RESPONDING TO EBOLA · RESPONDING TO EBOLA WHAT MUST BE DONE NOW, AND HOW DO WE GET AHEAD OF THE...
Transcript of RESPONDING TO EBOLA · RESPONDING TO EBOLA WHAT MUST BE DONE NOW, AND HOW DO WE GET AHEAD OF THE...
Davos, Switzerland, 21 January 2015
RESPONDING TO EBOLAWHAT MUST BE DONE NOW, AND HOW DO WE GET AHEAD OF THE NEXT EPIDEMIC
“ An epidemic like Ebola is not an African problem—it is a global problem, a human problem, the solution to which lies in building local, regional, and global collaborations and shared responsibility.”
Suresh Kumar – Partner, Oliver Wyman, and Former US Assistant Secretary of Commerce
“ People will continue to struggle to survive and, unfortunately, some will die. In a humane world, we cannot allow the people of West Africa to suffer so much.”
Margaret Chan – Director General WHO
“ We’ve passed a milestone of 4,000 deaths today, almost feels like the world’s waking up to it, and they only wake up to it when a few white people are infected.”
Javid Abdelmoneim – Médecins Sans Frontières doctor in LIberia
“ Ebola is drawing oxygen away from businesses and basic services, driving up food prices, stigmatizing growing numbers of people, keeping children out of school and preventing pregnant women and those suffering from malaria and other diseases from accessing medical care. Household incomes across entire nations have declined by as much as one-third in six months.”
Ban Ki-moon – Secretary-General, United Nations
“ If we had the right health infrastructure in Sierra Leone, Guinea and Liberia, we wouldn’t have gotten to this stage. Now the health system will crumble and have to be rebuilt... So that’s where the world is going to have to go next, is really investing in primary healthcare.”
Melinda Gates – Gates Foundation
“ If all global systems and structure remain the same in March 2016 as they were at the start of the Ebola outbreak in March 2014, the world would have made a great mistake... WHO reform could be a first step.”
Ron Klain – White House Ebola “czar”
Copyright © 2014 Oliver Wyman 3
With more than 21,000 infected and 8,400 dead, with three nations devastated not just
medically, but economically and socially, the African Ebola epidemic has been a tragedy. No
one involved in public health—indeed, no person of conscience—can be happy about the
response to the most recent outbreak of this disease or about the price that has been paid by
people who deserve our compassion, but more importantly our help.
How could this happen on our watch? What can we learn from what worked and what failed
in Liberia, Sierra Leone, and Guinea? What does the world need to do to prepare for the next,
inevitable outbreak?
To pursue that question, Oliver Wyman assembled what we believe to have been a unique
group of experts to discuss Ebola in conjunction with the World Economic Forum annual
meeting in Davos, Switzerland, this past January. We brought together a group with immense
experience on the ground in Africa and on the front lines against infectious disease who further
share a sophistication about how public health systems and structures work and how global
organizations interact. They also appreciate the importance of balancing the needs of the
people at the center of a desperate fight with those of the developed-world nations who supply
resources without necessarily understanding the reality they are participating in.
We asked our panelists to be frank, and they were. We asked them to help us see the connection
between the Ebola hospitals of Africa and a global architecture of support. They succeeded
beyond our expectations.
Our meeting was a small one, but we believe that what we heard there deserves a wider
audience. Toward that end, we have compiled this set of excerpts (edited somewhat for clarity
and brevity). We hope that they contribute to a much needed discussion.
The Hon. Suresh Kumar
Partner, Oliver Wyman, and Former US Assistant Secretary of Commerce
INTRODUCTION
“ Best wishes to the panel and the extraordinary leaders from around the world gathered at this event. Your continued leadership will help ensure that we win in the fight against Ebola.”
