TIME health

What Does It Mean for an Ebola Outbreak to End?

West Africa Ebola
A Nigerian port health official speaks to a passenger at the arrivals hall of Murtala Muhammed International Airport in Lagos, Nigeria, Aug. 6, 2014. Sunday Alamba—AP

And how does the World Health Organization decide when that happens?

Nigeria’s most recent outbreak of Ebola is over, the nation’s government and World Health Organization (WHO) announced on Monday.

But — with fear of Ebola continuing to grip the world — what does that even mean? How does the WHO know that Nigeria is in the clear?

The answer, it turns out, is very specific: The WHO says a country can declare their outbreak to be over when it makes it through 42 days without a new case. That’s two incubation periods for the Ebola virus, so as long as 42 days have passed, during which the country had in place active surveillance and diagnostics but discovered no new cases, the WHO says it’s enough time to confidently say an outbreak is over. For health care workers to be considered “in the clear” they have to be monitored for 21 days after their last possible exposure to the virus, even if they were wearing full protective gear. Health care workers’ date of last contact is considered the day when the final patient with Ebola tests negative for the disease.

“Recent studies conducted in West Africa have demonstrated that 95% of confirmed cases have an incubation period in the range of 1 to 21 days; 98% have an incubation period that falls within the 1 to 42 day interval,” said WHO in a statement. “WHO is therefore confident that detection of no new cases, with active surveillance in place, throughout this 42-day period means that an Ebola outbreak is indeed over.”

MORE: Nigeria is Ebola-free: Here’s What They Did Right

This is not the first time WHO has declared Ebola outbreaks over using this particular standard — Senegal was declared Ebola-free on Oct. 17, and the strategy has proven effective in prior, unrelated, outbreaks.

In 1995, there was an Ebola outbreak in the country then called Zaire (today’s Democratic Republic of the Congo); it was declared clear on Aug. 25 of that year. The New York Times reported at the time:

The World Health Organization declared today that an outbreak in Zaire of the deadly Ebola virus was officially over after killing 244 of its 315 known victims.

The United Nations agency, which is based here, said that 42 days, the equivalent of two maximum incubation periods, had passed without any new cases reported. It said it was still not known where the Ebola virus existed between human epidemics, although samples from some 3,000 birds and mammals collected in the Kikwit area, the center of the outbreak, were now being analyzed.

It’s important to have definitive parameters for declaring outbreaks over because, as the current and former outbreaks have shown, oftentimes an outbreak will appear to be extinguished, only to reappear in full force a couple weeks later. This past April, Guinea’s health ministry thought the outbreak was slowing, which turned out to be false; in the 1995 outbreak, public health experts were also fooled. As TIME reported:

For a while last week it looked as though the outbreak might soon be brought under control. The plague police-medical teams dispatched by who in Geneva, the Centers for Disease Control and Prevention (CDC) in Atlanta and other public health groups-had set up an effective isolation ward at the main hospital in Kikwit, where the first case had been identified. Belgium’s Doctors Without Borders (Medecins Sans Frontieres, or MSF) rushed in loads of gloves, gowns, masks and other essential equipment to restore hygiene to filthy clinics. But when the strike forces, aided by local medical students, fanned out through the countryside around Kikwit, trying to follow the path of the fever, it became clear that the danger was far from past.

In an announcement made Monday morning, WHO called Nigeria a “spectacular success story,” citing proof that Ebola can be contained. “The story of how Nigeria ended what many believed to be potentially the most explosive Ebola outbreak imaginable is worth telling in detail,” WHO says in a statement.

To read more about how Nigeria contained their most recent outbreak of Ebola, check out our coverage, here.

TIME ebola

Nigeria Is Ebola-Free: Here’s What They Did Right

It's been 42 days since the last new case

The World Health Organization declared Nigeria free of Ebola on Monday, a containment victory in an outbreak that has stymied other countries’ response efforts.

The milestone came at about 11 a.m. local time, or 6 a.m., E.T. The outbreak has killed more than 4,500 in West Africa is remains unchecked in Liberia, Sierra Leone and Guinea, so Nigeria is by no means immune to another outbreak.

