-If you were born in 1900,
you could expect to live on average, just 32 years.
Today, global life expectancy is more than twice that.
It's one of the greatest achievements in human history.
-This is the story of the ideas that have in the space of
just a century or two changed what it is to be us
by transforming the kind of lives we might live.
No longer short and under the shadow of disease,
but healthy and long.
I'm David Olusoga, a historian.
I have to say, it does look like
the sort of laboratory you see in a Frankenstein movie.
-[ Chuckles ]
And I'm science writer Steven Johnson.
-The average Black American
lives three-and-a-half years less than the average American.
-That, to me, is just really shocking.
-We're investigating the forgotten heroes
of global health.
-The scientists, doctors, researchers, and activists
who touched billions of lives.
One of their revolutionary ideas was fighting disease,
not with vaccines and drugs,
but by persuading people to alter their daily routines.
Today, as the world grapples with another deadly pandemic,
we reveal how changing our behavior
became one of the most powerful tools
that we have in the fight for extra life.
♪♪
-I'm in the U.S., and David's in the U.K.
-Sound, take one, day two.
-With travel restricted at the moment,
we're meeting online.
Better mask here.
I remember walking through the streets of New York City
in March of 2020 and seeing these sidewalks
that are normally so teeming with people,
and they're just empty. No one's there.
And I remember thinking at the time
that this was an experience
that was happening all over the world,
all of these extraordinary changes in behavior
that, when you sum it all up,
is probably the single most concentrated
and immediate transformation in human behavior
on a global scale ever experienced
in the history of this planet.
-And perhaps understandably, there were no shortage of people
saying that this was all impossible,
that this couldn't happen, that you couldn't possibly
shut down high-tech, industrial, 21st century societies,
that people wouldn't accept lockdowns.
And I think what it showed
is that, at times of real stress and real threat,
we are surprisingly able of adaptations,
of making changes to our lives
that in normal times we just -- would be unthinkable.
-And that kind of behavior change
has actually played a huge role
in the expansion of life expectancy
over the past few centuries.
We tend to celebrate the vaccines
and the magic-bullet drugs,
but there's also a crucial part of that history
that involves just ordinary people,
you and me, making changes to our lifestyles.
♪♪
-One lifestyle change in particular...
...that made a huge difference in extending our life-span
was the move to cleaner living.
Two centuries ago, big cities like London
were unimaginably filthy.
The Thames was thick with sewage and streets
like this were just covered in horse manure.
And along with the manure,
household waste was just thrown out here
and left to rot.
And the people were filthy, too.
With no running water in ordinary homes,
washing was a luxury.
[ Bell tolls ]
It seems obvious to us now that conditions like these
were the perfect breeding grounds for disease,
diseases that can kill in weeks, sometimes in just days.
As a Londoner in the 1800s,
you'd be lucky to live beyond 35.
Many of the people who fell victim to these diseases
were children.
Frank, aged 1 year and 10 months,
died 19 August 1891.
John, aged 2 years, 2 months, died 14th of August, 1890.
Arthur, who died 19th of April, 1892,
aged 14 days.
At the time, it was thought
that diseases were spread through the air,
and it took decades for those ideas to be overthrown
and for people to understand
that hygiene and sanitation was fundamental,
critical to controlling the impact of disease.
♪♪
-[ Crying ]
-Since then, there's been a revolution in the way we live...
[ Babies crying ]
...that has transformed life expectancy...
...and it all began with a young doctor from Hungary
called Ignaz Semmelweis.
In 1846, he lands the job of assistant physician
at Vienna General Hospital,
which has the largest maternity unit in the world.
[ Crying continues ]
Not that long into the job,
Semmelweis has a major problem on his hands
and a mystery to solve,
the hospital has two birthing wards,
one staffed by doctors and the other by midwives.
[ Crying continues ]
In the doctor-led ward,
an alarming number of women are dying of a fever.
It kills at the most tragic of moments,
shortly after childbirth.
How could two wards in the same hospital
have such radically different death rates?
What I've always found so thrilling, really,
about this story is that, on some fundamental level,
it's a mystery,
and that's what drives Semmelweis further and further
into trying to understand what's happening.