Dr. Rajiv Shah – USAID Administrator
Copyright © 2014 Oliver Wyman 4
FINDINGS FROM THE RESPONDING TO EBOLA PANEL
A breakfast discussion held as part of Oliver Wyman’s participation in the World Economic Forum, Davos, Switzerland, Wednesday, January 21, 2015
If Ebola has taught us one lesson it is that our current institutional frameworks may have
outlived their utility. We need new approaches of shared responsibility and local, regional,
and global collaborations and lines of responsibility encompassing governments; public,
private, and multilateral institutions; and civil society. At this special, invitation-only event,
a panel of administrators, donors, scientists, and doctors discussed how to address the
current ongoing crisis and reviewed the structure of future health security that will keep
global communities safe.
PANELISTS
Dr. Seth Berkley, Chief Executive Officer, Gavi Alliance
Dr. David Nabarro, Special Envoy on Ebola, United Nations
Dr. Hans Rosling, Leader in Liberian response effort
Dr. Paul Stoffels, Chief Scientific Officer, Johnson & Johnson
Participants (l-r) IFRC
Secretary General
Elhadj As Sy, Johnson
& Johnson Chief
Scientific Officer Paul
Stoffels, Gapminder
Co-founder Hans
Rosling, Oliver Wyman
Partner Suresh Kumar,
UN Special Envoy
David Nabarro & Gavi
CEO Seth Berkley
Copyright © 2014 Oliver Wyman 5
GETTING TO ZERO
DAVID NABARRO: During August this year, the numbers of confirmed new cases of
Ebola were increasing at a very rapid rate, doubling every three weeks. But we did not
fully understand, any of us, what this actually represented, beyond a really frightening
situation for the communities, for the governments, and for the world: the possibility
that Ebola might become widespread in Africa and spread beyond the continent in a
significant way.
The response at the time was simply to try to get on top of the outbreak, to try to make sure
that there were enough spaces where people with the disease could get treated, that there
was the capacity to enable everyone who died of the disease to have a dignified and safe
burial, and to work hard to bring communities to some understanding of the disease.
It was a fearful time. It was also a time of extraordinary leadership, particularly by the
presidents of the three most affected countries: Ellen Johnson Sirleaf, Ernest Bai Koroma,
and Professor Alpha Condé.
Fast-forward to January. There’s still a major Ebola outbreak under way in West Africa,
but there is much greater understanding among communities of what causes the risk of
disease, and there is much more capacity to care in a decent, humane, and effective way
for people who are ill. Now we are in a much more traditional phase of an outbreak control
effort, seeking to find cases, to trace their history very carefully to identify their contacts,
keeping them under surveillance, and moving towards the elimination of the disease.
SETH BERKLEY: I want to emphasize why we have to go to zero, because that may not be
obvious. There are many endemic diseases in these places, but as long as a doctor in a
clinic has to ask whether a child coming in with a fever has Ebola or not, you’re not going
to have the same treatment patterns you would have had in the past with other infectious
diseases. Obviously the economic effects in this region have been unbelievable in terms of
engagement, of exports, of travel of citizens, etc., so zero has to be the number, not a small
number of cases moving forward.
HANS ROSLING: It’s a completely different thing to go and search for those final cases. It’s
detective work. You have to be cunning like a spy and compassionate like the best nun or
social worker you could have in the world. You must combine them in the same person. It’s
real specialist’s work.
NABARRO: I actually think the task ahead might be even more difficult than the task that’s
been with us up till now—a paradox, but I think it’s true. All of you who have worked in crisis
situations and then watching the response develop will appreciate that it’s never a smooth
and efficient process. But in this instance, it’s my belief that the global community has been
more responsive, more speedy, and more organized than usual. The total pledged amounts
so far are at least US$4 billion, and those have been made available to the governments, to
international organizations, and to a lesser extent to nongovernmental groups. A relatively
small amount has gone to research. I estimate that at least another $4 billion will be needed
both to complete the job and to help these countries, which were extremely prosperous
until last year, get back onto the trajectory they had before.
Copyright © 2014 Oliver Wyman 6
THE VACCINE RACE
BERKLEY: There are three lead vaccines and a number behind them that give 100 percent
protection in the most rigorous animal models. They were originally created not because
people were concerned about Africa. There have been 35 Ebola outbreaks in the last 39
years, but they’ve been very small, and there hasn’t been an opportunity to do large scale
clinical trials. These vaccines were done to protect against bioterrorism, and the authorities
were actually to license them on a provisional basis based on animal models.
