By Brian Finlay and Cameron Trainer:
Two years ago this month, the international community watched in dismay as Ebola ran rampant throughout West Africa. Although the earliest reported cases had occurred six months earlier, prophylactic treatment and disease management had not kept pace as infection rates accelerated at an alarming rate. In September 2014, more than 40% of the then-reported cases had occurred in the previous 21 days.
By the time coordinated health interventions gained control over Ebola, the outbreak cost over $3.6 billion and led to over 21,000 deaths in Guinea, Liberia, and Sierra Leone. Moreover, the economies of those countries lost a combined $2.2 billion in GDP in 2015 alone. Perhaps most distressing is that virtually all post-incident reporting concluded that, through earlier and better coordinated responses, the international community could have — and should have — dramatically reduced the impact of the outbreak.
After action reports universally agreed that the first and most glaring failure of the international community in addressing the threat of Ebola was the delay between the initial outbreak and large-scale intervention. Despite the fact that Ebola cases had been reported as early as March 2014, it was not until late June that the World Health Organization (WHO) declared the outbreak a level 3 emergency. Without question, corralling the requisite political will for early intervention in advance of the next health crisis is an essential objective — but one that is also likely to be unachievable. This vexing conundrum should not impede active efforts to correct for those failures of the last intervention that are actionable today.
Principle among such issues is the struggle to supply adequate material to healthcare workers in affected regions. Many hospitals in proximity to populations either at risk for or suffering from Ebola were forced to close, and remained closed, due to a lack of basic medical supplies. Air passenger and cargo connections into and out of the three most heavily impacted West African nations were hardly plentiful prior to the onset of the crisis. As publicity surrounding Ebola grew, many major airlines with the capacity to provide critical lift halted flights to the region. The unwillingness of many commercial carriers to provide regular lift, much less surge, capacity ultimately meant that the military along with a select few commercial operators would be primarily responsible for moving the requisite people and supplies into and out of the region.
While the military response to the crisis was praised as showcasing “[…] the expeditionary capabilities required to complete this type of emergency humanitarian operation effectively and successfully,” reliance on military means to solve civilian crises is concerning. Humanitarian missions are assumed to be impartial, giving aid where it is needed without a thought to political affiliation. Relying on military forces sworn to the support of a nation-state and, therefore, a political agenda risks politicizing humanitarian missions and turning them into perceived avenues for states to exert power abroad. More subtly, ceding civilian operations to military forces erodes the boundaries between civil and military spheres, both threatening the stability of countries with proto-professional militaries and altering institutional relationships in developed countries to uncertain ends.
For these reasons, it is necessary for the international community to identify sufficient air logistics capabilities independent of military structures. Our goal should be to ensure that the private commercial market can provide the requisite surge capacity to transport needed medical supplies and health professionals in times of crisis (either naturally occurring or deliberately propagated) without fear of adverse market effects. Identifying appropriate market-based incentives and protections will be essential.
Airlines’ decision to restrict operations to and from impacted counties was motivated by an array of factors: political and public pressure, immediate financial losses, and longer-term risk related to liability. Even in the United States, a country well-removed from the epidemic, fear was widespread: polls calculated between 58% and 67% support for travel bans to countries affected by the epidemic. This fear cut directly into airlines’ stock value. At the height of the hysteria in the United States over Ebola, the stocks of Delta and American Airlines — two of the world’s largest — fell for a week straight. Perhaps fearful of effects similar to SARS outbreak of the early 2000s, which cost American airline companies approximately $1 billion, carriers such as British Airways restricted service to West Africa. In addition to British Airways, Air France, Emirates Airline, Korean Air, Senegal Airlines, Arik Air, Gambia Bird, Kenya Airways, and Asky Airlines all suspended flights in spite of the WHO’s recommendation to avoid unnecessary travel restrictions.
To facilitate future cooperation between the WHO and airline companies, it is necessary to explore the humanitarian application of public-private partnerships. Because airline companies operate on thin margins of profit, they logically avoid possibilities for major financial loss, including being associated with the outbreak of an infectious disease. While such companies maintain corporate social responsibility (CSR) programs, such programs are ordinarily divorced from major business decisions. A notable exception can be found in Brussels Airlines’ conduct during the Ebola outbreak when it was one of two airlines to continue servicing Sierra Leone, Liberia, and Guinea, which it viewed as its humanitarian duty. Given that this view was only expressed in action by Brussels Airlines and Air Maroc, it is clear that we cannot rely on CSR to guarantee airline cooperation with humanitarian missions, especially when there is a possibility for financial loss.
For this reason, governments and international institutions should collaborate to provide sufficient incentives by providing preferential contracts for peacetime business to those civilian airlines that offer aircraft for assistance in humanitarian missions. Such an ambitious proposal has precedent, albeit at a national level.
The Civil Reserve Air Fleet (CRAF) program in the United States asks for civil carriers to commit aircraft in order to assure adequate airlift reserves in return for peacetime government airlift business. Airlines participating in the program are required to commit at least 30% of their passenger and 15% of their cargo fleet with four complete crews for each aircraft. With such commitments, the program can draw on a fleet of over 450 aircraft. For comparison, the two carriers that maintained service to countries affected by Ebola — Brussels Airlines and Air Maroc — field a combined fleet of just over 100 aircraft. Creating an international public-private partnership similar to CRAF would provide the requisite capabilities to respond quickly and in force to future public health crises.
The Logistics Cluster, which has operated under the authority of the United Nations World Food Program since 2005, is the logical body to control a civil reserve fleet in the CRAF model. While the Logistics Cluster was active in the fight against the Ebola epidemic from September 2014, and assisted in the transportation of 30,594 metric tons and the storage of 22,994 metric tons of cargo on behalf of over 77 organizations, it should be encouraged to expand its public-private partnerships so as to better facilitate the rapid deployment by air of necessary supplies and personnel. Recognizing the success of the Logistics Emergency Team (LET) — a partnership between the Logistics Cluster, Agility Corporation, the Maersk Group, and United Parcel Service — and the reticence of these partners to grow the LET, we propose the creation of a parallel structure also under the auspices of the Logistics Cluster to manage a civil reserve fleet on the CRAF model.
Though the question of finding the proper incentives for airline participation in such an initiative remains open, the existence of such an initiative is imperative. Only through such an initiative will the international community be prepared to address future crises without relying on the crutch of military assistance.
Brian Finlay is President and CEO of the Stimson Center. Cameron Trainer is a research intern for Stimson’s Managing Across Boundaries initiative.