Calming the fears over Ebola

In the wake of recent Ebola scares, the World Health Organisation (WHO) has been urging international companies that operate in Africa not to panic and pull out and create problems such as supply of food and other resources. “Currently, some companies have taken the decision to suspend services to the affected countries. This includes airlines and shipping companies. As a result of these decisions, countries are beginning to experience supply shortages, including fuel, food, and basic supplies,” stated the WHO. The organisation said that it is working with the UN World Food Programme to ensure adequate food and supplies. But it called on companies to make ‘business decisions based on scientific evidence’ with regard to transmission of the Ebola virus.hide“In the current outbreak, the majority of Ebola virus disease [EVD] cases are a result of human-to-human transmission and failure to apply appropriate infection prevention and control measures in home care, some clinical settings, and in burial rituals,” explained the WHO. “It is important to understand that EVD is not an airborne disease. Individuals may become infected as a result of contact with the bodily fluids (vomit, diarrhoea, sputum, blood, etc) from persons who are confirmed to have EVD or who have died from EVD. “Companies bringing goods and services to the affected countries are at low risk for exposure to EVD and WHO, under the International Health Regulations, encourages companies and organisations to continue providing these necessary supplies,” continued the health organisation. While WHO is clearly now calling for calm within the wider African and international community about the EVD outbreak it was probably responsible for much of the panic, particularly outside Africa, after it designated the outbreak as a Public Health Emergency of International Concern early last month. The first meeting of the emergency committee convened by the director-general under the International Health Regulations of 2005 was held by teleconference on 6 August, 2014. Representatives of Guinea, Liberia, Sierra Leone, and Nigeria took part in what WHO described as an informational session to provide an update on and assessment of the Ebola outbreak in west Africa. WHO reported that after discussion held at this meeting the Committee advised that the Ebola outbreak in west Africa constituted an ‘extraordinary event’ and a public health risk to other states; The possible consequences of further international spread are ‘particularly serious’ in view of the ‘virulence’ of the virus, the intensive community and health facility transmission patterns, and the weak health systems in the currently affected and most at-risk countries; and A coordinated international response was deemed ‘essential’ to stop and reverse the international spread of Ebola. The latest announcements from WHO, backed up by experts such as RMS, do appear to suggest that from a broader African and international perspective the outbreak is under control. But breaking news headlines give the impression that this is not necessarily the case. As professional risk managers who have been involved in such crises will readily attest, risk perception is often more powerful than risk reality. The outbreak has hit Liberia hardest and Liberians, for example, can surely be excused for being extremely worried about the development of the EVD outbreak. Towards the end of last month soldiers opened fire on residents of a poor township just outside the country’s capital city Monrovia after it was locked down in an effort to contain the spread of the virus. By 25 August, two communities on the outskirts of Monrovia had been locked down with makeshift barricades manned by soldiers. The residents trapped in the quarantined areas suffered shortages of food and water and faced fast rising prices for basic foodstuffs within the now isolated communities. Despite WHO’s announcement that no travel restrictions are necessary, Kenya Airways, Africa’s third largest carrier, said towards the end of August that it would cease flying to Liberia and Sierra Leone. The airline acted on the advice of the Kenyan health ministry. This followed the decision on 20 August by Korean Airlines to end trips to Nairobi because of the risk of infection spreading to Asia via services from west Africa. Cameroon has formally closed its lengthy border with Nigeria. Furthermore, a team of experts were sent to a remote part of Congo where 10 people died after suffering Ebola-like symptoms. Witnesses said the victims had all suffered fever, diarrhoea and bleeding from the ears and nostrils—all of which are symptoms of the deadly virus. At the time of writing, WHO maintained that formally recognised cases remain restricted to Liberia, Guinea, Nigeria and Sierra Leone. But the BBC reported on 25 August that the Democratic Republic of Congo had confirmed that an outbreak of haemorrhagic fever in the north of the country had been identified as Ebola. Health Minister Felix Numbi reportedly told the BBC that tests on two people had confirmed the disease in Equateur province, where 13 had already died. The WHO later confirmed it is not the