On September 20th, 2017, a young hunter, in his 30s, arrived at a health center in Kween District, located in Eastern Uganda, on the border with Kenya. He had symptoms of fever, bleeding, diarrhea, and vomiting. Within 5 days he was dead. Two weeks later, his sister also showed up at the same health facility: she had similar symptoms. Within a week, she too was dead. Posthumous samples confirmed that she had Marburg Virus Disease (MVD), one of the most virulent pathogens known to infect humans. On 19th October, the Ugandan government notified WHO and publicly announced an outbreak of MVD. Not long after this announcement, MVD claimed another victim – this time, the hunter’s brother.
The Ebola Virus Disease (EVD) crisis ended more than a year ago in Liberia. It resulted in over 10,000 cases and 5,000 deaths. For many children, the crisis continues through intrusive memories of illness, isolation, and death. These memories are particularly acute for the children directly affected by Ebola; those that were quarantined, separated from family during treatment, or orphaned. The Liberia Ministry of Health (MOH) identified 3,091 such children, and a World Bank working paper calculated that approximately 4,200 Liberian children lost one or both parents to Ebola.
Tears cascade down her face as she embraces the mound, her cheek pressed to the dirt, a body six feet below. She wails, screams, bends backward and then throws herself back on the grave, again and again. A wreath sheathed in plastic nestles below a simple cross marker with a name and a date: April 24, 2015 -- marking one of the 4,809 lives claimed by Ebola in Liberia.
Dear Colleagues and Friends,
I wanted to take this opportunity to wish you a Happy New Year, and reflect on several notable events from 2015 - a year of remarkable progress in global health, and remarkable expansion for the World Bank Group's health, nutrition and population portfolio, which grew to more than $10 billion.
Amid the devastating effects of West Africa’s Ebola outbreak to human lives, communities, institutions, systems and the economy, there are lessons to be learned for the region to be better prepared to handle future outbreaks.
Granted, the Ebola outbreak in Nigeria was caught early before it spiralled out of control, unlike in Sierra Leone, Liberia and Guinea, but Nigeria was also able to successfully contain the disease. The country would have not been able to respond so swiftly if it had not had a history of responding to public health emergencies, such as recurrent cholera and Lassa fever outbreaks and lead poisoning, and developed an appropriate response capacity.
Some components of the Ebola response in Nigeria were adapted from the country’s polio eradication efforts, as well as infrastructure and capacity built in response to an Avian Flu outbreak in 2006. Until recently, polio had debilitated thousands of Nigerian children annually. In 2015, Nigeria marked the one-year anniversary of Wild Polio Virus interruption, and had before been declared Ebola-free.
So we ask: How did a previously weak system suddenly gain the momentum to operate efficiently and yield favorable outcomes? Are there lessons we can learn related to the effectiveness of future disease surveillance and emergency response efforts? In both instances [Ebola and polio], we found an alignment of several factors – what we call the seven “P’s:”
We trudge past the towering mosque, past where the girls had skipped rope, past a trash heap piled high with cars. We step over a sewage trough, amble down a dusty hill, see the ocean skirt the horizon.
I consider myself a pretty lucky person. I often work across the beautiful islands of the Caribbean, with their glistening turquoise seas, the lush greenery, fresh tropical fruit… I could go on, but I think you get the idea. Paradise is not always perfect, however: Beneath the postcard views is an often not-so-perfect public health system.
A recent “close encounter” in the Caribbean served as a stark reminder of this truth. Different from the movie “Close Encounters of the Third Kind”, it didn’t involve little green men nor giant floating spaceships, but something just as unknown, at least to me: chikungunya, a viral disease transmitted by the bite of infected mosquitoes.
Unfortunately, I was infected with chikungunya a little over a year ago during a work trip to the Eastern Caribbean in support a results-based financing project for the health sector. Our team was de-briefing near the ocean when it happened: I felt a quick sting from a mosquito bite, but didn’t think much of it. I felt unusually tired that evening, and by the next morning a number of other symptoms appeared – it was indeed chikungunya.
Exactly one year ago, I received an unexpected call from my manager just as I was finishing a week of paternity leave following the birth of my daughter. She asked me to lead an “absolutely urgent” project and said she was cutting her summer break short to return to the office. That project was on Ebola response. We had monitored Ebola cases in Guinea, Liberia and Sierra Leone over the previous months with growing concern, but now the World Bank was mobilizing its first emergency funding commitment to help the three affected countries contain the disease’s spread and help communities cope with the economic fallout.
In Liberia, the number of weekly new cases of Ebola Virus Disease (EVD) has fallen sharply since November 2014, and domestic “aversion behavior” due to the crisis is abating. There is greater mobility of people, as reflected in the reopening of markets and increasing petrol sales. The government is more bullish about the future course of the epidemic and has lifted curfews, recalled furloughed civil servants, and opened borders, and is reopening schools, shuttered since the onset of the crisis.