By Melanie Mayhew, World Bank Group
Every day for 27 years, in the early morning blackness that only fishermen know, John* and his crew dislodged their boat from Sierra Leone’s shore and paddled north toward Guinea, returning at sunset with nets flopping with fish.
Today John stands in a few inches of water in the port of Aberdeen, Sierra Leone, gazing at the colorful boats skirting the horizon, wishing he could return to the sea. It’s been a year since he captained a boat, a year since he fished.
“I would love to go fish but I can’t because I don’t have a boat,” John, 43, says.
John is landlocked by Ebola.
John doesn’t have a boat because the boats won’t hire an Ebola survivor—they’re afraid of contracting Ebola. Like the other former fisherman milling about the port, he is unemployed, unskilled to perform any job other than fishing. All are eager to work despite the blurry vision, body pain and headaches that they live with every day, reminders that they survived Ebola, but that Ebola never will go away for them.
The captains among them each made an average of $12 on a good fishing day. Now none of them can feed their families.
While much of the world has turned its attention away from Guinea, Liberia and Sierra Leone—which are just now emerging from the deadliest Ebola outbreak in history—the human and economic devastation endures. West Africa’s experience fighting Ebola is a lesson for the world, and for countries, as they prepare for the next pandemic.
With that lesson in mind, at the G7 later this month, world leaders will discuss a new mechanism, the Pandemic Emergency Financing Facility, which could help stop the next outbreak before it becomes the next Ebola crisis.
Rebuilding a life, block by block
Abdulai*, 34, sits in a flimsy plastic chair on the front porch of his home in Crab Town, Sierra Leone. He pushes his sunglasses to the top of his head so he can wipe tears from his eyes. Eight people in the house, including his parents, contracted Ebola. He was the only one to survive the disease.
Like John the fisherman, he was fired from his job when his boss learned that he was an Ebola survivor. He had a regular job in construction until late 2014, when he contracted Ebola. Now he lays concrete blocks, but the work is inconsistent. This week, he showed up for work five days, but was hired only one. He made $3 this week for a day’s work.
The family’s only other income is from his wife’s shop, which she runs from their home. She sells soap, cigarettes and garri. Sixteen cups of garri, a staple food that is made from cassava tubers, sells for about $4. The shop’s profits barely feed Abdulai, his wife and their children.
They haven’t paid rent in 18 months. They recently received a notice that they may be evicted from their home, which is made of concrete blocks, metal windows and doors, and a sturdy roof. If they’re evicted, they’ll move to a corrugated-metal shack with mud floors and no doors or windows. They say they’ll have to wash twice a night because of the heat. When the rains come, they’ll shiver when water streams through the roof and sides of the shack.
“We were not a wealthy family but we were coping,” Abdulai says. “Ebola was a setback for us.”
Stopping Ebola, and other diseases, at the source
The Ebola epidemic, which began in Guinea in December 2013, infected more than 28,000 people in Guinea, Liberia and Sierra Leone. It also rapidly exposed the paralyzing weaknesses in the countries’ health and public health systems.
Before Ebola, the countries were three of the poorest in the world, but had recently made significant health gains. However, when Ebola struck, the countries’ hospitals and clinics—overwhelmed by an influx of Ebola cases and the catastrophic loss of health workers to the disease— crumpled. Basic primary health care services, like maternal and child health care, were not available. A World Bank study found that the deaths of health workers may result in more than 4,000 deaths of women each year across the countries, as a result of complications in pregnancy and childbirth. These deaths are on top of the more than 11,000 people who died of Ebola.
The countries also had limited—and in some places, no—ability to detect and respond to infectious disease outbreaks as they spread in communities. Before Ebola, the country did not focus enough on disease surveillance and control, says Dr. Foday Daffae, the director for disease prevention and control for Sierra Leone.
If disease surveillance had been stronger, “we could have stopped Ebola,” Dr. Daffae says.
In addition to saving lives and building healthier communities, disease prevention and control efforts save the country money: Preventing diseases is much cheaper than caring for people when they get sick.
The Ebola crisis crippled the economies of Guinea, Liberia and Sierra Leone, costing them $2.8 billion in GDP losses, according to World Bank economists. Commodity prices collapsed; for example, the price of iron ore, which used to account for 60% of the Sierra Leone’s exports, crashed from $185/ton to $35/ton. Both of the country’s mines shut down and iron ore exports plummeted to zero. And donor funds, which helped the countries fight the Ebola crisis, now are drying up, leaving governments struggling to pay their bills and keep systems running.
Because of Ebola and its human and economic toll, countries like Sierra Leone are changing how they approach disease surveillance and control.
District surveillance officers now provide weekly and monthly reports on 47 diseases in communities, immediately reporting diseases like Ebola, Lassa Fever, Cholera and Measles. The country has focused on training health workers and surveillance officers, improving labs’ capacity to quickly test specimens, and collecting better data so they can analyze and address disease trends, Dr. Daffae says.
“This outbreak is over, but that doesn’t mean it won’t happen again,” says Dr. Daffae. “But we should detect it immediately and control it at the source the next time.”
The World Bank Group is working with nine countries in West Africa, including Guinea, Liberia and Sierra Leone, to improve surveillance and early reporting; strengthen laboratory capacity; bolster workforce training, deployment and retention; and enhance preparednes and rapid response. Because most contagious disease outbreaks cross borders, countries are working together to prevent and control diseases—no country can do this alone. This regional effort is part of the World Bank Group’s $1.62 billion commitment to help West Africa respond to and recover from Ebola.
In Liberia, the World Bank also is working with the Liberian government and many partners, including Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and USAID, with resources from the International Development Association and the Global Financing Facility Trust Fund, to reconstruct and strengthen its health system to increase the use of services and enhance its resilience to shocks. This includes emergency preparedness, surveillance and response, with a special focus on maternal and neonatal death surveillance and response.