and we saw that this community was doing things very right. That there was some communities that didn't get infected at all. And so I remember taking the president in a community in Monrovia to certificate that community, because number one they didn't get the infection because of the strategies and the measures they took. And we went to another community that had one infection, but then they took care of all of the other households and gave them their own initiative. We adapted those and scaled them up to all our communities. Another thing was we decentralized the IMS. Liberia has 15 counties and out of those 15 counties, there are about 93 health districts in the country. One idea was to appoint incident managers for every county. So there were granular incident management teams that were taking place at county level and at district level. And we distributed the leadership battle strategy. The response was one strategy and one response. One coordination. And then the bottom was reporting upwards. For example, you were in Monrovia, Peter. You saw that we had to create another IMS for Montseraddo County. The National IMS was in Monrovia, which is in Montseraddo County, but we created another IMS so that they can move granularly at a district level to do all of the things that we wanted them to do, the contact tracing and the rest of them. 

Peter Harrington: Yeah, that local level was so important. I love that you emphasized this learning happening everywhere. 

Tolbert Nyenswah: Exactly.

Peter Harrington: Tolbert, you've had such a unique experience and played such a unique role. Just thinking about the public leaders, you know, other public servants like yourself, who are standing in the headlights right now who are watching this onrushing crisis coming towards them? Do you have any parting words that you would say to people standing in similar shoes around the world? Something for them to think about and take forward as they plan, you know, try and play that difficult role.

Tolbert Nyenswah: Number one, look for technicians. Look for the people with the skills who can lead and stop the outbreak and give them the support. That's that's number one. Political leadership should give resources, political leadership, decision making that affects the lives of people. They should not interfere into the actual response that the technical people are supposed to do and report to them. The leadership should be distributed. And learn by doing and follow the science. Those are the things that I would really, really recommend because no one person can do it. You must have a leadership team that is coherent, distributed leadership, but then you are also in charge with a command and control. You have to be in charge. Every single detail you have to know as the one managing to response because delays are dangerous in crisis management. The disease does not wait for you. The disease does not wit for you. The more chaotic the system is, it works in the favor of the disease. 

Peter Harrington: Thank you so much, Tolbert. We've been speaking to Tolbert Nyenswah, who is a Senior Associate at the Johns Hopkins Bloomberg School of Public Health and the Former Chair of the Incident Management System during the Liberian Ebola crisis of 2014. Thank you so much for speaking to us. 

Tolbert Nyenswah: Thank you, Peter. Thank you. Thanks for having me. 

Matt Andrews: Thank you, Tolbert. 

Tolbert Nyenswah: Thank you. 

Katya Gonzalez-Willette: To learn more about the Building State Capability Program's Public Leadership Through Crisis Blog Series, visit bsc.cid.harvard.edu/public-leadership-through-crisis. Thank you for listening.