-And you have to admire how methodical and punctilious
he is with every variable.
He looks at the diet of these women.
He plots the deaths over the years
so we can see if there's any seasonal variation.
But the one thing he doesn't do
is the first thing that the modern doctor would do,
which was to try to identify pathways
by which these women might be becoming infected.
He doesn't do it because it's the 1840s,
because it's before anyone understands that down
the microscope is this empire of microbes and bacteria
which are at the heart of disease and infection.
-It therefore doesn't matter to anyone that
in between shifts in the maternity ward,
the doctors go upstairs to the mortuary to dissect corpses
and then pop back down to deliver more babies...
...without washing their hands.
Then, one day, a tragedy occurs,
one of Semmelweis' colleagues cuts himself with a scalpel
while performing a dissection.
He comes down with the same fever
that's plaguing the first clinic and dies,
and this really gets Semmelweis thinking.
Could it be that some kind of invisible particle
is responsible for his colleague's death?
And were those same invisible particles
being transmitted from the hands of the doctors
to the bodies of the mothers?
To test his theory,
Semmelweis proposes a radical intervention.
From now on, all doctors delivering babies
in the first ward will have to wash their hands
with a chlorine solution after dissections.
The results are irrefutable.
As soon as handwashing is introduced in the first clinic,
death rates plunge by 90%.
♪♪
So this is the point where you might think science
has solved the problem, everyone will adopt handwashing,
and thousands of lives will be saved, but not so fast.
Semmelweis' ideas are rejected by the medical establishment.
He loses his job and winds up in a mental-health institution
after suffering a breakdown.
♪♪
To me, David, the important lesson of the Semmelweis story
is that [chuckles] having the data on your side,
being a brilliant investigator, is often not enough.
-There's a social element to this story
because it's also about who Semmelweis was
and who he wasn't.
He is a junior doctor
in an extraordinarily hierarchical society,
in a very, very hierarchical profession.
He's the wrong person to be telling his profession
full of grandees this quite difficult message
that the cause of the death was something about them,
even with that weight of evidence,
even with women's lives being saved by that intervention.
-But I think it shows how people get entrenched
in certain ideas, right?
There's actually a term for this,
the Semmelweis reflex, right,
which is the idea of just kind of rejecting
out of hand some new proposition,
because that's just not the way it was done.
When we look at the history of progress, you know,
we traditionally look at it
as a series of kind of breakthroughs
and in leaps forward
and when the brilliant idea happened and change the world.
But part of that history is also a brilliant idea that emerges
and doesn't change the world.
-While Semmelweis is being ignored in Vienna...
...elsewhere in Europe,
others are pursuing the idea that cleanliness saves lives.
♪♪
Everybody's heard of Florence Nightingale,
the young British woman who,
much against the wishes of her wealthy family,
embarked upon a career in nursing.
And that decision led her in 1854 to the Crimean War,
where she was in charge of caring
for injured British soldiers.
When she returns home from the war,
Florence is troubled by the unsanitary conditions
she's witnessed in the Army hospitals,
so she begins meticulously analyzing data
on the causes of death
for the thousands of British soldiers
who've lost their lives in the Crimea.
And it confirms what she suspects,
that disease has been killing them far faster than gunfire.
Disease, she believes, is caused by poor hygiene.
She then has an ingenious idea about how to present this data
so that people pay attention to what's happening.
What she comes up with is this, the rose diagram,
and it shows the number of soldiers who've died
in the British military hospitals in the Crimea.
And each of these wedges,
each of these petals of the rose,
they represent a different month.
And each of these blocks of color
represent the numbers of soldiers who've died
and the colors, they represent the different causes of death.
So this pinky red color,
that is the number of soldiers who have died of their wounds,
black represents the number of soldiers
who've died in the hospitals from other causes,
but blue, that's the number of soldiers
dying in the hospitals from infectious diseases.
And what we instantly understand from this diagram
is that the big killer in the Crimea is disease.
Now, this other diagram offers some hope
because what it shows is how,
after changes to the sanitary conditions in the hospitals,
the story begins to change.
And month by month,
the number of soldiers dying of diseases in the hospitals
begins to fall as the conditions in those hospitals
are improved.