The challenge in front of us is to try and validate the animal model. If we knew that protection
in the animal model equaled protection in people, that would allow us to tinker and change
and look at new strains.
A critical issue now is how to get those vaccines moving forward as fast as possible into efficacy
trials, perhaps with larger numbers but also with innovative trial designs, not necessarily to get
the perfect trial with tight confidence intervals but to validate the animal models.
PAUL STOFFELS: Through the years we learned that in Ebola you need a very significant
exposure to get a good response. That’s why from the start we took a prime-and-boost
approach to get to 100 percent protection in the most stringent animal models. Because this
is a deadly disease, we said from the beginning we don’t go with a shortcut here; we go with
maximum protection.
Back in September or October I went to my board at Johnson & Johnson, and I can tell you
it was the shortest board meeting I ever had—10 minutes and I got $200 million. That is the
benefit of working in a large company. It allowed us to go really fast.
The breakfast included
a special showing of
the video “The Scourge
of Ebola”
Copyright © 2014 Oliver Wyman 7
We went for a monovalent vaccine focusing on the strain that is present in the region.
We kicked off in parallel preparing for clinical trials but also production. In December we
produced 500,000 vaccines. We can produce 150,000 a week at the moment, so we are
gearing up for a few million this year, but it all depends, first, on whether they work—so we
need to prove that—but, second, on what the global community wants to do.
It’s a lead time of 12 to 18 months to go to five or even 18 million vaccines to vaccinate
the entire region. If we kick it off today, we can have it within 12 months. That’s a huge
investment which we have to go after. We’ll start on our own without support, and we’ll see
how the world will pay for it.
We are kicking off trials. I was in Sierra Leone two weeks ago talking to the Minister of Health
and the regulators to see how we can do it. It will come down now if we want to prove the
value of a vaccine in very large clinical trials. Because of the challenge of the epidemic at this
moment, it will take a few hundred thousand people to prove that this vaccine is effective,
and we are gearing up to do that.
BERKLEY: An important point is to make sure that there’s a stockpile. When this epidemic
is over we want to ensure that if the vaccine works and another epidemic occurs with this
particular strain of Ebola, the vaccine that works is made available. It’s also critical to ensure
that there are incentives in place for the pharmaceutical companies to invest in second-
generation vaccines The three vaccines that are most ahead as well as the ones that are behind
them are not optimized. They’re being stored at minus 70, minus 80. They haven’t been
optimized for shelf life. So what we want is a multivalent vaccine that would work against the
different strains and that would have a long shelf life and be able to be used within normal
systems of countries.
STOFFELS: You can’t come in with an objective to have a commercial outcome. But
institutions like ours also are just normal people. We think like you think—if there’s a crisis
like this, how can we use our capabilities to help sustain society?
With this response, there was a fantastic response from the regulators. We get reviews now
within days instead of weeks or months. There are some kinds of incentives that are in place. For
example, there’s an accelerated voucher if you get the approval that is worth today $100 million
or so, and we get some tax benefits. So if you’re lucky you get to break even, you don’t lose too
much money. At the same time, we don’t calculate that in advance. We say, “This needs to be
resolved. We have the platforms to do it. Let’s get it done, and we’ll figure it out later.”
BUILDING A GLOBAL INFRASTRUCTURE
NABARRO: This particular disease is spread not through the air, not through water, not through
food, not through soil, but it’s spread as a result of the way in which people go about their
lives. That leads somebody like me to conclude that health professionals are but a small part
of the total response. And I think it’s a lesson that we learn year after year, whether working
on infectious disease caused by bacteria or a virus, obesity and diabetes, or cardiovascular
disease: It’s societies themselves that find the ways in which to live with the risk of illness and
also the ways to be resilient and avoid it. So whilst I am very keen that there is more work to do
on the global institutional architecture, I’d like to remind ourselves time and time again that the
power and the energy need to be strengthened within communities, within local governments.
