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


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


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.


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”


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.


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


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.


“ 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


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.


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.


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.

REPRESENTING OLIVER WYMAN

Copyright © 2015 Oliver Wyman. All rights reserved.

Oliver Wyman is a global leader in management consulting. With offices in 50+ cities across 25 countries, Oliver Wyman combines deep

industry knowledge with specialized expertise in strategy, operations, risk management, and organization transformation. The firm’s

3,000 professionals help clients optimize their business, improve their operations and risk profile, and accelerate their organizational

performance to seize the most attractive opportunities. Oliver Wyman is a wholly owned subsidiary of Marsh & McLennan Companies

[NYSE: MMC], a global team of professional services companies offering clients advice and solutions in the areas of risk, strategy, and

human capital. With 52,000 employees worldwide and annual revenue exceeding $10 billion, Marsh & McLennan Companies is also

the parent company of Marsh, a global leader in insurance broking and risk management; Guy Carpenter, a global leader in risk and

reinsurance intermediary services; and Mercer, a global leader in human resource consulting and related services.

Oliver Wyman’s Health & Life Sciences practice serves clients in the pharmaceutical, biotechnology, medical devices, provider, and

payer sectors with strategic, operational, and organizational advice. Deep healthcare knowledge and capabilities allow the practice

to deliver fact-based solutions. In 2011 Oliver Wyman launched a Health Innovation Center (OWHIC) dedicated to promoting positive

change in healthcare. OWHIC champions innovation by disseminating proven innovations; envisioning market-based solutions to

today’s and tomorrow’s challenges; and establishing a cross-industry community of thought-leaders to share and shape ideas.

For more information, visit www.oliverwyman.com

Follow Oliver Wyman on Twitter @OliverWyman

ABOUT OLIVER WYMAN

CONTACTS

TERRY STONE [email protected]

SURESH KUMAR [email protected]

CRISPIN ELLISON crispin.ellison@oliverwyman

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