And by the end of the year,
the number of soldiers dying from disease
has fallen by 99%.
♪♪
Now, this diagram is not really
what Florence Nightingale is famous for,
but perhaps it should be because it was absolutely critical
in getting across the fundamental key message
that, in the Crimea,
the British military hospitals have been deathtraps
and that much of this death and much of this suffering
could have been avoided.
[ Bell tolls ]
-When you're trying to persuade people
to change their behavior, how you make the argument
is almost as important, if not more important,
than the data behind the argument itself.
I mean, if you look at Semmelweis' argument
that he makes for handwashing,
you know, it's presented in the form of statistical tables.
I mean, it's just pages and pages of kind of raw numbers.
Whereas Nightingale does something very different, right,
she converts all that data into these vivid diagrams.
-And she then uses things about herself to force the issue,
to force the discussion.
She returns from the Crimea literally a living legend.
She's a national hero.
And she's a very difficult woman to say no to,
and that's partly because of her personality,
but she's also an aristocrat in a deeply class-based society.
So you have a combination of a powerful-minded individual
who is a national hero
and also a sort of genius with arguments and statistics.
-What also helps Nightingale's life saving ideas get noticed
is timing.
Her work coincides with a period of intense scientific discovery.
The hygienic movement
is seriously hampered by a centuries-old idea
that all illness is caused by poisonous vapors,
basically bad smells emanating from things
like stinking trash and rotting meat.
But a handful of pioneering European scientists
are starting to develop an alternate idea.
In Britain, Dr. John Snow challenges
the centuries-old belief
that all disease is caused by bad smells
by proving that cholera spreads through dirty water.
Meanwhile, in France,
scientist Louis Pasteur uses a powerful new microscope
to identify invisible organisms in water
that's been exposed to the air...
...prompting German scientist Robert Koch
to discover just which of these germs are the most deadly.
All of this creates a tipping point,
finally persuading the medical establishment
that hygiene is the first line of defense against disease.
By the 1890s, doctors are routinely washing their hands
and using antiseptic techniques in surgery.
Soon, ordinary people are being persuaded
to clean up themselves and their homes, too.
There are calls from the influencers of the day
to take a daily wash and a Saturday-night bath.
Everyone is going mad for soap.
♪♪
The tide begins to turn on deadly germs in Europe
and the U.S.,
helping us gain an extra two decades of life
in the first half of the 20th century,
taking life expectancy to 62 years.
-But what is it about soap that's so effective?
Simple soap and water is enough to rupture
and to kill some of the most deadly pathogens.
Soap rips pathogens apart like a crowbar,
trapping the fragments in tiny bubbles
that are then flushed away by water.
♪♪
And it works on all kinds of germs, viruses,
bacteria, and dirt.
At the molecular level, soap breaks everything apart.
And what that means is that, at the level of society,
it helps us to hold everything together.
-You think about the objects that made the modern world,
right, and what naturally comes to mind
are much more kind of high-tech machines, right?
But if you look at it honestly, if you look at the consequences
for health and our life-span,
you have to put the humble bar of soap on that list.
-You know, there was a certain amount of disbelief
in the early months of the COVID-19 pandemic
that the most important thing we could do
was to use something that was just part of ordinary life
that we all had in our homes. -And yet, apparently,
despite the pandemic that's raging around us,
people still aren't washing their hands enough.
And so that gets to the question of, how do you persuade people
to change their behavior, even if the behavior in question
is something that is so easy to do,
something so familiar as washing your hands?
And this is one of these places where, actually, we do have
a very rich, nuanced,
well-funded science of persuasion that's out there,
which is the advertising business, right?
So the question is,
can we take some of that persuasive power
and use it to get people to change their behavior,
to make themselves healthier?
♪♪
-Look them in the eyes, and tell them you're doing
all you can to stop the spread of COVID-19.
Stay home, protect the NHS, save lives.
-[ Speaks indistinctly ]
Today, advertising agencies employ behavioral scientists
to help persuade people to make healthy lifestyle choices,
and they've discovered key insights
into how the human mind works
when faced with a call to action.
-So there's something we call in psychology
the intent-action gap.