“It’s possible to control Ebola. It’s possible to defeat Ebola. We’ve seen it here in Nigeria,” Nigerian Minister of Health Onyebuchi Chukwu told TIME. “If any cases emerge in the future, it will be considered—by international standards—a separate outbreak. If that happens, Nigeria will be ready and able to confront it exactly as we have done with this outbreak.”

For the WHO to declare Nigeria as Ebola-free, the country had to make it 42 days with no new cases (double the incubation period), verify that it actively sought out all possible contacts, and show negative test results for any suspected cases.

Nigeria had 20 cases of Ebola after a Liberian-American man named Patrick Sawyer flew into Lagos and collapsed at the airport. Health care workers treating Sawyer were infected, and as it spread it ultimately killed eight people, a low number next to the thousands of cases and deaths in other countries. Nigeria’s health system is considered more robust, but there was significant concern from experts that a case would pop up in one of the country’s dense-populated slums and catch fire.

So what did Nigeria do right? Chukwu and Dr. Faisal Shuaib of the country’s Ebola Emergency Operation Center, broke it down for TIME.

Preparing early. Nigeria knew it was possible a case of Ebola would make it into the country, so officials got to work early by training health care workers on how to manage the disease, and disseminating information so the country knew what to expect.

Declaring an emergency—right away. When Nigeria had its first confirmed case of Ebola, the government declared a national public health emergency immediately. This allowed the Ministry of Health to form its Ebola Emergency Operations Center (EOC). The EOC is an assembly of public health experts within Nigeria as well as the WHO, Centers for Disease Control (CDC), and groups like Doctors Without Borders. “[We] used a war-room approach to coordinate the outbreak response,” Shuaib said. “So you have a situation whereby government and staff of international development agencies are co-located in a designated facility where they are able to agree on strategies, develop one plan and implement this plan together.”

The EOC was in charge of contact tracing (the process of identifying and monitoring people who may have had direct or indirect contact with Ebola patients), implementing strict procedures for handling and treating patients, screening all individuals arriving or departing the country by land, air and sea, and communicating with the community. Some workers went door-to-door to offer Ebola-related education, and others involved religious and professional leaders. Social media was a central part of the education response.

Training local doctors. Nigerian doctors were trained by Doctors Without Borders and WHO, and treated patients in shifts with their oversight.

Managing fear. “Expectedly, people were scared of contracting the disease,” Shuaib said. “In the beginning, there was also some misinformation about available cures, so fear and inaccurate rumors had to be actively managed.” Nigeria used social media to to ramp up awareness efforts, and publicized patients who were successfully treated and discharged. “People began to realize that contracting Ebola was not necessarily a death sentence,” Shuai said. “Emphasizing that reporting early to the hospital boosts survival gave comfort that [a person] has some level of control over the disease prognosis.”

Keeping borders open. Nigeria has not closed its borders to travelers from Guinea, Sierra Leone and Liberia, saying the move would be counterproductive. “Closing borders tends to reinforce panic and the notion of helplessness,” Shuaib said. “When you close the legal points of entry, then you potentially drive people to use illegal passages, thus compounding the problem.” Shuaib said that if public health strategies are implemented, outbreaks can be controlled, and that closing borders would only stifle commercial activities in the countries whose economies are already struggling due to Ebola.

Remaining prepared for more patients. Even though this outbreak was contained, Nigeria is not slowing down its training and preparations for the possibility of more cases. “Outbreak response preparedness is a continuous process that requires constant review of the level of the response mechanisms in place to ensure that the health system is ready to jump into action at all levels,” Shuaib said. “There is no alternative to preparedness.”

Advocating for more international response. “The global community needs to consistently come together, act as one in any public health emergency, whether it is Ebola or a natural disaster.” Shuaib said. “While a lot has been done, it still falls short of what is necessary to get ahead of the curve. We must act now, not tomorrow, not next week.”

