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:”
Just two weeks ago, the citizens of Sierra Leone celebrated the end of Ebola transmission in their country with cheering and dancing in the streets of Freetown. It’s a milestone worth celebrating in a country that has suffered nearly 4,000 deaths from the deadly virus.
Sub-Saharan Africa is making significant economic and development strides. Yet, natural disasters, combined with the effects of climate change, rapid urbanization, and conflict situations are threatening these gains, keeping vulnerable and poor communities in a chronic cycle of poverty:
- 425 million people who live in Africa’s drylands are highly exposed to climate shocks, and this number is set to grow by at least 50% by 2030. We cannot fully quantify the human cost, but Kenya alone suffered losses of $12 billion in the 2008 to 2011 drought. Official development assistance (ODA) in humanitarian aid to the Horn of Africa after the 2011 drought was $4 billion, 10% of all aid to Africa.
- Africa’s coastal cities are engines of growth, but are highly vulnerable to flooding and sea-level rise. In the last three years, major floods have hit cities such as Maputo, Dakar, Lagos and Douala. Like droughts, floods won’t go away. Along with periods of extreme heat, strong winds and coastal storms, they are likely to become more frequent.
- Ebola Virus Disease outbreak, from March 2014, was the most widespread, and reached epidemic proportions. The poor bore the brunt, lost their jobs and incomes, had difficulty accessing medical services and suffered psycho-social trauma. On a macro-level, Guinea, Liberia and Sierra Leone are estimated to lose over $1.6 billion in forgone economic growth in 2015.
- Conflicts and disasters often reinforce each other to worsen negative development impacts and increase human suffering. From 2005 to2009, more than 50% of people affected by disasters lived in fragile and conflict-affected states (globally). Fourteen out of the 20 most conflict-affected states are in Africa.
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.
At this week's UN Sustainable Development Summit, the world's oceans will be getting the attention they have long deserved -- but not always received. They are the focus of Sustainable Development Goal 14: "Conserve and sustainably use the oceans, seas, and marine resources for sustainable development."
The inclusion of oceans for the first time in the international-development agenda illustrates the ambitious and holistic view of challenges and solutions that nations are embracing. With the SDGs, nations are calling for a future in which nature is managed to drive economies, enhance well-being and sustain lives -- whether in Washington or Nairobi, on land or sea.
Fifteen years ago, nations convened at the UN and created an unprecedented set of guideposts, the Millennium Development Goals. In that timespan, the number of people living in extreme poverty was more than halved. But the oceans were not part of those goals. We now have the opportunity to focus minds globally on restoring healthy oceans for resilient economies and thriving communities.
This attention comes not a moment too soon.
- What's Working: Sustainable Development Goals
- disaster risk management
- coral reef
- food security
- marine resources
- ocean health
- sustainable development goals
- Sustainable Development
- Agriculture and Rural Development
- Climate Change
- East Asia and Pacific
- Latin America & Caribbean
- Sierra Leone
Ebola has largely disappeared from news headlines in recent months as the epidemic started to settle. Earlier this week, on August 24, Sierra Leone’s last-known Ebola patient was released from the hospital, possibly signaling the end of the disease in that country. No new cases have been reported in Liberia since mid-July, and only three new cases have emerged in Guinea as of last week.
Yet, experts have warned that international organizations are still not capable of containing it, if it were to re-emerge. It's also clear that the economic impact of the Ebola virus outbreak in Guinea, Liberia and Sierra Leone is profound, as the disease affected livelihoods and led to food shortages, loss of education, and widespread fear and mistrust in communities.
This is why #TrendOnThis, a new campaign from the Ad Council and Y&R New York, aims to keep Ebola on the forefront of people’s minds. The campaign includes a series of public service announcements featuring celebrities David Oyelowo, Olivia Munn, and Lance Bass. These ads play on the typical, pandering commercials many celebrities have done and, instead, uses ironic self-deprecation to get the message across. Here’s Actor David Oyelowo, who introduces some tongue twisters based on his own name, like Oyelowo's Yellow Oboes, while emphasizing the seriousness of Ebola:
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.