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Getting to Zero: A Doctor and a Diplomat on the Ebola Frontline
In 2014, a 28-year old British doctor found himself co-running the Ebola isolation unit in Sierra Leone's main hospital after the doctor in charge had been killed by the virus. Completely overwhelmed and wrapped in stifling protective suits, he and his team took it in turns to provide care to patients while removing dead bodies from the ward. Against all odds he battled to keep the hospital open, as the queue of sick and dying patients grew every day. Only a few miles down the road the Irish Ambassador and Head of Irish Aid worked relentlessly to rapidly scale up the international response. At a time when entire districts had been quarantined, she travelled around the country, and met with UN agencies, the President and senior ministers so as to be better placed in alerting the world to the catastrophe unfolding in front of her. In this blow-by-blow account, Walsh and Johnson expose the often shocking shortcomings of the humanitarian response to the outbreak, both locally and internationally, and call our attention to the immense courage of those who put their lives on the line every day to contain the disease. Theirs is the definitive account of the fight against an epidemic that shook the world.
442 pages, Paperback
Published August 3, 2018
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Displaying 1 - 15 of 15 reviews
August 19, 2018
This should be compulsory reading material for anyone involved in humanitarian aid and international crisis management and beyond, for epidemiologists, NGO workers, volunteers and the general public. In light of the new Ebola crisis in DRC right now, this is key preparation as to what to do in the case of such a dangerous threat to humans. A lot can be learnt from this, without needing to reinvent the wheel. What I took away from it really is that it is key to have solid day to day management in place before a crisis kicks in. Solid lines of accountability, dedicated and flexible workers, a willingness to engage the community and adapt the response to its customs and uses. And even a willingness to recognise that corruption must be taken into account and talked about to avoid it freezing and delaying a response.
The book is narrated in diary format and makes for an urgent and passionate read about the early response to the crisis from two individuals who were on the ground already, and Irish ambassador and a King's health specialist. Their daily issues and struggles, defeat and success, are laid out honestly and compellingly. Their personal motivation and drive is what made the difference in this crisis. As did many other individuals' against the conversely slow and mammoth-like responses from organisations such as WHO and the UN. It seems these organisations were initially stoppers rather than enablers at least in Sierra Leone.
The book is narrated in diary format and makes for an urgent and passionate read about the early response to the crisis from two individuals who were on the ground already, and Irish ambassador and a King's health specialist. Their daily issues and struggles, defeat and success, are laid out honestly and compellingly. Their personal motivation and drive is what made the difference in this crisis. As did many other individuals' against the conversely slow and mammoth-like responses from organisations such as WHO and the UN. It seems these organisations were initially stoppers rather than enablers at least in Sierra Leone.
August 11, 2018
A fascinating account of two peoples experience within the ebola outbreak in sierra leone. Much that is infuriating, moving and inspiring.
June 3, 2019
A brilliant read. A very balanced and insightful account into Sierra Leone's struggle against Ebola. Many thoughtful criticisms coming from a place of genuine desire for positive change. Thank you for documenting your important perspectives on this critical time in history. Let us all be humble and open to do things better.
March 10, 2026
I had to read this book for a class, but finished it so quick. I liked how they went back and forth between the authors and followed the outbreak so closely in time. Total global health nerd out
June 16, 2026
"... One of the most horrifying things I have read in my whole life".
-- Stephen King on Richard Preston's The Hot Zone.
While true, Preston's Hot Zone and especially the first chapter is graphically extremely gory, where the Ebola virus dissolves the organs before the patient drowns in his own blood, it nonetheless is a sensationalizing of what the virus, belonging to the family Filoviridae, is capable of wringing. The best criticism of Preston is a memoir, titled Level-4: Virus Hunters of the CDC, written by Joseph McCormick and Susan Fischer, who called Preston out for fictionalizing the narrative. Moving on from Preston, and a few films that have underlined the dangers of Ebola, Lassa and Hanta, the common ground is that Ebola punctures the health infrastructure and overwhelms the frontline workers with a lethality that is nothing short of harrowing.
