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Transform Care January 22, 2015

Davos Ebola Panel Advances Architecture for Robust & Responsive Global Health Security

Partner, Health & Life Sciences, Oliver Wyman
Key Takeaway
The core solution to health crises like Ebola must be rooted in local health infrastructure

Crispin Ellison is a London-based partner in the Health & Life Sciences practice group of Oliver Wyman where he advises senior government and health decision makers on policy, strategy, performance improvement, and cost reduction. He shares this dispatch from the World Economic Forum annual meeting in Davos, Switzerland:

There’s no place like Davos, Switzerland, during the World Economic Forum’s annual meeting if you want to bring together world-class experts and significant global leaders to discuss an urgent issue where you have knowledge and a perspective. This year, Oliver Wyman’s Health & Life Sciences practice took advantage of the opportunity and convened a panel focused on what the world has learned from Africa’s Ebola epidemic—and what needs to happen to prepare for the inevitable next outbreak.

We were especially interested in pursuing a topic that has become increasingly important in the discussions we’ve had with numerous parties with a stake in preventing future epidemics, up to and including the White House and 10 Downing Street: Now that the world understands that episodes like the African epidemic are not just local crises but truly global events, how do we proceed? How do we engage and coordinate multiple stakeholders from vastly different institutional and cultural backgrounds? What will it take to overcome the cultural and political challenges that were all too obvious in responding to Ebola? What steps can governments and other institutions take to develop scientific cures and disease control? And how can the global community rebuild healthcare, especially primary care and community clinics in affected countries?

We will need another $4 billion before we are finished: to stop Ebola and rebuild shattered healthcare in affected communities. – David Nabarro, UN Special Envoy

For the event, which took place January 21, we were fortunate enough to attract a nearly ideal panel for both its stakeholder diversity and authority: Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance; Dr. David Nabarro, the UN Secretary-General’s special envoy on Ebola; Professor Hans Rosling, public health expert and adviser on Ebola to the Liberian government; and Dr. Paul Stoffels, chief scientific officer for Johnson & Johnson (one of the companies currently developing an Ebola vaccine). My colleague Suresh Kumar, a partner at Oliver Wyman and former US Assistant Secretary of Commerce, moderated the event. We were pleased to receive from Number 10 Downing Street before the event a statement from Prime Minister Cameron lending his support to what Oliver Wyman was seeking to achieve.

As we hoped, the discussion was wide-ranging and impassioned centered on a uniquely complex issue with scientific, cultural, political, logistical and economic challenges. We’ll report what our panelists had to say in more detail over the next few weeks in this space. But for now, while the experience is still fresh in my mind, I wanted to point out a few areas that I found especially striking.

Short-needs and long-term needs. Hans Rosling was eloquent in describing the end-game in fighting Ebola in Liberia. There, the effort now is to track down every single case and all their connections, so that no new infection comes as a surprise. But it’s not easy to find people with the appropriate skills. “We need about 1,000 or so epidemiologists, and about 80 or so who are ready to become real experts on Ebola, and who are preferably from the African continent and can embrace its social and cultural mores,” he told us. “But they are never available. They are always committed to some other crisis.” Shutting down the current epidemic is only part of the job. Said David Nabarro: “We will need another $4 billion before we are finished: to stop Ebola and rebuild shattered healthcare in affected communities.” Seth Berkley agreed: “We need to recognize infectious diseases are here to stay. We need steady investment year on year, not just after an outbreak.”

The importance of local ownership. There was general agreement that the core solution to health crises like Ebola had to be rooted in local health infrastructure, not just airlift medicine. As one of our guests, Elhadj As Sy, Secretary-General of the International Federation Red Cross and Red Crescent Societies, put it, “Ebola can only be defeated in Liberia, Sierra Leone, and Guinea, not in Europe or the U.S.” There’s good reason for that. Explained David Nabarro: “The contribution of healthcare to solving crises like this is no more than 30 percent,” he said. “What is critical are on-the-ground logisticians and top-class coordinators who can work with humility within communities.” And the attractions of the developed world have done much to deprive Africa of those on-the-ground resources, said Oxfam’s Winnie Byanyima: “The brain drain of healthcare workers from Africa has left already poorly resourced local healthcare denuded of trained people.”

The role of the private sector. Both on the panel and in the room there was a clear sense by commercial organizations of their social obligation in times of crisis like Ebola. Dr. Paul Stoffels explained, “The J&J Board agreed to release $200MM for vaccine development in a single day, even though they could not see how they would get the money back.” And it’s not just the pharmaceutical companies willing to jump in to secure solutions. Stoffels added, “For Ebola vaccine development regulators would give an answer overnight, even at weekends, when normally it might take 6 weeks or more.”

Coordinating the effort: The panelists agreed that supra-national organizations such as the World Health Organization need reinforcement, but they were wary of launching new bodies. “If the WHO is only funded for about 15 percent of its needs, it cannot be sensible to blame it for limitations in its ability to respond,” said Rosling. Besides, he argued, “the real need for coordination is at the operational level on the ground.” And David Nabarro pointed out that coordination is only an issue when there are resources available to coordinate: “Whilst there is a real need for coordination with so many state actors and especially NGOs on the ground, this is a good problem to have. In July there was not enough resource to require coordination.” For Seth Berkley, one neglected area for coordination was science: “We need a NATO type body bringing coherence to the global scientific effort.”

For me, the most moving moment of the discussion came near the end. As the panelists discussed how much more rapidly the global community responded than in the past, Hans Gosling remarked, “I saw the face of the new Africa in the response to this tragedy. He meant it as a statement of hope. But the world will see whether it plays out this way.

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