From January 19-27, my colleague Cathryn Streifel and I traveled to Liberia and Sierra Leone to engage with national leaders, health workers, non-governmental organization implementers, international organizations, and United States, United Kingdom, and other officials. It was a moment of hope and nervous adjustment, as Ebola cases dropped suddenly and unexpectedly in Liberia, followed by reductions in Sierra Leone and Guinea. We listened to the reflections of those who lived through and led the mobilization to roll back the unprecedented Ebola emergency, as it raged in the second half of 2014. We sought to understand the latest phase, as complicated efforts have begun to move beyond an emergency response and seek to achieve “zero” Ebola infections in 2015 — while safeguarding against new outbreaks. We discussed briefly early plans for long-term recovery. Across these different phases and concerns, we had a special interest in examining the US contribution. In this post, we share some of the major impressions we carried home.
In a recent blog post, PEPFAR director Ambassador Debbi Birx outlines an aggressive agenda (called PEPFAR 3.0) for the next four years that emphasizes her commitment to focusing its resources better (their theme: “Focus, Partner, Achieve: An AIDS-free Generation”). Overall, it’s a smart approach that capitalizes on the fact that the HIV epidemic, while global, is actually heavily concentrated in a few countries and populations: just seven countries account for more than half of the world’s HIV cases.
As we head into the new year, here are three global health stories to keep an eye on in 2015:
The session grew out of a shared sense that a pivotal moment has arrived. In the final quarter of 2014, rapidly accelerating efforts to develop Ebola vaccines have stirred excitement and raised expectations, tempered by continued uncertainty about the safety and efficacy of vaccine candidates. 2015 is likely to witness multiple, ambitious field trials in West Africa and elsewhere, in the midst of formidable challenges and continued debate.
Since 2000, there have been impressive, historic gains in malaria control. An estimated 3.3 million lives have been saved world-wide, a function of elevated political commitment and enhanced international mobilization that featured more than a tripling of the dollars invested in programming – roughly $3 billion per year today – and a steep rise in R&D commitments, to roughly $600 million. According to the WHO World Malaria Report 2014, the malaria target contained in the 6th Millennium Development Goal has been achieved.
In a recent interview with the CSIS Global Health Policy Center in Dakar, the Senegalese minister of health, Dr. Awa Marie Coll-Seck, used a familiar term to express her commitment to expanding access to family planning—“yes we can.” That is a bold proposition in such a conservative country, in a region with some of the world’s highest maternal mortality and unmet need for family planning. Her leadership reflects an important moment in Senegal.
Sekou Toure Referral Hospital is a public facility serving the population of Mwanza Region on the shore of Lake Victoria in western Tanzania. Set in Mwanza Town, the regional capital, the hospital is a sprawling collection of low buildings arranged around courtyards planted with shady trees. Compared with the hustle and bustle of a fast-growing city and hub of Tanzania’s fish-export industry, the hospital is an oasis of calm, with white-coated doctors and nurses in blue dresses attending patients of all ages.
On Wednesday, November 19, the CSIS Global Health Policy Center hosted a discussion focused on the economic impacts of the Ebola epidemic in West Africa. Panelists included David Evans, Senior Economist at the World Bank Africa Region, and Abebe Aemro Selassie, Deputy Director of the International Monetary Fund African Department. J. Stephen Morrison, Director of the CSIS Global Health Policy Center, moderated the discussion.
The risk that any particular person in the United States will contract Ebola is truly infinitesimal. Over two million people in the United States will die of all causes this year—600,000 of them from heart disease—and so far one has died of Ebola. Yet a great number of people in the United States are afraid, in some cases very afraid, of Ebola. Why have they spent psychological and political energy fearing a fate so unlikely?
J. Stephen Morrison, director of the Global Health Policy Center here at CSIS, got my attention when he described the Ebola outbreak as a two-front war: a public health battle in plague-like conditions in West Africa, one, and a communications battle against fear and overreaction in the United States, two. Government officials, wrote Dr. Morrison, “failed to appreciate just how swiftly a small number of Ebola cases in Dallas could ignite fear across the nation, raise the risk of panic, and begin to erode public trust.”
The latter were not the only critics he faced while in the United States. He also met with multinational CEOs unhappy with India’s commercial regulatory environment, including those of pharmaceutical giants Merck and Hospira that have longstanding complaints about India’s application of its patent laws. Modi’s business-friendly election platform has created hopes that he will reverse what multinationals perceive to be an unfair competitive environment in India. For U.S. and European pharmaceutical companies, India’s emergence as the leading supplier of low-cost generic drugs has been particularly galling.
While prevention messages are critical, a lesson from the struggle against HIV/AIDS is that women’s and girls’ risk of infection is compounded by gender disparities and inequalities, and many U.S. programs lost precious time before realizing that A, B, and C were often not within a woman’s or girl’s power to control. Similar concerns might apply to the Ebola crisis.