same strain to that found in west Africa. Dr Numbi said a quarantine zone was being set up to contain the disease. These would have been the first cases reported outside of west Africa since the outbreak there began at the end of last year. The economic impact on those countries hardest hit could be severe and the timing could not be worse as the region has only just begun to emerge strongly from a long period of turbulence. The closure of borders and the suspension of flights immediately hit trade and severely limited the ability of affected countries to export and import goods. The agriculture sector, in particular, has already been hit. “The economy has been deflated by 30% because of Ebola,” Sierra Leone’s Agriculture Minister Joseph Sam Sesay told the BBC late last month. He said President Ernest Bai Koroma revealed the bad news to ministers at a special cabinet meeting. “The agricultural sector is the most impacted in terms of Ebola because the majority of the people of Sierra Leone—about 66%—are farmers,” he reportedly said. Roadblocks manned by police and military are preventing the movement of farmers and labourers as well as the supply of goods. “We are definitely expecting a devastating effect not only on labour availability and capacity but we are also talking about farms being abandoned by people running away from the epicentres and going to areas that don’t have the disease,” Mr Sesay added in his interview with the BBC. The problem is compounded by the fact that the region is just entering the planting season. The chief co-ordinator for the United Nations Development Programme (UNDP), David McLachlan-Karr, told the BBC that this will create food shortages and put pressures on food prices. Inflation has already started to rise and there is pressure on the national currency as well as a shortage of foreign exchange, he said. The longer-term impact on the region’s long-awaited economic recovery could be devastating. Sierra Leone’s economy was expected to grow 14% this year, almost three times faster than the average for Sub Saharan Africa. Its neighbours, Liberia and Guinea, were just beginning to digest the economic potential of the discovery of rich iron ore deposits that would attract billions of dollars in foreign investment. As noted by WHO, international companies have started to pull back from the region, notably in the mining sector. The world’s largest steelmaker ArcelorMittal has seen work disrupted on its iron ore mine expansion project in Yekepa in Liberia because contractors swiftly moved people out of the country. Vale, the world’s biggest iron ore producer, was involved in Simandou, Africa’s largest iron ore mine and infrastructure project, in the forests of eastern Guinea, until April when it evacuated six international members of staff and put the rest of the workforce in the area on leave. London Mining, the UK-based company, has moved out some of its non-essential expatriate staff from Sierra Leone. Mining is very important to Sierra Leone and the main driver of its recent recovery. The International Monetary Fund calculates that Sierra Leone’s output grew by 20% last year. If iron ore mining were stripped out then it would only have grown by 5.5%. The World Bank recently revealed that it has downgraded its GDP growth forecast for Guinea from 4.5% to 3.5%. The Liberian economy had been expected to grow by 5.9% this year. But the country’s finance minister, Amara Konneh, was recently reported as admitting that this was no longer possible because of a slowdown in the transport and services sectors and the departure of foreign workers because of the Ebola outbreak. The longer-term human and economic impacts of the disease are very difficult to estimate currently as so much uncertainty remains. The World Bank believes that it could take six to nine months to peak given the resources available to manage the spread of the disease and lack of readily available cures. The bank has, however, carried out in-depth research into the long-term financial and economic impact of HIV/AIDS in the region and the potential is harrowing. According to a major research project carried out by the World Bank and published in 2012, there were some 22.5 million people worldwide living with HIV/AIDS that year, of which two thirds were in Sub Saharan Africa. HIV/AIDS is now the leading cause of premature death in the region. Between 2001 and 2009, global funding for HIV/AIDS treatment increased tenfold from US$1.6bn to US$15.9bn and more than five million people in developing countries were receiving treatment in 2012. In Sub Saharan Africa, an average of 5% of the population suffers with the condition and life expectancy has been reduced by up to 10 years as a result. Botswana is one of the countries hit hardest by HIV/AIDS, with some 24.8% of the population between the ages of 15 and 49 affected. Life expectancy in Botswana fell from 66 years in 1990 to 50 in 2002, before moving back up to 54 by 2008. The fiscal cost is big. The World Bank estimates that by its peak in 2016, treating HIV/AIDS will account for some 3.5% of the country’s GDP. The fiscal cost to government is huge, accounting for some 10.8% of government