Ebola is an extremely deadly disease, with an average overall fatality rate of roughly 50% across all historical outbreaks. However, the exact mortality rate varies significantly—ranging from 25% to 90%, depending on the specific viral species, the patient's access to modern medical care, and how early they receive treatment. The devastating 2014-16 West African Ebola outbreak in Sierra Leone was caused by the Zaire ebolavirus species (specifically a variant lineage known as Ebola virus Makona). While the Zaire species can be up to 90% fatal without treatment, the massive scale of the West African epidemic saw an overall case-fatality rate of roughly 39% to 40% across Guinea, Liberia, and Sierra Leone due to international intervention and supportive medical care. This was the largest Ebola outbreak in history, resulting in 28,610 cases and 11,308 deaths across the region.
Getting to Zero is Sinead Walsh's (the then Irish Ambassador to Sierra Leone) and Dr. Oliver Johnson's (a British citizen and a faculty of medicine at King's, London) account, or rather memoir at the frontline of the deadly outbreak in Sierra Leone in 2014-15. The book is not a treatise on epidemiology as much as it is the 'blow-by-blow' struggle against the inept bureaucracy, the international agencies, Government's blasé response, and even the citizenry, who, ensconced in traditions were non-cooperative in the initial stages, before turning the lethal events associated with the outbreak around. Lancet, the famed journal of the medical fraternity noted its "honest and engaging tone" and its illumination of "operational errors that increased the number of lives lost"; while The Guardian called it a "compelling read, full of compassion, grief, ingenuity and stories of courage".
After the first case was confirmed in the middle of May in 2014 in Sierra Leone, it spiralled out of control in no time. Though Freetown, the capital city came under the influence later than Kenema and Kailahun, both of which were ravaged, Freetown eventually became the centre of the dreaded epidemic. With hardly any experience in tropical medicine, Sinead Walsh and Oliver Johnson decided to fight the battle with whatever resources were available at their disposal. Battling it out with international donor agencies, their own country's state apparatus, and other humanitarian bodies, the duo finally converged in on one another, which until then, they were warring along their respective tasks. When the first case of Ebola was confirmed, Sierra Leonean health infrastructure was not ready for what was to come. Indeed, a key issue that conditioned the response to the outbreak was the nature of the national public health infrastructure, which made it difficult for Johnson and his team to handle the initial outbreak effectively. Worse, the main hospital in Freetown was poorly resourced, and it experienced numerous problems with a demotivated staff. That Johnson and his team transformed the emergency unit into an isolation ward that became the center of Ebola management and containment, even though they had limited resources at their disposal, points to the dedication and sacrifices they made in providing care to patients. The responses were conditioned by a complex set of issues, including relations between international organizations and the central government and international concerns that the outbreak might extend beyond West Africa. For political reasons, the Sierra Leone government responded slowly to the challenge, significantly delaying the containment of the outbreak. The authors highlight how international organizations failed to provide coordinated responses. Only after it became clear that the outbreak could become an international emergency, with massive implications for international security and peace, did more sustained and coordinated responses come from international organizations, such as the WHO.
The WHO (and even the CDC) came in for sharp criticism in its handling of the epidemic, as they were too lackadaisical in their speed in declaring the outbreak an emergency. The complacency had its international nodes from New York to London, and from Washington to Geneva, with the state capitals of the three West African countries themselves embroiled in state inefficiency. Had any of these paid any heed to the outbreak in the beginning, thousand of lives could have been saved and many thousands more could have been protected from the aftermath of the epidemic. When experts were flown in to much fanfare, their presence was inadequate as many couldn't translate their expertise into a pragmatic approach. The link between theory and practice was evident. It was only after the death of Sierra Leone's 'Hero', Dr. Sheikh Humarr Khan, did the country and slowly the international community started to wake up from their slumber. Finally, the UK and the US decided to intervene, and especially the former in Sierra Leone, whose erstwhile colony the African nation was, felt the moral grounds for. It came in late, but was efficiently spearheaded thereafter, when the infrastructure was set up, and eventually the number of beds available crossed the number of cases recorded on a weekly basis. This phenomenon is what pushed the authors to call the memoir, Getting to Zero.