And this is the gap between what we ought to be doing,
what we say we're going to do,
but what we actually do in practice.
And I think health is a really, really good example of this.
-So everybody knows that wearing a seatbelt,
eating healthy food and not fast food,
we all know that that's what we should be doing,
we all know that's kind of what we want to do,
but it's not what we do. -Definitely.
Changing behavior is really difficult,
and maintaining that change can be even harder.
And it's sometimes these kind of psychological barriers
which stop us doing things that we know are good for us.
-Ella's team was recently approached by a client
concerned about hand hygiene at a food factory in Guatemala.
-The factory workers weren't washing their hands properly
or if at all.
They'd been given extensive hygiene training,
and they had all their soap hand towels,
and everything they needed to actually wash their hands,
but nothing was making any difference.
And the microbiology tests were identifying
that 4 out of 10 people had unsafe hands
that could be deemed an actual threat to humans.
And what we did was we designed the hand-safety stamp,
and it works by having a specialized sticky ink,
which takes as long to rub off
as it does to accurately wash your hands.
So, essentially, the workers had to arrive to the factory,
and every single person was stamped as they entered.
And this provides a really visible symbol.
-So, suddenly, having dirt on your hands, which is dangerous
if you're preparing food, suddenly, that becomes visible.
-Exactly. If we can't see something,
we find it quite easy to kind of ignore.
♪♪
One thing that really drives our behavior is a fear of shame
or social rejection.
So the factory workers could see their colleagues
stamping the hand and then washing their hands
and they didn't want to be part of the group
who kind of were deemed unsafe and unhygienic.
-And it did work? -It did work, yeah.
It actually reduced levels of dirty hands by 63%,
which was deemed kind of an acceptable level
to operate the factory in.
-To me, it's interesting to think about
what really motivates us
to make changes, particularly in the middle of a crisis.
Part of it is shame, right?
You don't want to appear to be behaving
outside of kind of social norms.
We're social animals.
Were influenced by the behavior around us.
But, to me, there's also a really important sense
of solidarity.
I just remember walking around in Brooklyn and seeing,
you know, 99% of the people on the sidewalk
in open air walking around with masks on,
and there was a sense of,
you know, we're in this together.
-And I think in societies where you saw
that level of coming together in solidarity,
what you tended to see later on
was that people who had broke rules,
people who didn't see themselves
as part of this collective effort,
they tended to become figures of hate.
That's sort of solidarity does have a flip side to it,
which is that those who reject it,
they tend to become seen as outside the group,
outside the society, letting everyone down.
And what's so important in any of these kinds
of situations is the message
that one's getting from the top, from our leaders, right?
And so when we find ourselves in the middle of this crisis,
in a crisis where our own behavior is so important
in determining the outcome,
what we see our leaders doing and saying and the messages
that they give us is extraordinarily important.
-[ Chanting in native language ]
♪♪
-Throughout our lives, we've been asking people
to come to the mosque
and now actually we were asking people
not to come to the mosque.
It was really surreal.
Throughout our lives, we've been asking people
to show love and care by embracing each other,
by shaking hands with each other.
Yet now we were asking people not to shake hands
with each other.
That was phenomenally difficult for people to understand.
♪♪
One of the elderly members of the community said to me,
for 35 years, he'd never missed a Friday prayer.
Some of the young people were saying,
"We're absolutely fine,
and we can keep the distance from each other.
Why do we have to close the doors of the mosque?"
I was really caught in the middle.
I felt that my leadership was being tested.
And so I had to convince them in the language
that they could understand.
Eventually, I think people understood
that it wasn't just about them.
It was also protecting everyone in our community.
Once the lockdown was lifted,
we had to change the way the mosque operates.
Before, we used to do the handshake to please God.
Now we don't do the handshake to please God Almighty.
Now, it's not easy wearing a mask
and giving a sermon for half an hour,
you know, I have to do so to lead by example that,
look, this is -- if I can do it, others can do it, as well.
I think it's not just talking the talk
but walking with people.
You have to constantly tell people
that, you know, "We will get through this together."
Maybe standing here socially distant,
but God is not socially distant.
Who hears the whispers of the heart.
And that is extremely challenging
and emotionally draining as a faith leader,
to go through that.
