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Preventing Pandemics: Ebola and the Global Health Supply Chain

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By Sharon Jackson and Brian Finlay:

There is progress being made in the countries most severely impacted by Ebola. Liberia released its last confirmed Ebola patient during the first week of March and has not reported any new cases since the beginning of the month. While the number of cases in Sierra Leone and Guinea increased for that same period, improvements in the timeliness of diagnostic testing in both countries hints at our growing capacity to head off the sort of unchecked outbreaks that prompted (perhaps unreasonable) fears of a global pandemic.

The lessons learned from the earliest days of the outbreak point us toward improving our response to the next crisis. High among those lessons must be a clearer understanding of how — and how quickly — assistance could move to the worst stricken regions. The initial stages of the emergency response to Ebola struggled to deploy essential equipment and materiel where it was most needed and it was also hampered by the absence of a deliberate planning process for transportation logistics. There can be little doubt that this exacerbated the crisis. Fixing this challenge must be a new global priority.

The Ebola outbreak of 2014 began in a remote area of Guinea in December 2013. It spread to other remote communities and large cities in Guinea, Liberia, and Sierra Leone, along with a small number of sporadic cases in Nigeria and Mali. As worries over spread of the disease grew, many of the limited air transit routes needed to carry supplies to impoverished, isolated West Africa were threatened with suspension. Public health authorities from the affected countries, as well as experts from the international community, recognized limitations in capacity to move critical medical goods were contributing to the spread of disease. 

At best, the slowing or shutting down of logistics routes during the Ebola crisis hampered resistance efforts but at worst, with life-saving medical gear and protective wear failing to reach regions and individuals in need, it proved life-threatening. A September 2014 report from the U.N. Office for the Coordination of Humanitarian Affairs (UNOCHA) states that an effective Ebola response would require 2,000 flights every month for healthcare workers, plus 4,000 flights per month for aid workers, and an additional 3,242 tons of equipment shipments. Yet from outbreak of Ebola in December 2013 to August 2014, commercial airlines cancelled more than one third of international flights to affected regions, reducing monthly flights to just 374 each month — despite the fact that the World Health Organization never recommended travel bans.

There are additional reports of transportation infrastructure issues delaying shipments, such as those of humanitarian aid sitting on tarmacs for weeks at a time due to airline cancellations and of reductions of 30 percent in container shipping to affected areas due to docking bans in other countries. In one extreme case, $140,000 worth of donated equipment sat in containers on Sierra Leone’s docks for over three months due to lack of coordination and refusal to pay shipping costs at the governmental level. During these same months, from August-October of 2014, infection rates of Ebola increased exponentially in Sierra Leone by 500%.

In short, augmenting existing transportation capacity is essential to reducing Ebola disease transmission and the number of cases.

A multilateral regional mechanism to develop contingency plans for transportation logistics support would be invaluable to respond to the current health crisis as well as future health emergencies or natural disasters. Such a planning process could include all major stakeholders from national governments, regional multilateral organizations, the private sector, civil society, traditional and community leaders, and non-governmental organizations.  The task would be to identify and discuss the types of logistic resources that could be quickly committed — and in some cases, pre-committed — to an emergency response and to facilitate the coordination and integration of the effort.  It may be advantageous to have a small permanent staff under the aegis of a multilateral health or economic development organization (such as the World Health Organization or the World Bank) undertake regular reviews or updates to ensure the plan is always ready for implementation.

Last year, President Obama launched the Global Health Security Agenda to, “prevent, and detect, and fight every kind of biological danger — whether it’s a pandemic like H1N1, or a terrorist threat, or a treatable disease.” The Ebola outbreak highlighted shortcomings in large scale outbreak response in the developing world. Because critical resources did not arrive in affected communities in a timely manner, the outbreak grew and became a major international crisis. Establishing a regional, multilateral mechanism to undertake deliberate transportation logistic planning for crisis contingencies could facilitate a more rapid and robust response and help limit the consequences of future health crises. If the president’s initiative is meaningful, it will address this glaring shortcoming.

___

Sharon Jackson is a former Franklin Fellow at the US Department of State where she worked on enhancing global health security and systems. Brian Finlay is Vice President at Stimson.

 

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Photo credit: Simon Davis/DFID via flickr

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