Read next: Dozens Who Had Contact With the First U.S. Ebola Patient Are in the Clear

TIME Nigeria

Nigeria Says Boko Haram Cease-Fire May Lead to Release of Kidnapped Girls

Kidnapped schoolgirls are seen at an unknown location in this still image taken from an undated video released by Boko Haram
Kidnapped schoolgirls are seen at an unknown location in this still image taken from an undated video released by Boko Haram. Reuters

More than 200 schoolgirls were kidnapped in April, sparking the #BringBackOurGirls campaign

A top military official in Nigeria was reported Friday to have announced a cease-fire between the government and the military group Boko Haram, igniting both skepticism and hopes that more than 200 schoolgirls who were kidnapped in April would be released.

The truce was announced by Air Marshall Alex Badeh, Nigeria’s chief of defense, the BBC reports. The release of the girls is still being negotiated, Maj. Gen. Chris Olukolade added, according to the Associated Press, but the cease-fire would begin immediately and could take take several days to reach the groups of militants.

“Already, the terrorists have announced a cease-fire in furtherance of their desire for peace. In this regard, the government of Nigeria has, in similar vein, declared a cease-fire,” said Mike Omeri, a government spokesman on Boko Haram, at a news conference. The AP adds that Omeri confirmed negotiations about the girls’ potential release were held throughout the week.

“They’ve assured us they have the girls and they will release them,” government aid Hassan Tukur told the BBC. “I am cautiously optimistic.” He also said that final negotiations are scheduled to take place next week.

There was no announcement immediately released by the insurgent group, according to the New York Times.

Reports of the deal were met with hesitation by those who have followed the saga since the girls were abducted from their school in Chibok on April 14. The Nigerian government has in the past misled the public about the girls’ status; its fight against Boko Haram has been fraught with challenges since the militant group rose up in 2009, from inefficiency and corruption in the military to lax local support in the northern communities that are threatened most.

Boko Haram, which released a video in May that claimed responsibility for the girls’ abductions and vowed to “sell them on the market, by Allah,” has previously demanded the release of rebel prisoners in exchange for their freedom. But Nigerian President Goodluck Jonathan, who has faced intense global pressure to free the students, said that’s a trade he will not make.

In August, the Wall Street Journal reported that American surveillance planes spotted groups that appeared to be the missing girls, suggesting that not all of them had been sold into marriage or slavery — as feared — and that some were perhaps being kept as a bargaining tactic.

TIME Nigeria

Why the Girls Kidnapped by Boko Haram Still Aren’t Home

Experts say the plight of the girls are "symbolic" of the larger problems in Nigeria's fight against the militant group

A lot has happened since April 14th. Malaysia Airlines Flight 17 was shot down in Ukraine; the Islamic State of Iraq and Greater Syria (ISIS) seized vast swathes of Iraq; and Ebola has killed thousands in Africa, and spread to at least two other continents. In our hyper-speedy news cycle, six months passes in a blink of an eye. But for the schoolgirls kidnapped by Boko Haram militants when they struck the northeastern Nigerian village of Chibok in April, it probably feels like a lifetime. The militants abducted 276 girls; six months on, more than 200 remain in captivity.

Why haven’t they been rescued yet? Largely, observers say, because of Nigeria’s failure to effectively counter Boko Haram, which has claimed thousands of lives over the years in its violent campaign to carve out a hardline religious state in the north of the country. “The problem is that the girls are symbolic,” says Adotei Akwei, managing director for advocacy for Amnesty International USA. “They’re part of a larger human rights catastrophe, a bad situation in Nigeria.”

“Nigeria’s military strategy isn’t working well,” he continues. “We clearly have not been able to get the girls back, or to change the mindset or approach of the Nigerian government in terms of how it responds to Boko Haram or how it protects its citizens”

Carl LeVan, a professor at American University in Washington D.C. who writes about Nigeria, adds that many civilians consider the Nigerian military almost as bad as Boko Haram when it comes to human rights violations, even as the rebels continue their reign of terror in the north.

Akwei says the problems with the Nigerian military also hinder international efforts to lend a hand. “The Nigerian military has got such a bad reputation that even the US military is concerned about how much they can cooperate because of the kind of abuses we’ve documented,” he explains. “There’s no transparency, no accountability whatsoever.”