But every day, I have to get up and see
that it'll be a better day,
and I have to keep on inspiring people.
♪♪
-The COVID-19 pandemic has been the ultimate challenge
for our leaders,
galvanizing and mobilizing people to adapt to new rules
and alter their behavior like wearing masks
and maintaining social distance, all to fight the virus.
But the truth is, we've been here before,
and there are lessons to be learned from past health crises,
starting right here in Philadelphia.
September 1918 --
Philadelphia Public Health Chief Wilmer Krusen
hears news of a deadly flu
sweeping army barracks across the country...
...as soldiers return from the war in Europe.
Young people are dropping like flies.
In one Boston barracks,
100 deaths in a day are reported.
The U.S. surgeon general warns
that influenza is a crowd disease.
To save lives, all social gatherings must be avoided.
This leaves Krusen with a harrowing decision
to make on behalf of his community,
because preparations are already underway for a massive parade
right here in downtown Philadelphia
to support the Liberty bonds,
which is a major effort to fund the war.
Cities are competing to see who can raise the most money,
and parades are a big part of this.
And so, under pressure from the political machine,
Krusen decides to ignore the warnings about the epidemic,
calling it no different from the normal flu.
The war is the priority, and the show must go on.
And it did.
On the afternoon of September 28th,
a two-mile-long parade of 200,000 people
packed into the streets of Philadelphia.
Nearly 3,000 miles away in the west-coast city of Seattle,
the health chief, J.S. McBride, reads the same news reports
with a growing sense of dread.
On October 4th,
just days after the Liberty loans parade,
he, too, gets word of a flu outbreak at an army barracks
outside the city.
But McBride decides to take
a dramatically different course of action.
Enlisting the support of the city's mayor,
a stunning public announcement is made.
Schools, libraries, dance halls, pool rooms,
cinemas, and churches all must be closed immediately.
When one of the city's theater managers objects,
the mayor publicly announces,
"Some will kick, but we'd rather listen
to a live kicker than bury him.
When pastors complain about closing churches,
he says, "Religion which won't keep for two weeks
isn't worth having."
It quickly becomes clear that it's going to take more
than a few days to get this outbreak under control.
By mid-October, a flu squad has been recruited
to patrol the streets.
On their first day, 31 men are arrested for spitting in public.
Even worse, some are publicly shamed
with their names printed in the newspaper.
By the end of October, this hard-line health chief
really ups the ante,
introducing a mask order for the flu squad to enforce.
-Now, they're bulky six-ply gauze
and not at all pleasant to wear.
It's no wonder that people resisted them.
But the masks become a symbol of the epidemic in Seattle
and all around the country.
Borrowing language used to describe draft resisters,
people who refuse to wear the masks
are known as mask slackers.
With nothing to do,
the people of Seattle retreat to their homes.
Historian Nancy Bristow has studied the 1918 flu pandemic.
-So beautiful. -Yeah, it's great.
It's kind of fitting to be here
in this completely empty theater,
given that this very theater
would've been closed down in 1918.
-That's right.
Seattle had really strict public closures,
so this would've been closed down
like so many other public spaces in the city.
-There's been a lot of great music here.
Nancy was inspired by her own family's experience
of the deadly virus.
-I grew up very fond of my grandfather,
who lived until I was 12,
and it wasn't until 1995,
when I was fully an adult and he was long gone,
that I learned that he had lost his parents
within four days of each other
in what was probably the fourth wave
of the influenza pandemic.
And so he was orphaned.
He was 14 years old,
and his younger brother, in fact,
was sent to an orphanage.
So, I pretty much kept them with me every day,
as I was researching the flu.
A photograph of the four members
of the Bristow family sat on my desk to remind me
that always, I was talking about real people.
♪♪
-What do the numbers really say
about the difference in these two cities' response,
between Seattle and Philadelphia?
-I can give you one simple statistic
that I think makes it very clear.
For the week ending October 26th,
the excess death rate per 100,000 in Philadelphia
is around 250.
In Seattle, it's about 40.
Roughly six times higher in Philadelphia
than in Seattle.
What was really special about Seattle
is that they acted very quickly.