Copyright © 2014 Oliver Wyman 8
What I’m currently seeking is about 60 experienced and brilliant coordinators who can work
in each of the different local government areas throughout this part of Africa. They will be
the people who determine the speed with which the response happens; they will almost
certainly be Africans; they may well come from the countries that are affected but they will be
brilliant, utterly humble, and extremely respectworthy people. They’re the people we need.
We need to pay a huge bounty to bring them in and keep them in. That doesn’t mean we
don’t need volunteer doctors and nurses to help other hospitals and treatment centers, but
their utility is much, much less than the skilled coordinator who can deal with extraordinary
complexity without going mad.
WINNIE BYANYIMA: I come from Uganda, which was hit by Ebola four times but managed
to contain it. A big part of that success was social mobilization. Social mobilization was
underperforming in this response in Liberia and Sierra Leone. We have people on the ground
working on the prevention side, but we see huge weaknesses. What are we going to do
about that? This is not a technical fix. It is about people responding and preventing and
cutting off the spread. Secondly, funding: We know that these two countries didn’t have the
basics for primary healthcare. Investment was really low, but that’s so across Africa. What is
the international community doing about that to support these countries?
The people who should be doing this response in Liberia and Sierra Leone are working
pushing the wheelchairs of wealthy men and women in the United States and Europe. What
are we doing about the brain drain?
ELHADJ AS SY: Building trust, building respect, creating an enabling environment free of
stigma and discrimination—that’s going to be critical. We tell people, “Give us your patients.
We’re going to treat them.” In 80 percent of the cases,
because of the nature of the disease, they will die. We will not
bring them back home for burial. Their families cannot wash
them the way they used to. They cannot mourn the way they
used to. And they have to trust us to do that in a respectful
and dignified way. That is the trust which is required.
We cannot afford to isolate these countries at a time when
they need international solidarity more than ever before. We
are cancelling flights, having stringent visa requirements,
economically isolating these countries, and then expecting
that they will bounce back. That will not work. There is only
one place to fight Ebola. It is not at the airport or somewhere
in Europe or America. It’s got to be in Liberia and Sierra Leone
and in Guinea.
NABARRO: What do we want? Brilliant epidemiological,
anthropological, organizational analysis and action. And
the difficulty is that when we need the very best people to
come and understand what’s going on, it’s very hard to find
them. They’re busy doing polio in Pakistan. Or they’re busy
dealing with another problem somewhere else. We don’t
have enough of these amazing people who understand
about patterns of disease from societal and organizational as
Moderator Suresh
Kumar & Oxfam
International
Executive Director
Winnie Byanyima
Copyright © 2014 Oliver Wyman 9
well as public health perspectives. So when you’re thinking about global architecture, don’t
think about it in terms of large numbers of people in a global volunteer workforce rushing
around here and there, but think in terms of a relatively small number of humble people who
will go in and empower national teams to be cleverer and smarter in the face of these kinds
of threats.
ROSLING: Working within the Liberian Ministry of Health, we saw fine work being done from
MSF and CDC, but they didn’t come in and work in the Ministry of Health. In fact, MSF didn’t
send one single person to the Ministry of Health for one single day. They’re antigovernment
by definition—and I started MSF in my country, so I have the right to criticize. There were
two places from which the crucial persons came: One was WHO. The other even surprised
me after much time working in Africa: the African Union, which sent very competent people
who worked directly with the health office. That’s what you need. You need to strengthen
the country’s organization itself. You don’t get to zero with social organization. Don’t even
think that.
BERKLEY: It’s easy to blame WHO, but we have to realize that the WHO is captive to its
financial masters. Look at what has happened: We have the flu pandemic. We put more
money in, then we take it away. We have SARS. We take that funding away. We have bird flu.
We take it away. When will the world realize once and for all that infectious disease is here to
stay. These bugs are going to continue to evolve. We need a global response, and it has to
be adequately financed. And it has to have some capabilities to draw extra funds. All that is
there in WHO, but it’s half of what it was in previous times.