While the authors had no intention of writing the book, it resulted only after a chance meeting after the epidemic subsided, and the two shared their common frustrations with a host of actors, whose inefficiency caused such a huge tragedy unfold. Sinead Walsh bases her testimony on the 85 interviews she conducted throughout her active presence on the field as well as literature review and attending scores of conferences on the topic. Oliver Johnson's is his close connect with frontline workers, including those exposed to the threat immediately, many of whom he lost to the deadly virus. These testimonies are reflected in the Afterword, which may come across as summarising the unfortunate experiences of dealing with the powers that be earlier noted in fine detail in the book, but also add to what could be done or could have been done differently. Expressing their gratitude to the strength of the community, individuals and adding the international actors to strategize the responses to the epidemic sums up the memoir that, in the words of David Miliband is brave, bold and humble at the same time, and calls for a compelling read so that the world is better prepared. But, who knew that give years down the line, the Corona virus would wreck havoc across the world.
-- Stephen King on Richard Preston's The Hot Zone.
While true, Preston's Hot Zone and especially the first chapter is graphically extremely gory, where the Ebola virus dissolves the organs before the patient drowns in his own blood, it nonetheless is a sensationalizing of what the virus, belonging to the family Filoviridae, is capable of wringing. The best criticism of Preston is a memoir, titled Level-4: Virus Hunters of the CDC, written by Joseph McCormick and Susan Fischer, who called Preston out for fictionalizing the narrative. Moving on from Preston, and a few films that have underlined the dangers of Ebola, Lassa and Hanta, the common ground is that Ebola punctures the health infrastructure and overwhelms the frontline workers with a lethality that is nothing short of harrowing.
Ebola is an extremely deadly disease, with an average overall fatality rate of roughly 50% across all historical outbreaks. However, the exact mortality rate varies significantly—ranging from 25% to 90%, depending on the specific viral species, the patient's access to modern medical care, and how early they receive treatment. The devastating 2014-16 West African Ebola outbreak in Sierra Leone was caused by the Zaire ebolavirus species (specifically a variant lineage known as Ebola virus Makona). While the Zaire species can be up to 90% fatal without treatment, the massive scale of the West African epidemic saw an overall case-fatality rate of roughly 39% to 40% across Guinea, Liberia, and Sierra Leone due to international intervention and supportive medical care. This was the largest Ebola outbreak in history, resulting in 28,610 cases and 11,308 deaths across the region.
Getting to Zero is Sinead Walsh's (the then Irish Ambassador to Sierra Leone) and Dr. Oliver Johnson's (a British citizen and a faculty of medicine at King's, London) account, or rather memoir at the frontline of the deadly outbreak in Sierra Leone in 2014-15. The book is not a treatise on epidemiology as much as it is the 'blow-by-blow' struggle against the inept bureaucracy, the international agencies, Government's blasé response, and even the citizenry, who, ensconced in traditions were non-cooperative in the initial stages, before turning the lethal events associated with the outbreak around. Lancet, the famed journal of the medical fraternity noted its "honest and engaging tone" and its illumination of "operational errors that increased the number of lives lost"; while The Guardian called it a "compelling read, full of compassion, grief, ingenuity and stories of courage".