They were willing to continue to increase,
make more comprehensive the restrictions they put in place,
and they sustained them.
They sustained them over a long period of time.
And those three things in combination --
that was the winning formula.
♪♪
-You have such extensive knowledge
of the last terrifying pandemic to hit the United States.
As you've observed
the 2020 pandemic,
what surprised you and what seemed
all too predictable
in our response?
-I guess what's surprised me is how much it's been like 1918,
that here we were with all of this evidence
taken from 1918 that shows, for instance,
that social distancing and masking and closures works,
and yet, there's resistance.
It's been so disappointing to me.
People are anxious to do the right thing
if they have leadership that is clear and direct,
that makes very obvious for them not only what's at stake
but what they can, in fact, do.
-For all our advances, we're still in the same place.
♪♪
-We've had over 100 years to look for patterns
and try to understand why some cities
and some countries did better than others
in controlling or limiting the spread of the Spanish flu.
We're now in the midst of trying, in real time,
as it happens, to understand
the patterns that we're seeing with COVID-19.
And if you take the countries that have done well,
they don't appear to have very much in common.
Vietnam and South Korea.
Then there's also Australia and New Zealand.
There's Denmark and Ghana.
It's hard to see what links them all together.
This is a disparate picture, and the answer is,
we just don't know yet, but it's bound to come down,
to a certain extent, to good leadership.
-Absolutely. Absolutely.
I think, as you say, it's just too early to tell.
But if you look at the history
of big changes in public health
and the changes in public behavior
that have expanded our life-span,
sometimes those changes don't come from leadership.
And sometimes the most powerful ones,
the most transformative ones come from below.
[ Indistinct chanting ]
-In 1980s New York City,
in the midst of the AIDS crisis,
those changes came from within the gay community.
-Richard. -Hi.
-It's so good to see you. -Same here.
-40 years ago, this was the epicenter.
-Yes, it was, because so many gay men
who came out in the '70s moved to this area
to be close to the center of gay life on Christopher Street.
♪♪
It was the gay promised land.
I grew up in a suburban town,
and the one thing
people couldn't embrace
was homosexuality.
Growing up in that environment
and then coming to New York City
to suddenly see gay men kissing on the street
and no one having to hide,
it was life changing.
I was living life in the fast lane.
I went to the backroom bars.
I went to the clubs, the discos.
I went everywhere.
And so I was aware
of the whole range of sexual expression
and sexual opportunities
and what was becoming, like,
a bustling sexual amusement park in downtown Manhattan.
-In 1982, as news spread of an incurable disease
affecting drug users and gay men,
Richard noticed a lump on his neck.
-My doctor at the time,
he did blood work, and he said to me,
I want you to go for a lymph node biopsy
'cause you have swollen glands.
And I remember thinking, "A gland cut out of my neck?"
-In a New York hospital, a lonely man lies dying of AIDS,
but he's not really alone.
15,000 Americans have already died from the disease,
and the numbers are doubling each year.
Most people, the first thing they think about is death
when you say AIDS.
-If I knew... I wouldn't be here.
-That's one of the harder parts to deal with.
-Richard was diagnosed with AIDS.
But with the government unresponsive to the suffering,
he had to reach out to the community for help.
-So, I met Michael in the first
public support group in New York City
for gay men with AIDS,
and we hit it off right away.
Michael and I said
that we needed to reexamine our lifestyle
because whatever was spreading,
you are more likely to get it the more partners you had.
You couldn't always wait for the government
to provide the answer.
You couldn't really trust the medical establishment.
They were often very conservative,
and it was really difficult for them to speak publicly
about trying to help gay men and other disenfranchised groups
who were affected by the epidemic.
We had to figure out how we in our own community
could find ways to protect each other.
♪♪
-Richard and his friend Michael,
with the help of a pioneering AIDS doctor,
came up with their own solution
for how to stop the spread of the disease
♪♪
-"How To Have Sex In An Epidemic."
-It was a pamphlet.
This is a historic document. -Yeah.
What me and Michael wanted to do was to say,
we want to empower you by explaining to you
how a virus gets transmitted during sex.
That something as simple as a condom
could mean that whatever other people are doing,
you have it in your hands,
the power to protect yourself and your partners.
