As soon as the Republic of Georgia’s National Center for Disease Control and Public Health (NCDC) sounded an alarm about a cluster of unusual pneumonia cases in Wuhan, China, Prime Minister Giorgi Gakharia’s government set its pandemic response into motion.  It was early January 2020, and there was still no hard evidence that the infection had spread across borders, but the country’s health leaders were wary. As outbreaks of the virus, identified as COVID-19, began to appear in other countries, the government quickly created a multisectoral coordination council chaired by the prime minister and then adopted a number of emergency response measures. Working with a network of local public health centers, the NCDC launched a communications blitz, with scientists and physicians at the forefront. The public health campaign encouraged compliance with stringent—and unpopular—lockdown measures. Through the first half of 2020, the weekly number of new cases remained low, even as infections surged in many high-income industrial countries. But it was too early for a victory lap. Pressure grew to open up resort centers during July and August in an economy heavily dependent on tourism. During September, October, and November the number of new cases per day climbed sharply, driven mainly by expansion of the outbreak in Adjara, a vacation destination. Compared to most European countries, the incidence of disease remained low, however, and the number of new infections later plummeted, approaching initial levels by March 2021. This case study highlights how a small, middle-income country with a privatized and decentralized health-care system initially succeeded in its pandemic response, struggled with sharp reversals, and then brought the infection rate close to earlier levels prior to vaccine distribution.

Tyler McBrien drafted this case study based on interviews conducted with Nona Tsotseria, MD, PhD, in January and February 2021. Case published June 2021. This case study was supported by the United Nations Development Programme Crisis Bureau as part of a series on center-of-government coordination of the pandemic response.

The views expressed in this publication are those of the author(s) and do not necessarily represent those of the United Nations, including UNDP, or the UN Member States.

When the first cases of Ebola virus disease appeared in Liberia at the end of March 2014, a critical first step in preventing an epidemic was to identify those who had contracted the virus. However, Liberia’s disease surveillance capacity remained feeble in the wake of a 14-year civil war that had weakened the health system, and citizens’ distrust of the government sometimes raised risks for public health teams dispatched to carry out that vital surveillance function. In August, as the number of new infections began to escalate, the government and its international partners shifted to a proactive strategy. Rather than wait for families to call for help, they began to engage local leaders and community health workers in hunting the disease. They also developed data management practices to more effectively track and analyze the evolution of the epidemic. By year-end, most of the new Ebola infections involved Liberians who were already under observation. In another important measure of success, the time between patients’ onsets of symptoms and their medical isolations shortened markedly. The ability to hunt down Ebola slowed the spread of the disease and helped bring an end to the epidemic in May 2015.

Leon Schreiber and Jennifer Widner drafted this case study based on interviews conducted in Monrovia, Liberia, in April and May 2016 and with international organizations from June to August 2016. Béatrice Godefroy provided initial guidance.

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)