After the first case was confirmed in the middle of May in 2014 in Sierra Leone, it spiralled out of control in no time. Though Freetown, the capital city came under the influence later than Kenema and Kailahun, both of which were ravaged, Freetown eventually became the centre of the dreaded epidemic. With hardly any experience in tropical medicine, Sinead Walsh and Oliver Johnson decided to fight the battle with whatever resources were available at their disposal. Battling it out with international donor agencies, their own country's state apparatus, and other humanitarian bodies, the duo finally converged in on one another, which until then, they were warring along their respective tasks. When the first case of Ebola was confirmed, Sierra Leonean health infrastructure was not ready for what was to come. Indeed, a key issue that conditioned the response to the outbreak was the nature of the national public health infrastructure, which made it difficult for Johnson and his team to handle the initial outbreak effectively. Worse, the main hospital in Freetown was poorly resourced, and it experienced numerous problems with a demotivated staff. That Johnson and his team transformed the emergency unit into an isolation ward that became the center of Ebola management and containment, even though they had limited resources at their disposal, points to the dedication and sacrifices they made in providing care to patients. The responses were conditioned by a complex set of issues, including relations between international organizations and the central government and international concerns that the outbreak might extend beyond West Africa. For political reasons, the Sierra Leone government responded slowly to the challenge, significantly delaying the containment of the outbreak. The authors highlight how international organizations failed to provide coordinated responses. Only after it became clear that the outbreak could become an international emergency, with massive implications for international security and peace, did more sustained and coordinated responses come from international organizations, such as the WHO.
The WHO (and even the CDC) came in for sharp criticism in its handling of the epidemic, as they were too lackadaisical in their speed in declaring the outbreak an emergency. The complacency had its international nodes from New York to London, and from Washington to Geneva, with the state capitals of the three West African countries themselves embroiled in state inefficiency. Had any of these paid any heed to the outbreak in the beginning, thousand of lives could have been saved and many thousands more could have been protected from the aftermath of the epidemic. When experts were flown in to much fanfare, their presence was inadequate as many couldn't translate their expertise into a pragmatic approach. The link between theory and practice was evident. It was only after the death of Sierra Leone's 'Hero', Dr. Sheikh Humarr Khan, did the country and slowly the international community started to wake up from their slumber. Finally, the UK and the US decided to intervene, and especially the former in Sierra Leone, whose erstwhile colony the African nation was, felt the moral grounds for. It came in late, but was efficiently spearheaded thereafter, when the infrastructure was set up, and eventually the number of beds available crossed the number of cases recorded on a weekly basis. This phenomenon is what pushed the authors to call the memoir, Getting to Zero.
While the authors had no intention of writing the book, it resulted only after a chance meeting after the epidemic subsided, and the two shared their common frustrations with a host of actors, whose inefficiency caused such a huge tragedy unfold. Sinead Walsh bases her testimony on the 85 interviews she conducted throughout her active presence on the field as well as literature review and attending scores of conferences on the topic. Oliver Johnson's is his close connect with frontline workers, including those exposed to the threat immediately, many of whom he lost to the deadly virus. These testimonies are reflected in the Afterword, which may come across as summarising the unfortunate experiences of dealing with the powers that be earlier noted in fine detail in the book, but also add to what could be done or could have been done differently. Expressing their gratitude to the strength of the community, individuals and adding the international actors to strategize the responses to the epidemic sums up the memoir that, in the words of David Miliband is brave, bold and humble at the same time, and calls for a compelling read so that the world is better prepared. But, who knew that give years down the line, the Corona virus would wreck havoc across the world.
January 2, 2019
I read this having just finished ‘The Hot Zone,’ which warns of an Ebola epidemic, and essentially wanting to gain more information on what happened when the Ebola virus did spread in humans. ‘Getting to Zero’ was perhaps not the best book to read as it really focuses on the response rather than on what caused the outbreak or how it spread.
It’s written from two perspectives - an ambassador and a health worker - which is interesting but also somewhat confusing if you don’t fully understand the two roles.
I feel bad giving this an average review as both the narrators are clearly incredible people who have made a huge difference in Sierra Leone. But really, this book is more like an essay written on the key failings as well as the achievements of the Ebola response. If you are an emergency worker or looking to coordinate disaster responses then this book is probably invaluable to you but as a general reader it is quite heavy going and details-focused.