-There is a way to continue being sexually active.
You just have to make certain changes
in the way that you do it, and here, in this booklet...
-Right. -...here is a recipe for that.
-Right.
And we knew when we went to work on this
that we were doing something seminal,
you know, something that could really
curb the tide of the epidemic.
♪♪
-When "How To Have Sex In An Epidemic"
first appeared in gay bars and bookshops,
some gay men didn't want to listen.
-This was an affront to their belief
that the pinnacle of gay liberation
was having sex with as many partners as you could
as often as you wanted.
♪♪
-But soon, people started to take notice.
-Though we didn't realize it at the time,
to ordinary, everyday sexually active gay men
and eventually women and people in general,
safe sex just struck them
as a sensible, rational response
to a health crisis that was deadly.
It just made sense.
♪♪
-It took years of activism like Richard's
and then the death of Hollywood actor Rock Hudson
for the U.S. government to finally wake up to the crisis.
In 1987, six years after AIDS was first detected in the U.S.,
a commission finally began to investigate
and raise awareness of the virus.
-Every morning I get up, I look in the mirror and say,
"Thank God you're still here. -[ Chuckles ]
-I mean, the most painful, heartbreaking thing
that I ever witnessed in my entire life
was watching the friends,
the circle of friends that I nurtured and cultivate
to be my substitute gay family,
you know, was watching one by one,
them waking up and realizing
that they wouldn't live to see 40.
So when I talk about being old to people,
they're like, "Oh, no. No, you're not old."
I'm like, "Yes, I am.
And I'm proud of it."
-That's the thing that really strikes me
about all these interventions.
The sum total of it is
the freedom to grow old, right?
That's what it's all about.
♪♪
Richard, to me, embodies a kind of figure
that doesn't show up that often
in the history of human health, right?
He's not a doctor.
He's not a public health authority.
And yet, he and handful of collaborators
are able to come up with this idea
and get it into circulation
in a way that no one else wants.
And those figures
are crucial to the story of our expanded life-span.
-The awful coincidence is the other group
who were affected most severely in those early days
were people who were taking illegal drugs intravenously,
using needles.
It allowed people who wanted to see
these two marginalized groups who had been deemed
to have transgressed society's norms
of, in some ways, being deserving of that,
and people like Richard came about
and had to take up positions that they took up
and take the stance that they took
because, you know, our societies,
for a few years back there,
abandoned part of our community.
-They really had the key
because they understood the language of that community
because they were members of it.
And getting people to improve their health
by changing their behavior,
that kind of insider knowledge is often critical.
♪♪
-In 2014,
international troubleshooter, OB Sisay,
turned his attention to a health crisis
that was then taking place in his home country,
Sierra Leone.
Cases of the deadly Ebola virus
were doubling every three weeks,
threatening the lives of hundreds of thousands of people
across West Africa.
-This was the most difficult area to fight Ebola.
The capital city, which had all the slums.
-So, these these are campaign maps.
-Yes. -The language we use
when it comes to epidemics is very military.
-Why, it was a war.
We're fighting for the existence and survival of our country.
The world had locked us down.
There were travel bans.
We weren't getting shipping.
We weren't getting imports.
Our people were dying like flies.
Oh, yes, this was a war.
It's just that the enemy cannot be seen
and doesn't carry a gun.
-With no effective treatment or vaccine for Ebola,
people had to quickly adopt
new ways of protecting themselves.
OB started by putting the people of Sierra Leone in charge.
-The problem was that the response at the time
was not owned by civil unions.
We were being led by our international partners.
We were not going to be able to be everywhere
to stop people infecting each other.
What we had to do
was convince them not to infect each other.
And to do that, we had to decentralize power
and hand it to the people.
And we had to use their own local leaders,
their own languages,
their own structures that they trusted.
-And those targeted interventions
involves asking people to change their patterns of life.
How did you deliver those ideas to the people of Sierra Leone?
-The message, the messenger,
and the medium through which you're communicating
is extremely important
if you're going to change people's behavior.
One of the first things the government had done
was to ban traditional healers from practicing.
But the problem is, these people are
an embedded part of our society.