Part of that is that donors come in and say that we have to work on non-communicable
diseases. Or we have to work on smoking. There are many other problems, but the
fundamental skills have to be there.
STOFFELS: In the end, we have to make sure Africa can grow as a region where there’s
economic prosperity and the healthcare system can function, and we don’t have to send
billions of dollars every time to solve the problem. If the world can help to find a different
solution for Africa economically, and building healthcare systems up, the response to
Ebola could come from within the country itself. And that’s the most fundamental solution
for the long term.
Copyright © 2014 Oliver Wyman 10
“ This event ‘Responding to Ebola’ fully reflects the priority the UK attaches to fighting Ebola and global health security, which the Prime Minister set out in his recent visit to Washington. Through our action in Sierra Leone, the US action in Liberia, France in Guinea—we are beginning to turn the corner in our fight against Ebola. But as the Prime Minister and President Obama set out last week, we must improve how we face down the threat from diseases and get better at responding collectively to these global health emergencies. The Prime Minister has set out two specific areas where he would like to see immediate progress prior to the G20 at the end of this year:
• A new international rapid-response team of epidemiologists who can deploy to assess risks from new disease outbreaks as they emerge.
• Development of an international platform to support rapid discovery, development, and deployment of new drugs and treatments in response to new global threats.
We look forward to hearing the outcomes from today’s discussion, and to exploring these issues further in coming months.”
– UK Prime Minister’s Office Number 10 Downing Street
Copyright © 2014 Oliver Wyman 11
PANEL BIOGRAPHIES
SETH BERKLEY
Dr. Seth Berkley has served as CEO of GAVI, the Vaccine
Alliance, since 2011, joining the organization as it was
launching its five-year strategy to immunize a quarter-
billion children in the developing world by 2015. Prior to
joining the GAVI Alliance, Dr. Berkley was the founder,
president, and CEO of the International AIDS Vaccine
Initiative (IAVI), the first public-private partnership for
developing vaccines.
Previously, Dr. Berkley served as an officer in the Health
Sciences Division at the Rockefeller Foundation. He has
also worked for the Center for Infectious Diseases of
the U.S. Centers for Disease Control and Prevention,
the Massachusetts Department of Public Health,
and the Carter Center, for which he served as an
epidemiologist at the Ministry of Health in Uganda.
He has consulted or worked in more than 50 countries
in Asia, Africa, and Latin America. Dr. Berkley sits on
a number of international steering committees and
corporate and not-for-profit boards, including those of
Gilead Sciences, the New York Academy of Sciences,
and the Acumen Fund.
SURESH KUMAR
The Hon. Suresh Kumar, who moderated the panel, is a
New York-based Partner in Oliver Wyman’s Health & Life
Sciences and Public Sector practice groups.
Prior to joining the firm, he spearheaded U.S. trade
promotion and export as Assistant Secretary of
Commerce and Director General of the U.S. & Foreign
Commercial Service. From 2003 to 2010 The Hon.
Kumar was president and managing partner of Kaizen
Innovation, a consulting practice focused on global
management, marketing innovation, and global
development. His clients included the Bill & Melinda
Gates Foundation, the Alliance for a Green Revolution
in Africa, and the African Development Bank. He has
also held executive leadership positions with Johnson &
Johnson and Warner-Lambert.
The Hon. Kumar is a distinguished visiting professor
of international business at George Washington
University and has served on the faculties of the
Rutgers University EMBA program, the Schulich
School of Business at York University in Toronto,
Canada, and Bombay University in India. He holds
degrees from Delhi University and Bombay University
and is an alumnus of the Thunderbird International
Consortium Program.
DAVID NABARRO
Dr. David Nabarro is the UN Secretary-General’s
Special Envoy on Ebola, the Secretary-General’s special
representative for food security and nutrition, and
coordinator of the Scaling Up Nutrition Movement.
Previously he served as senior coordinator for avian and
pandemic influenza and coordinator of the UN System’s
High-Level Task Force on Global Food Security, director
of the WHO Department of Health Action in Crises,
executive director in the office of former WHO director-
general Gro Harlem Brundtland, and director of WHO’s
Roll Back Malaria Department.
