Fighting Ebola and the hard‑won lessons of the 2014 outbreak for research support teams

Author: Sacha Billett

What does it take for research systems to function effectively in a crisis? For academic institutions and global health organisations, the 2014 Ebola outbreak remains a defining example of how evidence, communication, and community trust must work together, often in real time. The firsthand experience of frontline clinicians continues to shape today’s research practices, information infrastructures, data needs, and preparedness strategies. 

We spoke with Dr. Marta Lado, an infectious disease specialist and Director Clinical Programs in Partners in Health, Sierra Leone about how she distilled these lessons into Ebola Virus Disease: A Manual for EVD Management. Her book captures the practical insights she and her colleagues gained while responding to the outbreak, offering guidance that extends well beyond Ebola to other emerging diseases. She shared with The Link the experiences that informed the manual and how she came to play a central role in the 2014 response.

In 2014, Dr. Marta Lado began what she thought was to be a 1-year sabbatical in Sierra Leone. But that was also the year of the Ebola outbreak that struck Sierra Leone, Liberia, and Guinea. As an infectious disease specialist, fighting that outbreak changed her 1-year sabbatical into a 10-year mission.

This experience became the basis of her book, Ebola Virus Disease: A Manual for EVD Management, in which she recounts the hard-won lessons from fighting one of the world’s deadliest viruses. For organisations supporting global health research, the manual demonstrates how lived experience can be translated into structured, shareable, and actionable knowledge during a global crisis.

Confronting fear and misinformation during the Ebola outbreak

Outbreaks of novel diseases, especially highly lethal ones, challenge communities, especially when the healthcare system is poorly funded. Fear and lack of information can make managing the situation difficult for public health authorities and healthcare providers. “There are many challenges when a new disease comes into a community, especially with a high mortality rate. There is a lot of reluctance, especially in countries where the healthcare system is not very well funded,” Dr. Lado says.

The absence of clear, trusted information exposes a critical challenge for research support teams: how to deliver reliable, usable evidence at speed, often before formal guidance is fully established.

This challenge reflects a broader issue: during crises, the effectiveness of research depends not only on the quality of evidence, but on how clearly and quickly it is communicated and supported institutionally. As explored previously, sustained investment in clear communication structures and institutional backing can significantly influence how research findings are understood, trusted, and acted upon during periods of uncertainty.

Early messaging described Ebola as untreatable and almost always fatal, creating panic and distrust. Restrictions on funerals and isolation deepened grief and suspicion among communities. “People saw others going to hospitals and never returning,” recalls Dr. Lado. This led to many hiding symptoms or simply avoiding care, thinking death was inevitable. 

The initial response focused on breaking the chain of transmission. That meant that every new infection required quarantine, which can be hard on both the patient and the patient’s family. “We had to make them understand isolation doesn’t mean abandonment,” Dr. Lado stressed.

Building trust through communication and community engagement 

In 2021, after the vaccine effective for the Zaire strain of Ebola was approved, trust grew and people started coming to get vaccinated. “We used ring vaccination, whenever we have a case of Ebola, we vaccinate all the ring contacts, household contacts and people from the community, almost everyone. People come voluntarily and it is a huge success. This means that people do engage more when they understand the disease.”  For organisations supporting research and public health policy, these experiences underline the importance of aligning evidence generation with communication and community engagement as part of research design.

Dr. Lado says that mistrust often stems from lack of information, past negative experiences, and fear of the unknown. In places like North Kivu, repeated outbreaks eventually led to better preparedness and community acceptance. Unless sensitisation and education happen alongside medical intervention, people may refuse vaccines, hide symptoms, and avoid treatment centres. 

Standard intervention like optimized supportive care: IV fluids, Oxygen therapy, treating co-infections, blood products when needed were simple to implement and managed to save countless lives. “People were able to return to their communities and explain the positive side of the experience. They could say ‘I was extremely sick, I was in a coma for a week, but they took care of me. There were always people around me dressed up like astronauts, but they did give me the medication I needed and took good care of me," Dr. Lado explains.

Dr. Lado also learned that even the best medical technology won’t work without patient and community trust, and good communication. These lessons have led to a rethinking of treatment centres and practices, resulting in new treatment centres often built separately from hospitals, and with transparency in mind. Transparency and communication also means that community leaders can come to learn about the procedures, and there is a respect for practices like dignified burials. 

