In 2014, an unprecedented outbreak of Ebola virus disease in Liberia, Sierra Leone, and Guinea shined a harsh spotlight on global capacity to deal effectively with a fast-moving epidemic that crossed international borders.  By the end of July, the outbreak had started to overwhelm health care systems in all three affected countries. In Liberia, health centers began to close, and President Ellen Sirleaf appealed for help from the United States. President Barack Obama tasked USAID’s Office of US Foreign Disaster Assistance (OFDA) to lead an interagency response. From early August 2014 to January 2016, an OFDA Disaster Assistance Response Team, or DART, deployed to Liberia to help coordinate efforts to stop the spread of infection. The DART was the first to involve a large-scale partnership with the US Centers for Disease Control and Prevention (CDC) to combat an infectious disease outbreak. Although the deployment, which scaled up earlier assistance, took place five months after the first reported cases and required extensive adaptation of standard practices, it succeeded in helping bring the epidemic under control: the total number of people infected—28,616—was well below the potential levels predicted by the CDC’s models. This US–focused case study highlights the challenges of making an interagency process work in the context of an infectious disease outbreak in areas where health systems are weak.

Jennifer Widner drafted this case study based on interviews from August 2016 to August 2017. The case is part of a series about the Liberian response to the 2014 Ebola outbreak, available through the Innovations for Successful Societies website. Case published June 2018. IBM’s Center for The Business of Government helped finance this case study.

The report “Responding to Global Health Crises: Lessons from the U.S. Response to the 2014-2016 West Africa Ebola Outbreak” is a version of the “All Hands on Deck” case produced in partnership with the IBM Center for The Business of Government. 

The DART was the first to involve a large-scale partnership with the U.S. Centers for Disease Control and Prevention (CDC) to combat an infectious disease outbreak. Although the deployment, which scaled up earlier assistance, took place five months after the first reported cases and required extensive adaptation of standard practices, it succeeded in helping bring the epidemic under control: the total number of people infected—28,616—was well below the potential levels predicted by the CDC’s models. This U.S.—focused case study highlights the challenges of making an interagency process work in the context of an infectious disease outbreak in areas where health systems are weak.

For more information on the IBM Center for The Business of Government, please visit: www.businessofgovernment.org

In mid 2014, health-care services in Liberia were being overwhelmed by the largest-ever outbreak of Ebola virus disease. Transmitted through contact with the bodily fluids of an infected person, the disease was spreading at a rate of 80 new cases per week by the end of July, killing up to 70% of the people it infected. The country’s fragile health-care system, damaged by a 14-year civil war, could not respond to all of the demands it faced. The rate of new infections rose, and schools and health facilities closed. Collaborating with international partners and five months into the epidemic, the Liberian government created a dedicated Incident Management System (IMS) to coordinate all elements of the country’s fight against the disease. The IMS team created a clear decision-making framework, provided responders with adequate infrastructure and technical support, and set up a coherent procedure for communicating with a frightened and anxious public. At the end of the outbreak, the question was whether Liberia’s approach had provided a model for managing responses to infectious disease outbreaks in other, similar settings or whether the approach had left room for making the system work better.

Leon Schreiber drafted this case study in consultation with Jennifer Widner of Princeton University based on interviews conducted in Monrovia, Liberia and London in November and December 2015.

Princeton University’s Grand Challenge supported the research and development of this case study, which is part of a series on public management challenges in the West African Ebola Outbreak response.

Timeline: West African Ebola Outbreak (poster infographic)

Timeline: West African Ebola Outbreak (page version)

When Ebola crossed into Liberia in early 2014, the West African nation had few defenses. Because no effective vaccine was available at the time, the only way to limit the spread of the viral disease was to restrict physical contact with those who were infected, what they had touched, and the bodies of victims. But that advice countermanded the most basic of human instincts: to comfort a sick child, hug an ill relative, or shake hands with a friend or coworker. The challenge of changing human behavior was especially difficult because Liberia was still recovering from a long civil war. Public distrust of government, persistent rumors, linguistic diversity, and limited communication capacity hobbled efforts to send a clear public message and win citizens’ cooperation. After top-down tactics—including forcible quarantines of whole communities—failed to stem the rate of infection, a small team of Liberian officials, supported by international partners, realized that effective steps to contain the disease would require active participation by citizens themselves. The officials engaged Liberians in developing an information campaign and recruited people throughout the country to visit their neighbors door-to-door, explain the steps people could take to protect themselves, and respond to questions. Although the complexity of the Ebola response and the volatility of the outbreak had made it hard to measure the success of the social mobilization effort in reducing new infections, an analysis of timing together with anecdotal evidence strongly suggested that the effort helped save lives and contributed to the disease’s decline during the final months of 2014.

Leon Schreiber drafted this case study based on interviews conducted in Monrovia, Liberia in April and May 2016, with guidance and additional information provided by Jennifer Widner and Beatrice Godefroy.

Princeton University’s Health Grand Challenge supported the research and development of this case study, which is part of a series on public management challenges in the West African Ebola Outbreak response.

Timeline: West African Ebola Outbreak (poster infographic)

Timeline: West African Ebola Outbreak (page version)