The military has an embarrassing track record when it comes to fighting the militant group. Earlier this year, they claimed to have rescued the girls the day after the abduction, but then had to retract that claim. In late May, they released a statement saying they knew where the girls were being held, but wouldn’t use force to rescue them. And in a tragic incident early last month, several Nigerian troops were killed by their own airstrikes aimed at Boko Haram.

U.S. planes spotted large groups of girls in early August that might have been the kidnapped students. Time, however, continues to drag on without a rescue—and, says Jennifer Cook, the director of the Africa Program at the Center for Strategic and International Studies, the longer they stay in captivity, the harder it becomes to bring back the missing girls.

“With hostage situations with this many people, to bring one set back without endangering another set is very difficult,” says Cooke. “In some cases, there’s a pretty good idea of where they are, but extricating them from a group of armed criminals who have so little respect for life is a difficult negotiation process. And the longer they’re there, the greater likelihood they become dispersed, and the more difficult they are to track down.”

According to Cooke, the big-picture strategy for fighting the insurgency would involve capturing key Boko Haram leaders and cutting off funding sources to weaken the militant group. But it’s also important for the government to win the support of communities in that part of the country, where many feel both abandoned by the administration and terrorized by Boko Haram.

“A lot of civilians are feeling pinched between the terror of Boko Haram and the misbehaviors of the Nigerian military,” says LeVan, whose book on Nigeria, Dictators and Democracy in African Development, is set to be released later this month. “They said ‘we’re trapped, we’re fleeing Boko Haram but we also don’t have anywhere to go because our military is suspicious of us.'”

Winning the hearts of northern Nigerians is crucial to stopping the violence and finding the girls, but some communities are reluctant to support the government for fear of violent reprisals from Boko Haram, and because they don’t trust the government to protect them. Cooke says that “fundamental distrust” in the north is one of the government’s biggest impediments to finding the girls, because it makes it much more difficult to get accurate information. In the meantime, the girls are no better off. “These girls are being held under absolutely horrific circumstances, subjected to sexual violence and rape, forced into servitude,” she said. “There are reports that some have become pregnant.”

If those reports are true—and there’s a good chance they are, based on Boko Haram’s history of impregnating abducted women—the pregnant girls could face even greater challenges down the road. Sister Rosemary Nyirumbe runs the Saint Monica Girls’ Tailoring Center in Uganda, where she helps girls who have been victims of sexual violence rebuild their lives with their children, who are often outcasts in their communities. “Because the situation they are taken in, I would not be surprised if a good number of them are pregnant,” she says. “Raising the child of a person who has been maltreating you is always [hard.] That is why there is violence and anger returned on these children. Because they give [the mother] that reminder of the pain they have gone through.”

Sister Rosemary says that if the girls are ever released, they may have trouble re-joining their families and communities. That’s why continuing their education will be crucial for helping them move forward.

“If we leave these kids and say, they cannot catch up, I think we just are going to destroy them more.”

But before anybody can worry about education and rehabilitation, the girls have to come home. “Our world must not forget these adolescent girls,” says Phumzile Mlambo-Ngcuka, the Executive Director of UN Women and a United Nations Under-Secretary-General. “The world must come together and make every possible effort to rescue these girls and bring their captors to justice. We cannot and must not move on with this humanitarian tragedy still unresolved.”

TIME Innovation

Five Best Ideas of the Day: October 15

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Americans are often oblivious to the role of farming in their lives. To get the smart policies needed to feed our nation and the world, we must reconnect people to agriculture.

By Ian Pigott in the Des Moines Register

2. Even employer-paid health insurance can worsen poverty and increase inequality.

By David Blumenthal in Commonwealth Fund

3. Is “feminist marketing” an oxymoron?

By Chandra Johnson in the Deseret News

4. Helsinki has a plan cities everywhere could try: Combine the sharing economy, transit and mobile technology to eliminate cars.