So the practice of just banning them
wasn't really working,
perhaps rather than consider
the traditional healers as part of the problem,
why didn't we consider them as part of the solution?
So we reached out to them.
We gave them motorbikes to go and do surveillance for us.
So they became an early warning system for us.
If somebody goes to a traditional healer
with a broken leg,
they can use their herbs and fix them.
But if they see this person have symptoms of Ebola,
they call us.
♪♪
-And there's a tradition in Sierra Leone
of relatives washing their dead.
How do you persuade people to change their habits
when it comes to something that acutely personal?
-The corpse of an Ebola victim
has the highest load of the virus.
It is the most dangerous that you can imagine.
So how are we going to do this
to make it both safe and dignified?
Because if you don't do that, people will bury in secret,
and you will never contain the virus.
♪♪
So we trained the locals in the burial safety procedures
and gave them PPEs.
Training the locals to bury
and respect their cultural practices
was one of the most significant steps we did
to stop Ebola spread.
-[ Speaking native language ]
-Armies of young Sierra Leonean volunteers
worked day and night until the battle was won.
♪♪
-No more Ebola!
No more disease!
-On the 7th of November, 2015,
exactly a year to the day
when I had received the call to join the response
on the 7th of November, in 2014,
exactly one year later,
we were declared Ebola free
by the World Health Organization,
and our city went into jubilation.
And we, for people like me, I couldn't speak.
All I could do was cry.
[ Bells ringing ]
♪♪
-Ebola was defeated by Africans in Africa.
Has the rest of the world been
knocking at your door ever since,
asking for help on on on how to plan for future epidemics.
-No, they haven't. They haven't.
So when COVID started,
some of us with experience from West Africa
have been shouting, saying, we have seen this movie before.
It's not gonna end well for you.
But we have largely been ignored.
If the world had learned its lessons
from Ebola,
we would have managed COVID very, very well.
But to learn those lessons,
the West would have needed to listen to Africans.
-Well, if you have to sit and get told by an African,
you're not very used to that.
♪♪
-I was in Sierra Leone
a year after the end of the Ebola epidemic,
and it felt like being in a country
that had been through a war in which they'd been victorious,
and there was a strong sense of pride
that Sierra Leone had done this.
It's not that the virus had gone away.
It had been defeated by the people of that country,
and they had done it.
We mustn't forget, not with a vaccine.
They'd done it themselves through behavioral change.
That's all they had.
[ Indistinct singing ]
♪♪
-And we underestimate that power.
We underestimate the way that behavior change
can be harnessed
to fight off lethal threats,
and I think one of the reasons we underestimate is that
we don't spend enough time
celebrating the track record
of the last 100 or 200 years,
doubling the human life expectancy
in just over a century.
It's a lot easier to build a war memorial
or have a national tribute
in memory of some kind of terrible tragedy
when we're commemorating lives that were lost,
but we don't do the same with lives that were saved.
And I think that's why we have, in a sense,
kind of a skewed perspective on our history
and don't realize the achievement
that all of us have participated in.
-I think we've imagined and we've assured ourselves
that this new world that we live in is permanent,
and the idea that we can slip back
into the world our ancestors knew
is almost too horrific to contemplate.
-Yeah, I think there's this belief that
there is this inevitable ladder of progress.
Once you start curing diseases and extending life
the way we've done over the last century or so,
that that march of progress will just continue.
But it doesn't.
♪♪
New threats emerge,
and so we have to continue the work,
inventing new solutions,
figuring out new ways to collaborate and sharing those
to fight the diseases of the 21st century.
♪♪
-Okay.
So Steven can't see me anymore.
-I can hear you, though.
-Okay. No, no. It's fine.
Steven, I will one day get on an aeroplane.
I will one day be in the United States.
We will one day have lunch. -[ Laughs ]
-As the world grapples with another deadly pandemic,
we reveal how vaccines became
one of the most powerful tools we have
in the fight for extra life.
-He modified the process and arrived at vaccination.
-So, it's a kind of training of the immune system.
-Immune system bootcamp. [ Laughs ]
-How can you make a vaccine if you don't have the pathogen?
Well, all you need is a computer screen.
-This is arguably
the biggest story in human history,
how we doubled our life expectancy.
♪♪