The slow deployment of international aid to countries most affected by the latest Ebola epidemic may have contributed to the virus’ spread, according to a new report, which highlights one of several lessons learned by aid organizations scrambling to contain the infectious disease.
As of December 31, 2014, international aid pledges were estimated at $2.89 billion. But only one-third of this amount — or $1.09 billion — has actually reached nongovernmental organizations (NGOs) or government agencies such as UNICEF or the World Health Organization (WHO), according to the report, “International Donations to the Ebola Virus Outbreak: Too Little Too Late?”
The remaining two-thirds of the promised funding — most of it from governments, corporations and individuals — has yet to be collected let alone distributed, reveals the study, which was published in the British Medical Journal.
“These delays in disbursements of funding may have contributed to spread of the virus and could have increased the financial needs,” said study author Dr. Karen Grépin.
Dr. Grépin, an assistant professor of global health policy at New York University, analyzed donations recorded by the UN Office for the Coordination of Humanitarian Affairs (OCHA). She looked specifically at the level and speed at which donations were made, and how these measured up to the consistently changing estimates of funding requirements.
News of the Ebola outbreak first came to the WHO on March 23, 2014, when Guinea’s Ministry of Health reported a “rapidly evolving outbreak” of the virus involving 49 cases and 29 deaths. Although the WHO donated protective equipment and medical supplies to Guinea within a week of this notification, it was only on August 8th that the outbreak was declared a public health emergency of international concern.
At that point, the WHO and presidents of Guinea, Liberia and Sierra Leone all pleaded for international donors to pledge $71 million to help control the outbreak. However, estimates for required funds kept evolving. In late August, the WHO estimated that $490 million would be required to implement a proposed response plan. Less than a week later, this figure was revised to around $600 million by the director general of the WHO and other UN leaders.
After the creation of the United National Mission for Ebola Emergency Response in November, the official request for funding stood at an estimated $1.5 billion. “Clearly, international leaders have found it challenging to estimate the financial requirements to tackle this rapidly spreading outbreak,” said Dr. Grépin.
‘Quality of response is the problem, not quantity of funding’
The WHO has attributed the dramatically changing estimates to the rapid spread of Ebola virus disease. On August 28th, they reported that nearly 40 percent of the total number of reported cases had occurred within the previous 3 weeks.
“Substantial donor support did not reach affected countries until October, more than 6 months after WHO was alerted to the outbreak,” said Dr. Grépin. “The problem has not been the generosity of donors but that the resources have not been deployed rapidly enough.” While a total of $2.89 billion has been pledged by international donors, it is estimated that it took until mid-October for $500 million to be received by the affected countries, and until at least December for $1 billion to be received.
The data analyzed for the study do not allow for a comparison of the speed of the response to the Ebola outbreak and that for other humanitarian crises, but they do indicate that existing mechanisms for fund disbursement are too slow, said Dr. Grépin
One potential solution could be a dedicated fund that could be rapidly deployed in the event of a similar crisis, the report suggests. Monitoring and tracking donor responses and how the donations are spent is crucial to being able to improve the way public health threats are dealt with.
“Although quantity of funding is important, so is the quality of the response,” concludes Dr. Grépin. “Learning from this experience will help us to understand what worked and what did not in this epidemic and will also help us better assess funding needs in the future.”
‘The world was too slow to see what was unfolding before us’
The sluggish response by donors was compounded by a widespread lack of expertise on Ebola. The humanitarian organization Doctors Without Borders — often known by the acronym MSF of its name in French, Médecins Sans Frontières — was the only aid group with Ebola field experience in the region. Training programs set up by the organization to instruct other health care professionals could not immediately make up for the global lack of expertise, the group has said.
The Ebola outbreak has also killed an unprecedented number of health care workers, including several prominent Ebola experts and at least 450 local professionals. This dealt a severe blow to the region’s fragile health care systems, which were already scrambling to stem the flow of patients. The World Health Organization (WHO) estimates that only one to two doctors are available to treat every 100,000 people in the affected regions.
Facing intense criticism over its handling of the Ebola crisis, the WHO last week proposed major reforms aimed at strengthening their ability to respond to emergencies. Upon announcing the measures, WHO Director-General Dr. Margaret Chan acknowledged that the agency was far too slow to grasp the significance of the Ebola outbreak, which is estimated to have killed more than 9,000 people, mainly in Guinea, Liberia and Sierra Leone.
“The world, including WHO, was too slow to see what was unfolding before us. Ebola is a tragedy that has taught the world, including WHO, many lessons also about how to prevent similar events in the future. … Never again should the world be caught by surprise, unprepared,” Dr. Chan said.
She said the current rules for reporting outbreaks — the International Health Regulations (IHR), created to prevent national health emergencies from becoming global crises — are insufficient and need to be expanded and streamlined. But the biggest lesson she and others at WHO learned during the outbreak fight was that well-trained, and appropriately paid health care workers, are essential to stemming the spread of disease.