Further, whilst I do understand not wanting to dramatise Ebola or focus on the ‘gruesome’ details this skims over what was happening to people almost in entirety, sort of assuming you know what was happening on a ground level - so if you don’t, it feels slightly confusing and detached.
If you are planning on working with Ebola, in infection or as an emergency response worker then this is a very necessary read- if not it might take you some time to work through.
It’s written from two perspectives - an ambassador and a health worker - which is interesting but also somewhat confusing if you don’t fully understand the two roles.
I feel bad giving this an average review as both the narrators are clearly incredible people who have made a huge difference in Sierra Leone. But really, this book is more like an essay written on the key failings as well as the achievements of the Ebola response. If you are an emergency worker or looking to coordinate disaster responses then this book is probably invaluable to you but as a general reader it is quite heavy going and details-focused.
Further, whilst I do understand not wanting to dramatise Ebola or focus on the ‘gruesome’ details this skims over what was happening to people almost in entirety, sort of assuming you know what was happening on a ground level - so if you don’t, it feels slightly confusing and detached.
If you are planning on working with Ebola, in infection or as an emergency response worker then this is a very necessary read- if not it might take you some time to work through.
April 29, 2022
“Ebola has taught us what works best in an emergency is not an emergency system – it is an everyday system that is robust, resilient, and functioning before the crisis begins.”
I read most of this book in 2019 and then set it aside for some reason. It was fascinating to return to the final chapter in which the authors comprehensively assess the world’s response to the 2014 Ebola outbreak in West Africa and read it now, two years into the global covid pandemic. Hopeful (but not wildly optimistic) that we’ll hold on to the lessons learned in both situations and be better prepared for the next one.
I read most of this book in 2019 and then set it aside for some reason. It was fascinating to return to the final chapter in which the authors comprehensively assess the world’s response to the 2014 Ebola outbreak in West Africa and read it now, two years into the global covid pandemic. Hopeful (but not wildly optimistic) that we’ll hold on to the lessons learned in both situations and be better prepared for the next one.
July 31, 2020
Really enjoyed this! Had to read it for my summer class about COVID-19 and the political science side of the current pandemic. I liked reading the two sides of the story (clinical AND political). I feel like both authors conveyed events and emotions to the reader well. My criticism of this book is concerning the amount of "characters". I feel as though I personally could not keep track of all of the people and actors that were discussed throughout the book. However, locations were very clear and continuously reminded of.
October 17, 2020
Brilliant description of the Ebola outbreak, the fight to get things done right and the resistance from all sides
January 12, 2021
Excellent book - particularly enlightening to read during COVID. Very insightful!
March 10, 2019
An intense book.
June 30, 2020
This was a great read and rather prescient for the failings of the WHO which we are all living with today.
January 6, 2025
Very insightful book. However, felt repetitive at times (especially the afterword).
April 11, 2026
This book is one of my favorites. The story switches from Sinead to Oliver, the authors narrate their experiences from different points of view during the Ebola pandemic of 2014. The events were horrific and heartbreaking, hard to keep moving with life after seeing so many lives taken by this dreadful disease, including those of friends and colleagues. I was inspired by the courage, resilience, and love of so many health care workers, cleaners, and volunteers that dedicated their time 24/7 to fight the Ebola battle. I received this book at a conference where Sinead briefly shared her experience, mainly to create awareness regarding the flows in the governments and health care system that contributed to the expansion of the outbreak and death toll.
November 30, 2018
This is a down to earth account of the difficulties that arose during the Ebola crisis due to cultural issues, and a lack of understanding of the people of Sierra Leone, their traditions and the Sierra Leone way of life. The doctor and diplomat, who wrote this book, merely stood in their shoes, and helped clear the path to "getting to zero". So well written, heart wrenching and compelling. A must read by everyone who sets foot in Sierra Leone! It will help you to understand the people, their feelings, traditions and culture.
Displaying 1 - 15 of 15 reviews