The Challenges

to Ebola Response

Kim Yi DionneSmith College

Challenges

• No recorded previous outbreak (though there is evidence of previous exposure).

• Outbreak across borders requires coordination across governments.

Intensity of

Spread

Challenges

• No recorded previous outbreak (though there is evidence of previous exposure).

• Outbreak across borders requires coordination across governments.

• All three of the heavily affected countries have weak health infrastructure.

Capacity to

Respond

Challenges

• No recorded previous outbreak (though there is evidence of previous exposure).

• Outbreak across borders requires coordination across governments.

• All three of the heavily affected countries have weak health infrastructure.

• International response was slow and then reactive/defensive.

Timeline of events

• [Mar 25: CDC announces Guinea outbreak]• [Mar 30: Liberia reports two cases]• [May 25: 1st confirmed case in Sierra Leone]

• Aug 8: WHO declares and international health emergency

• Aug 12: UN special envoy appointed• Sept 16: President Obama announces $750

million planned response by U.S.• Sept 18: UNMEER established

Slow and weak international response

• April 10: WHO says $4.8 million is needed for the response.

• July 31: WHO says $103 million is needed for the response.

• Sept 18: UN says $1 billion is needed for the response.

What hasn’t worked?

• Quarantine in West Point neighborhood in Monrovia, Liberia

• Late June: Liberian and Sierra Leonean presidents made threats of prosecuting anyone “harboring” the infected

• Closed borders and suspended flights

Photo taken during West Point Quarantine, Monrovia, Liberia, by John Moore, Getty Images

Photo taken during West Point Quarantine, Monrovia, Liberia, by Abbas Dulleh, Associated Press

What is working?

A common statement from the West

“We know what works…”

Who is responding?

C-17 Jet in Monrovia, Sept. 18 by Joe Penney (Reuters)

MSF volunteer preparing CDC doctor to enter Ebola unit in Liberia (CDC Global)

Who is responding?

Who is responding?

• Locals: the governments of Guinea, Liberia, and Sierra Leone; health workers; burial teams; contact tracing teams, and more.

• International agencies: World Health Organization (WHO); United Nations (esp. UNICEF); Red Cross; Doctors without Borders (aka MSF), and more.

• Powerful donors: US, UK, France• Others: Cuba (doctors); Malaysia (rubber

gloves)

What might work?

• Provide protection for local health workers• Pay local health workers• Evacuate all health workers who get sick, not

just the ones from Western countries• Work with and through local leaders

What new challenges might the response create?

• Militarization of humanitarian aid• Focus on potential Westerners who get sick• Multiple donor countries, still unclear on

coordination