revenues this year—rising to an estimated 12.2% by 2021. Such statistics are concerning and throw a dark shadow over the Sub Saharan Africa success story that we have covered in the pages of Commercial Risk Africa since its launch. But, as noted above and stressed by organisations such as WHO and risk experts such as RMS, the perception of the risk can be a lot more worrying than the reality, so long as basic principles are adhered to and local and international authorities can work together effectively to manage and contain the problem. Patricio Marquez is a World Bank Lead Health Specialist, currently serving as Public Health Focal Point (I) at the Health, Nutrition and Population Global Practice of the World Bank. Before assuming this role, he served as Human Development Sector Leader for Ghana, Liberia and Sierra Leone, as well as for Malawi, Zambia and Zimbabwe, based in Accra, Ghana and has focused on the HIV/AIDS epidemic in the region. In a note he penned recently for the World Bank, Mr Marquez was clear that Ebola can be contained and managed effectively using very simple techniques backed up by a coordinated and cross-border effort. “While an uncontrolled outbreak of Ebola is frightening, in principle, it should be easy to contain if health workers and health facilities adopt simple, inexpensive and effective strategies that include the use of gloves, hand-washing, safe injection practices, isolation of patients, safe and rapid removal of corpses of those killed by Ebola, tracing of contacts, and follow-up observation of at-risk populations,” said Mr Marquez. The health expert said that social mobilisation and risk communication activities that focus on ‘at-risk groups’ such as people who consume bat meat, or who frequently travel across borders and ‘at-risk behaviors and actions’ (preparation/consumption of ‘bush meat’, treating the sick, or handling corpses of infected patients), help increase knowledge about causes, symptoms and modes of prevention among the population. But Mr Marquez did add that the very forces of economic globalisation that have provided the potential for the peoples of Sub Saharan Africa to enjoy the rewards offered by the rich resources around them are a problem in themselves. “We should be mindful, however, that outbreaks of Ebola and other dangerous viruses such as the Middle East Respiratory Syndrome in Saudi Arabia, are an ever present danger in our interconnected world. The risk of animal-to-human transmission of lurking viruses will continue to be nurtured by close contact of people with wildlife, which is facilitated nowadays by the rapid spread of human settlements, aggressive mineral extraction practices, environmental degradation, the globalisation of trade and services, mobility of people across borders, and poor, inadequate, and dysfunctional health systems in many countries,” he said. More positively, Mr Marquez sees a chance for the regional and international community to receive the message from the latest health scare and take positive action to help mitigate the risk in future. He said that the universal health coverage agenda offers countries and the international community a ‘window of opportunity’ to move from ad hoc, short-term responses to the development of robust public health systems and service delivery platforms. “Adopting ‘One Health’ approaches is also essential—that is, collaborative efforts between public health, veterinary and environmental services. This would facilitate the sharing of information, and enable holistic analysis of risks and joint responses to prevent and control outbreaks of diseases of animal origin, such as Ebola,” wrote the World Bank health expert. Mr Marquez added that international experience shows that strong national leadership is critical to make progress in this area. Further, sustained domestic funding, coupled with regional funding arrangements such as the one proposed by the Economic Community of West African States at the recent Presidential Summit to establish a Regional Pool Fund for Ebola, are necessary complements to political commitment. “International support, both technical and financial, is justified as it would contribute to reduce the global risk of the spread of viruses at their source,” he said. “The Ebola virus in west Africa should be tackled the same way it was done in 1976: with soap, clean water, protective gear, safe medical practices and quarantine; technology and vaccines are of no use. Also, community engagement and involvement, effective contact tracing, cross-border collaboration and effective coordination would be critical,” added Mr Marquez. “But, I would add that in pursuing a broader development agenda to end poverty and enhance shared prosperity over the medium term, countries and the international community have the responsibility to act on the recognition that environmental factors can impact human health and support the development of sustainable ‘One Health’ platforms to deal with the emergence of new viruses or the reemergence of known pathogens that risk affecting all of us across the world,” he concluded.

Calming the fears over Ebola

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