By Randy Rieland in Smithsonian

5. America’s best bet in Africa is a strong relationship with Nigeria.

By Daniel Donovan in Foreign Policy Blogs

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME ebola

WHO: Nigeria, Senegal Days Away From Being ‘Ebola Free’

Ebola in Nigeria's main agenda
Ebola Virus news are the top stories on Nigeria's agenda on August 7, 2014. Mohammed Elshamy — Anadolu Agency / Getty Images

WHO officials tout a rare bit of "welcome news" in the battle to contain the virus

Nigeria and Senegal are days away from being declared Ebola-free, the World Health Organization said Tuesday, highlighting a rare patch of good news amid a sharp rise of new cases in nearby West African countries.

WHO officials said that Nigeria and Senegal have nearly reached 42 days without detecting any new Ebola cases, at which point both countries would be officially declared free of the disease. Senegal could reach that designation by Friday, and Nigeria by Monday. Both countries would then be relieved from active surveillance.

The WHO credited “a piece of world-class epidemiological detective work” in which officials traced 100% of the people known to have contact with an infected patient in Nigeria and 98% of the people known to have contact with Ebola patients in Senegal.

“The anticipated declaration by WHO that the outbreaks in these two countries are over will give the world some welcome news in an epidemic that elsewhere remains out of control in three West African nations,” read an official statement from the United Nations health agency.

Nonetheless, a surge of new cases in Guinea, Liberia, and Sierra had officials warning that the virus could rapidly spread across the worst-hit countries. “WHO epidemiologists see no signs that the outbreaks in any of these three countries are coming under control.”

TIME portfolio

A Truth Beyond Photojournalism: Cristina de Middel’s Nigerian Journey

Until 2013, Spanish photographer Cristina de Middel had never been to Africa, despite producing the critically acclaimed book, The Afronauts, a work of photographic fiction based on the true story of Zambia’s 1960s failed space program. “I was talking about Africa without having ever been,” she tells TIME. So, when the Lagos Photo Festival offered to show her work in Nigeria, she jumped at the opportunity. “They invited me to stay as much as I wanted, and asked me whether I’d consider doing another project about Africa.”

Following the success of The Afronauts, “a lot of people started sending me references for books to read about the continent,” she explains. “And one of these books was Amos Tutuola’s My Life in the Bush of Ghosts.”

The book, published in 1954, follows a young Nigerian boy forced to escape from his village, which has come under attack by soldiers. “The only way he can survive is by entering the Bush, this magical territory where no humans are allowed and where all the Yoruba spirits live and fight,” says de Middel. “This kid spent 30 years in the Bush, trying to find his way back home. He was married twice, became a king, a slave, a cow, a jar, a horse, a goat, ate gold, silver and bronze, snakes and snails. He fought two wars and was sentenced to death half a dozen times. All in just a hundred pages.”

In her new photographic series, called This is What Hatred Did, de Middel transposes Tutuola’s story to today’s world. “When I was reading Tutuola’s book, I was drawing sketches of how I would translate it into photographs,” she tells TIME. “I was thinking that, at some point, I’d visit a place where I’d be able to do this project.” That place ended up being Makoko, a slum in Lagos and one of the city’s most popular destinations among photojournalists. “If you’re in Lagos and you want to take pictures of poverty with beautiful light, smoke everywhere and dark waters, that’s where you go.”

De Middel could see and feel the “excitement” when she toured Makoko with other photographers during the Lagos Photo Festival. “It’s a very scary place, and I felt it had a lot of similarities with the Bush, this magical, forbidden place in the jungle. I decided Makoko would make for a great metaphor for the Bush.”

The photographer spent two weeks designing and producing props. “The most difficult part was to get the right birthday cake in Lagos,” she explains. Then, she had to seek permission from the community leaders, or “Kings,” in parts of Makoko before producing, composing and shooting her images.

“This work is a game, but it’s a game I couldn’t play alone,” she tells TIME. “I needed people to take part in it, to understand what I was doing. I was very interested in how the community would participate in the making of their own portraits. Sometimes they did things I didn’t know would happen, and that was the best part of the shoot. That’s what I wanted. In effect, I was generating the performance before acting as a photojournalist by taking pictures of what was happening in front of me.”

