Western African Ebola virus epidemic
The 2013–2016 epidemic of Ebola virus disease, centered in Western Africa, was the most widespread outbreak of the disease in history. It caused major loss of life and socioeconomic disruption in the region, mainly in Guinea, Liberia and Sierra Leone. The first cases were recorded in Guinea in December 2013; later, the disease spread to neighbouring Liberia and Sierra Leone,[12] with minor outbreaks occurring in Nigeria and Mali.[13][14] Secondary infections of medical workers occurred in the United States and Spain.[15][16] In addition, isolated cases were recorded in Senegal,[17] the United Kingdom and Italy.[18][19] The number of cases peaked in October 2014 and then began to decline gradually, following the commitment of substantial international resources.
It caused significant mortality, with a considerable case fatality rate.[12][18][20][note 1] By the end of the epidemic, 28,616 people had been infected; of these, 11,310 had died, for a case-fatality rate of 40%.[21] As of 8 May 2016, the World Health Organization (WHO) and respective governments reported a total of 28,646 suspected cases and 11,323 deaths[22] (39.5%), though the WHO believes that this substantially understates the magnitude of the outbreak.[23][24]
On 8 August 2014, a Public Health Emergency of International Concern was declared[25] and on 29 March 2016, the WHO terminated the Public Health Emergency of International Concern status of the outbreak.[26][27][28] Subsequent flare-ups occurred; the epidemic was finally declared over on 9 June 2016, 42 days after the last case tested negative on 28 April 2016 in Monrovia.[29]
The outbreak left about 17,000 survivors of the disease, many of whom report post-recovery symptoms termed post-Ebola syndrome, often severe enough to require medical care for months or even years. An additional cause for concern is the apparent ability of the virus to "hide" in a recovered survivor's body for an extended period of time and then become active months or years later, either in the same individual or in a sexual partner.[30] In December 2016, the WHO announced that a two-year trial of the rVSV-ZEBOV vaccine appeared to offer protection from the variant of EBOV responsible for the Western Africa outbreak. The vaccine is considered to be effective and is the only prophylactic which offers protection; hence, 300,000 doses have been stockpiled.[31][32] rVSV-ZEBOV received regulatory approval in 2019.[33][34]
In addition to the loss of life, the outbreak had a number of significant economic impacts. In March 2015, the United Nations Development Group reported that due to a decrease in trade, closing of borders, flight cancellations, and drop in foreign investment and tourism activity fuelled by stigma, the epidemic resulted in vast economic consequences both in the affected areas and throughout Africa.[50] A September 2014 report in the Financial Times suggested that the economic impact of the Ebola outbreak could kill more people than the disease itself.[448]
With regard to Ebola and economic activity in the country of Liberia, a study found that 8% of automotive firms, 8% of construction firms, 15% of food businesses and 30% of restaurants had closed due to the Ebola outbreak. Montserrado county experienced up to 20% firm closure. This indicated a decline in the Liberian national economy during the outbreak, as well as an indication that the county of Montserrado was hardest hit economically. The capital city Monrovia suffered construction and restaurant unemployment the most, while outside the capital, the food and beverage sectors suffered economically. A recuperation in the economy, at the end of the outbreak, was expected to be more rapid in some sectors than in others. Also, if the massive decline in economic activity persisted, the authors suggested a focus on economic recovery in addition to support for the healthcare system. The World Bank had projected an estimated loss of $1.6 billion in productivity for all three affected Western African countries combined for 2015. In Liberian counties that were less affected by the outbreak, the number of individuals employed fell by 24%. Montserrado saw a 47% decline in employment per firm in contrast to what was obtained prior to the Ebola outbreak.[449]
Another study showed that the economic effect of the Ebola outbreak would be felt for years due to preexisting social vulnerability. The economic effects were being felt nationwide in Liberia, such as the termination of expansions in the mining business. Initial scenarios had placed expected economic losses at $25 billion; however subsequent World Bank estimates were much lower, at about 12% of the combined GDP of the 3 worst hit countries.[450] The authors went on to state that social vulnerability has multiple factors and proposed a classification based on multiple variables instead of single indicators such as food insecurity or lack of hospitals, which were problems faced by rural Liberians. In spite of the end of civil violence since 2003 and inflows from international donors, the reconstruction of Liberia had been very slow and non-productive—water delivery systems, sanitation facilities and centralised electricity were practically non-existent, even in Monrovia. Even before the outbreak, medical facilities did not have potable water, lighting or refrigeration. The authors indicated that lack of food and other economic effects would probably continue in the rural population long after the Ebola outbreak had ended.[450]
Other economic impacts were as follows:
In January 2015, Oxfam, a UK-based disaster relief organisation, indicated that a "Marshall Plan" (a reference to the massive plan to rebuild Europe after World War II) was needed so that countries could begin to financially assist those that had been worst hit by the virus.[474] The call was repeated in April 2015 when the most-affected Western African countries asked for an $8 billion "Marshall Plan" to rebuild their economies. Speaking at the World Bank and the International Monetary Fund (IMF), Liberian president Ellen Johnson Sirleaf said the amount was needed because "[o]ur health systems collapsed, investors left our countries, revenues declined and spending increased."[475]
The IMF has been criticised for its lack of assistance in the efforts to combat the epidemic. In December 2014, a Cambridge University study linked IMF policies with the financial difficulties that prevented a strong Ebola response in the three most heavily affected countries,[476] and they were urged by both the UN and NGOs who had worked in the affected countries to grant debt relief rather than low-interest loans. According to one advocacy group, "... yet the IMF, which has made a $9 billion surplus from its lending over the last three years, is considering offering loans, not debt relief and grants, in response".[477][478] On 30 January 2015, the IMF reported it was close to reaching a deal on debt forgiveness.[479] On 22 December, it was reported that the IMF had given Liberia an additional $10 million due to the economic impact of the Ebola virus outbreak.[480]
In October 2014, a World Bank report estimated overall economic impacts of between $3.8 billion and $32.6 billion, depending on the extent of the outbreak and speed of containment. It expected the most severe losses in the three affected countries, with a wider impact across the broader Western African region.[481][482] On 13 April 2015, the World Bank said that they would soon announce a major new effort to rebuild the economies of the three hardest-hit countries.[483] On 23 July, a World Bank poll warned that "we are not ready for another Ebola outbreak".[484] On 15 December, the World Bank indicated that by 1 December 2015, it had marshalled $1.62 billion in financing for the Ebola outbreak response.[485]
On 6 July 2015, UN Secretary-General Ban Ki-moon announced that he would host an Ebola recovery conference to raise funds for reconstruction, stating that the three countries hardest hit by Ebola needed about $700 million to rebuild their health services over a two-year period.[486] On 10 July, it was announced that the countries most affected by the Ebola epidemic would receive $3.4 billion to rebuild their economies.[487][488] On 29 September, the leaders of both Sierra Leone and Liberia indicated at the UN General Assembly the launch of a "Post-Ebola Economic Stabilization and Recovery Plan".[489] On 24 November, it was reported that due to the decrease in commodity prices and the Western African Ebola epidemic, China's investment in the continent had declined 43% in the first 6 months of 2015.[490] On 25 January, the IMF projected a GDP growth of 0.3% for Liberia, that country indicating it would cut spending by 11 per cent due to a stagnation in the mining sector, which would cause a domestic revenues drop of $57 million.[491]