Understanding the Ebola Outbreak and How to Respond in the Future

On November 12, Brookings held an event on the Ebola outbreak of 2014 and the international response in its various aspects, with an eye towards understanding the current crisis and fashioning future policy.

Brookings President Strobe Talbott led a conversation with U.S. Agency for International Development Administrator Rajiv Shah and Assistant to the Administrator for Africa Eric Postel. The conversation was followed by a panel to discuss the effects of the Ebola crisis, moderated by me. Panelists included Oscar Bloh, director of the Liberian office of Search for Common Ground; Amadou Sy, a senior fellow in the Africa Growth Initiative in the Global Economy and Development Program at Brookings and a former IMF official; and Elizabeth Ferris, senior fellow in the Foreign Policy Program and director of the Brookings-LSE Project on Internal Displacement. In addition to the speakers, there were also a number of strong interventions from the audience, including from former Liberian officials and other Africans.

Shah and Postel made a number of very important points:

• Infection rates are declining in Liberia, but that could be a temporary phenomenon and may not be true even now in rural areas of the country (or in other afflicted parts of West Africa, such as the forested parts of Guinea).
• Ebola has decimated the health care systems of Liberia, Sierra Leone and Guinea, and rebuilding those sectors will be of paramount importance.
• Liberians, and others, have made major progress in changing burial practices, reducing human contact and improving basic hygiene that have helped lower the infection rates substantially from the 2:1 ratios of earlier this spring (meaning, on average, two new cases for every infected person), to something closer to a leveling off of the epidemic.
• However, in a best-case scenario, we won’t be able to expect a major decline in the severity of the crisis until at least the spring of 2015.
• And even then, just as happened this past spring, there could be a resurgence if the virus mutates or if it reaches new populations that do not get the kind of public health support they need at that time.
• Watching the data on trends with the epidemic provides an enormous help in how to respond, and indeed, we should be able to do even better in that regard given the prevalence of cell phones, even in poorer countries in Africa
• The president’s request for more Ebola funding to protect America is extremely important because we must avoid any false sense of complacency just because the epidemic is perhaps leveling off in Liberia and not presently expanding its reach into North America. That response includes preparations here at home, but also further work in West Africa, since this kind of problem can only truly be addressed by going to the source, and since there remains much work to do as indicated above.
• The economic effects of this crisis have been severe as well, bringing growth rates down from levels approaching 10 percent in these new success stories of West Africa to very low or no growth at all.
• As Talbott also noted, Americans continue to think that the United States spends far more than it does on international development and relief, and when told of what their dollars actually accomplish on the ground, Shah pointed out that they often express a willingness to do more, not less

Bloh echoed some of Shah’s observations and emphasized the degree to which Liberians have come together and changed the behavior to address the Ebola crisis. But he also underscored the importance of citizens, citizens’ groups and the international community keeping pressure on the Liberian government to restore and improve health care systems, and to make sure that future deals designed to lure investors back to Liberia are designed with the interests of the Liberian people in mind. He is concerned that often this has not been the case in the past.

Sy built on the points Shah and Postel made about the economic travesty that has resulted from Ebola. His greatest near-term concern was in helping the affected governments cover their fiscal gaps brought about by the general slowdown in economic activity and the termination or freezing of various projects by external investors. He thought that it would be difficult to reverse the trends in external investment in the nearby future, but saw an important, and indeed, urgent role for the international community to help Liberia and other regional governments with their fiscal gaps so that schools can soon be reopened, health care services restored and infrastructure projects resumed, among other things.

Ferris placed the West Africa Ebola crisis in a broader international context. She noted that the world’s relief and response capacity was already overstretched by long and intense crises from Syria to Sudan to the Central African Republic and beyond, and that some very fresh and even painful thinking might be needed to think about how to respond. Among other ideas, she suggested that there may have to be sunset terms on new humanitarian relief missions—not because the world has the power necessarily to declare an end to any disaster or crisis after a specific length of time, but rather because the humanitarian community cannot realistically manage acute crises for years on end, and may need to hand off certain problems to the development community after a certain number of years simply to preserve its capacity to handle new problems as they arise.

I concluded by noting how much Africans have already done to improve the governance of their own countries and their response capacity for problems like Ebola—and how encouraged those who focus on Africa should be, when one compares the continent’s current trajectory (even if clearly still mixed, and troubled in many ways) with earlier decades in the post-independence era.