The end result, she says, is not a Westerner’s take on Nigeria. “My images include the people’s beliefs, rituals, religions. This is trying to understand from the inside.” Of course, de Middel admits, the final edit will reflect her opinion on her subject’s stories—whether real or imagined—especially when they are compiled in a photobook to be published by the Archive of Modern Conflict in early 2015.

In the meantime, the former photojournalist has no regrets about leaving the world of news behind. “In fact, I wish I’d done The Afronauts ten years ago,” she says. “Now I feel like I’m really documenting places. I feel like I’m finally understanding the stories I’m documenting. The way I approach these subjects is much deeper, and I feel that, as a result, my ideas are much more truthful then when I was a photojournalists. They are less superficial. They are deeper. I’m sure there are a lot of photojournalists who can understand and can explain a situation in their images, but I wasn’t one of them.”


Cristina de Middel is a documentary photographer and artist based in Spain. Her book The Afronauts was awarded the Infinity Award for a Publication in 2013.

Olivier Laurent is the editor of TIME LightBox. Follow him on Twitter and Instagram @olivierclaurent


TIME ebola

Patient Admitted to D.C. Hospital With Ebola-Like Symptoms

The patient had recently traveled to Nigeria

A patient with Ebola-like symptoms who recently traveled to Nigeria has been admitted to Howard University Hospital in Washington D.C., according to a Howard spokesperson, but the person has not yet been confirmed to be infected with the disease.

“In an abundance of caution, we have activated the appropriate infection control protocols, including isolating the patient,” said Howard spokesperson Kerry-Ann Hamilton in a statement.

Hamilton declined to identify the patient, citing privacy concerns. The hospital is working closely with the Centers for Disease Control and Prevention and other health officials, she said.

This week marks a dramatic escalation in the spread of the deadly Ebola outbreak, which has killed more than 3,000 people in West Africa. If confirmed, the D.C. patient would be the second person diagnosed with Ebola in the United States. Earlier this week, a Liberian man was diagnosed with the disease and is currently being treated at a hospital in Dallas.

TIME Disease

What It Will Take to End Polio

President Franklin D. Roosevelt leaves his home at 49 East 65th Street for a short visit to his family estate at Hyde Park, north of New York City on Sept. 27, 1933.
President Franklin D. Roosevelt leaves his home at 49 East 65th Street for a short visit to his family estate at Hyde Park, north of New York City on Sept. 27, 1933. Martin Mcevilly—NY Daily News/Getty Images

Jeffrey Kluger is Editor at Large for TIME.

Franklin Roosevelt never knew the Pakistani babies battling polio today, but he knew their pain. The world is fighting to end that suffering forever

You can still see the ramps and rails at Franklin Roosevelt’s house on East 65th Street in Manhattan—even though they’ve been gone for decades. They’re easily visible in the pictures that decorate the home. They’re visible, too, in the popular iconography of Roosevelt, who was photographed standing countless times after being paralyzed by polio in 1921, but always with a hand on a bannister, an arm on an aide, a cane in his grip—and ramps and rails at the ready.

The six-story Roosevelt house, where the family lived from 1908 until their move to the White House in 1933, is now owned—and was restored—by New York’s Hunter College. These days it’s a place of learning and policy conferences. But it is also a place of historical serendipity.

“When the house was built, it was one of the first private residences in New York that had its own elevators,” Hunter president Jennifer Raab told me as we toured the building this morning. Those became indispensable once FDR became paralyzed, and it was in that house that his kitchen cabinet thus gathered in the four months between his election in 1932 and his inauguration 1933. “The New Deal was born here,” Raab says.

For FDR, there were abundant compensations for polio. As Ken Burns’ documentary The Roosevelts makes clear, the disease deepened and grounded him. It made him a champion of children with polio—an effort that led to the March of Dimes and the later Salk and Sabin vaccines—and for that matter a champion of all people who suffered hardship. It was polio that gave Roosevelt a fuller temperament—and in turn gave the nation a fuller Roosevelt.