Lessons in compassion: Balancing protocols with humanity

For Dr. Lado, the Ebola outbreak changed how medicine is understood and practiced in emergency settings. “It taught me that not all answers are already written down. Sometimes, we need to create them,” she explained. For novel situations, experts don’t already have the answers, but they have the tools, including the scientific method combined with past expertise, to find them. Conducting research during a humanitarian crisis was incredibly difficult, but Dr. Lado and her colleagues managed to do it progressively, building new knowledge as they responded and writing it down in her manual for Ebola virus disease management.

And remembering that every patient is a person, with hopes, and fears, and family is incredibly important. While protocols are essential, without empathy and clear communication, they can feel harsh, especially to families facing loss. Resistance to rules often comes from grief, not ignorance, and understanding the cultural and emotional contexts is vital.

“Of course, we all understand the rationality of what we need to do in times of a health crisis, but at the end of the day, it’s your son. Are you telling me I can’t hug him, feed him, or be with him? Or it’s your mother who died, and you’re not even allowed to say goodbye. That’s the kind of grief people were facing, and it’s not easy to accept.”

The experience reinforced that effective outbreak response must balance medical urgency with human dignity, ensuring that people feel seen, heard, and supported.

How Ebola transformed emergency response systems

Structured emergency response systems were built from scratch, with clear pillars such as case management, laboratory coordination, infection prevention and control, community sensitisation, and operations, each with designated responsibilities. They quickly became essential for managing outbreaks. “For me, this is the greatest achievement. Despite challenges in different areas, the planning and structure of our system is now effective and straightforward,” Dr. Lado added. Thanks to this foundation, Sierra Leone was able to respond better to subsequent health crises like Covid-19 and Mpox. 

Global cooperation and innovation after Ebola

In terms of the evolution of global health and outbreak response, Dr. Lado mentioned two important shifts. First, there’s a growing awareness that no country is isolated, and outbreaks in one region can quickly affect others, making international cooperation and preparedness essential. For organisations across the research and innovation ecosystem, this shift reinforces the need for cross-border data sharing, interoperable systems, and open access to validated research during emergencies.

Second, the lessons from Ebola helped shape better case management protocols, including early supportive care and the use of portable critical units. Along with effective vaccines and monoclonal antibody treatments for the Zaire strain, these developments had an impressive impact. “They can reduce the mortality from 80% to even 30% when combined with optimized supportive care. The problem is now in areas with other strain, like Sudan and Marburg,” Dr. Lado explained.

However, the experience with Zaire Ebola has laid the foundation for research and testing therapies during emergencies. This progress is now helping the development of vaccines and treatments for other strains of the virus, with hope for similar breakthroughs soon.

From crisis to innovation in Ebola treatment and research

A central takeaway from Dr. Lado’s work and her book is the importance of patient-centred care during outbreaks. Written at a time when no formal guidelines existed, the manual captures how frontline experience can be translated into practical, evidence‑based approaches. Its message remains highly relevant today: effective treatment places the patient at the centre, while ensuring that healthcare workers are equipped to deliver safe, high‑quality care, even in crisis conditions.

Dr. Lado’s reflections reveal a deep commitment to transforming global health through equity and compassion. “Healthcare should be a right, not a privilege. That’s the goal I’m working toward,” she explained. Her mission is to narrow the gap between healthcare systems in low‑ and high-income countries. “When people need care, we must find ways to make it available,” she added.

Today, her work extends beyond clinical practice to include policy development and health system strengthening. Drawing on lessons from Ebola and other diseases, she continues to advocate for resilient systems that can respond effectively across contexts. “At the end of the day, healthcare is healthcare. We need to build systems that work for everyone, whether we’re dealing with Ebola, HIV, or TB,” Dr. Lado said. Her aim is to ensure that no community is left behind when the next outbreak occurs.

For those supporting research planning and delivery, these lessons highlight the importance of prioritising equity and access early on, particularly in emergency‑driven research. 

Dr. Lado’s experiences are explored in greater detail in her book, Ebola Virus Disease: A Manual for EVD Management. Further perspectives on how knowledge has evolved over time are available in our virtual museum, When the Shelf Went Digital… 20 Years of Springer Nature eBooks.

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