Dr. Nabarro has worked on child health and nutrition
programs for Save the Children in Iraq, South Asia, and
East Africa; taught in the schools of tropical medicine of
the University of London and the University of Liverpool;
and served as chief health and population adviser
to the British government’s Overseas Development
Administration and as director for human development
in the UK Department for International Development.
A physician who studied at Oxford and London
Universities, Dr. Nabarro holds a masters’ degree in
reproductive endocrinology and public health.
Copyright © 2014 Oliver Wyman 12
HANS ROSLING
Dr. Hans Rosling is a professor of international health
at the Karolinska Institute in Stockholm, Sweden. Since
October, he has been working with the Liberian Ministry of
Health to address the country’s Ebola epidemic.
Dr. Rosling has a longstanding interest in infectious
diseases, epidemiology, and the impact of poverty. In the
1970s, while working in Mozambique, he discovered the
second known outbreak of the paralytic disease konzo and
helped confirm the disease’s etiology. He is the author of a
textbook on global health and co-founder of the Swedish
branch of Doctors Without Borders/Médecins Sans
Frontières.
Dr. Rosling is a co-founder of Gapminder, a not-for-profit
organization that describes itself as “a modern ‘museum’
that helps make the world understandable, using the
Internet.” As part of its mission Gapminder created
Trendalyzer, a computer program for creating interactive,
animated graphics—graphics that are at the heart of
Dr. Rosling’s acclaimed TED talks analyzing the impact
of poverty.
PAUL STOFFELS
Dr. Paul Stoffels is the chief scientific officer, Johnson &
Johnson, and worldwide chairman, Pharmaceuticals.
As chief scientific officer, he works with the R&D leaders
across Johnson & Johnson to set the enterprise-wide
innovation agenda. Dr. Stoffels serves as a member of the
Executive Committee and the Management Committee
and has more than 20 years of global health and
pharmaceutical experience. He chairs the company’s
Worldwide Research & Development Council, and
provides oversight to Johnson & Johnson Development
Corporation, the Johnson & Johnson innovations centers,
and for product safety for all of the company’s products.
Dr. Stoffels began his career as a physician in Africa
focusing on HIV and neglected disease research.
Copyright © 2014 Oliver Wyman 13
TERRY STONE
Terry Stone is the global managing partner of
Oliver Wyman’s Health & Life Sciences practice group.
She specializes in the development of differentiated
growth strategies for health payer, provider,
pharmaceutical, and biotech clients, as well as health
enablement companies. Ms. Stone has extensive
experience in the healthcare industry, including
devising growth strategies, improving the cost and
quality of healthcare services, establishing innovative
partnerships across players in the healthcare sector,
developing ACOs and other value-based solutions,
and redesigning organizations to support their
strategic transformations.
Prior to joining the Health &Life Sciences practice,
Ms. Stone was a partner in Oliver Wyman’s Financial
Services practice. She has worked at Dell Computer,
in the publishing industry, and at a small business-to-
business software start-up. She earned a BA in chemistry
from the College of the Holy Cross and an MBA from
the Kenan-Flagler Business School at the University of
North Carolina.
CRISPIN ELLISON
Crispin Ellison is a partner in the Health & Life Sciences
practice group of Oliver Wyman. He advises senior
government and health decision makers on policy,
strategy, performance improvement, and cost reduction.
He has operated at the permanent secretary level within
the UK government and is deeply connected with
key parliamentary and government decision makers
across the UK, EU, and the Middle East. His clients
include central government departments in the UK, EU
commissioners and their teams, the UK National Health
Service, and Gulf Cooperation Council governments.
Based in London he spends one week a month in the
Middle East.
Mr. Ellison has 17 years’ consulting experience. Before
joining Oliver Wyman, he was a partner at Corven and
before that at KPMG. He has a degree in geology from
Sheffield University.
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Copyright © 2015 Oliver Wyman. All rights reserved.
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SURESH KUMAR [email protected]
CRISPIN ELLISON crispin.ellison@oliverwyman