There are no such compensations for the handful of children around the world who still contract the crippling disease. On the same morning I was making my visit to the Roosevelt house, word came out of Pakistan that the country is on target to top 200 polio cases in 2014, its biggest caseload since 2000. Pakistan is one of only three countries in the world where polio remains endemic—the other two are Afghanistan and Nigeria, with 10 and six cases respectively so far this year—and it’s the only one in which the caseloads are moving in the wrong direction.

As recently as 2005, Pakistan’s case count was down to just 28, helping to push polio to the brink of eradication. That same year, however, religious leaders in northern Nigeria declared a boycott of the vaccine, claiming that it contained HIV and was intended to sterilize Muslim girls. This led to a wildfire spread of the Nigerian strain that stretched as far southeast as Indonesia.

But Nigeria got its house in order, and the hot zone now—a more challenging one—has shifted to Pakistan, particularly in the tribal areas in the north and in the mega-city of Karachi. Some of the problem is simply the crowded, unhygienic conditions in Karachi. But the bigger piece is the fighting in the tribal regions, which have made vaccinations difficult or impossible. That’s been exacerbated by Taliban gunmen, who have shot and killed 59 polio field workers and police officers trying to protect them since 2012.

“It’s a very sad thing,” Aziz Memon, head of Rotary International’s PolioPlus team, told TIME by phone from Pakistan today. “We’re trying to get vaccinators on the ground and into the field despite the ban. And now rains and flooding that have broken 100-year-old records are creating more problems.”

Rotary, which has been the point-organization for the eradication of polio for more than 25 years, is being assisted by the Gates Foundation, Save the Children and multiple other international groups, all working to push back against the Taliban blockade. Vaccinators routinely wait at bus stops around Pakistan, climbing aboard and looking for kids who have no vaccination records and administering the drops on the spot. Refugee camps in the war torn tribal regions provide another way of standing between the virus and the babies.

“When the virus is contained like this it’s a good opportunity to step in and control it,” says Memon. “We can also take advantage of the low-transmission season, which starts soon.”

The effort to snuff out polio altogether is more than merely the moral thing, it’s also the practical thing. Bill Gates repeatedly stresses that $1 billion spent per year over the next few years can save $50 billion of the next 20 years, money that would otherwise be spent treating polio and constantly fighting the brushfire war of vaccinating against outbreaks. Eliminate the disease for good and those costs go with it. What’s more, the delivery networks that are put in place to do the job can be easily repurposed to fight other diseases.

None of this long-range thinking makes a lick of difference to the 187 Pakistani children—or the 10 Afghanis or six Nigerians—who forever lost the use of their legs this year. They are paralyzed, as they will be for life. For them, there is no offsetting wealth, no townhouse with an elevator, no path to global greatness. There is only the disease—a pain FDR recognized and fought to fix. In Pakistan, that same fight is being waged today.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME ebola

Ebola Outbreak Contained in Nigeria, Officials Say

After a total of 19 cases and seven deaths

The Ebola outbreak in Nigeria appears to be contained, health officials said Tuesday.

The U.S. Centers for Disease Control and Prevention (CDC) said that due to a very rapid local and international response, the country may have fully contained its Ebola outbreak. The 21-day incubation period for the disease has passed.

Nigeria saw its first confirmed case of Ebola on July 17 when a Liberian-American man collapsed at a Nigerian airport after traveling from Liberia. The man infected the health workers who treated him, and the country experienced a total of 19 cases and seven deaths. Unlike in other countries like Guinea, Sierra Leone and Liberia, where it took months for Ebola to be recognized, the Nigerian government quickly declared a public health emergency when it discovered the traveler may have come in contact with 72 people at the airport and hospital.

The Nigerian government coordinated the outbreak response with state and national networks and rolled out a massive public education initiative, with trained “social mobilizers” who were deployed to do house to house visits in areas where an Ebola contact resided. Nigeria also recently worked to eradicate polio, and the country tapped into those strategies as part of their response.

Still, if there’s a lesson to be learned from Ebola thus far, it’s not to overestimate containment. As TIME reported last week, there was a period in April when it appeared Guinea’s outbreak had subsided. In actuality, there were several unreported and hidden cases that re-ignited the outbreak with an even greater wave of infections.

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