(Formerly IRIN News) Journalism from the heart of crises

  • Photo gallery: Ebola overshadows Decoration Day in Liberia

    More than 4,100 people have died from Ebola in Liberia since the outbreak began.

    At the height of the outbreak, the bodies of many Ebola victims were either cremated, or else put into body bags in unmarked graves, in
    order to help control the spread of the virus.

    This has left thousands of families with no place to go to mourn their lost loved ones. 

    Click here to see IRIN's photo feature on how people, in a country where traditional burial practices are deeply embedded in both religion and culture, are coping on Decoration Day - an annual event when people clean and decorate the tombstones of loved ones, in order to pay their respects, remember past deeds and accomplishments, and express gratitude for the sacrifices of bygone generations. 

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    Ebola: Liberians have nowhere to mourn
  • Ebola: Liberia's long road to recovery

    Liberia has lifted nationwide curfews and reopened its land borders with key trading partners Sierra Leone and Guinea, but a full recovery from the economic impact of the Ebola outbreak will take time, experts say.

    “The reopening of the border is going to have an impact immediately, both in terms of livelihoods and the availability of food, as well as informal trade,” said Errol Graham, the World Bank’s country economist for Liberia, who spoke to IRIN from Virginia. “But there is going to be a lot of asymmetry between the [speed of] recovery and the crisis. The crisis was an immediate thing because of fear and aversion. The recovery is going to take a little longer.”

    Within hours of the reopening of the border, people and merchandise began to flow from one side to the other. Local markets, once again stocked with fresh produce, meat and home goods, buzzed with activity, for the first time in more than six months.  

    In the interior of Liberia, Graham said, “We are also seeing, with the abatement of the crisis, people starting to go back to work and we expect to see more of that over time. And as foreigners who were involved in concessions in the natural resource sector come back, we expect to see more improvements in the employment situation.”

    But even for those back at work, business remains sluggish.

    “Before Ebola, I used to make 50 US dollars in profits every day from my sales,” said Emily Kennedy, a beverage seller in Margibi County. “But since Ebola came, I only make about 10 US dollars a day. People are afraid to come out and buy. They still think they will get Ebola.”

    The borders were closed in late July as one of several measures to contain the further spread of the virus. The closures brought cross-border trade to a virtual standstill in Liberia. Unable to sell their goods, many people lost their sole means of income.

    “When the border was closed, we had a closed economy,” said Jimmy Keyann, an economist in Liberia. “Nothing was going in and nothing was coming out. The country was losing [revenue] and people were suffering.”

    Very little data is available on the volume or value of local cross-border imports and exports, as much of the border trade is informal and goes unreported. 

    “The borders with Guinea, Cote d’Ivoire and Sierra Leone are quite important to Liberia, largely because of the amount of informal trade that takes place between these countries at the border,” Graham said. “It’s much easier for Liberians [living along the border] to go across into Sierra Leone, for example, than it is to go to other [Liberian] cities, such as Monrovia,” he explained. “Food and goods are also cheaper because the cost of transporting them to the market is less.”

    Economic impact

    Due in large part to the closed borders, curfews and pervasive fear over catching Ebola, nearly half of people who had been employed before the outbreak say they had lost their jobs by December, according to a series of nationwide mobile phone surveys conducted by the World Bank between October 2014 and January 2015.

    This figure has since dropped to 41 percent, but self-employed workers, who make up the informal sector, such as traders and farmers, remain the worst hit. 

    The Liberian economy is expected to grow by three percent this year – less than half the pre-Ebola projection. This equates to a loss of forgone income of around $200 million, according to the World Bank. In 2014, the growth rate was expected to be 5.9 percent; this plummeted to 2.2 percent, after Ebola hit. 

    “We depend on business at the border to survive, said Musu Freeman, a seller at the Bo-Waterside Market in Liberia’s Grand Cape Mount County, which borders Sierra Leone. “But during Ebola, everything was at a standstill. No business, no money. Things became very hard on us. There was no food to even eat. Our kids were suffering,” she said. 

    Now that the border has reopened, Freeman said she can once again buy and sell her wares in Sierra Leone and has started to earn money for the first time in months. 

    “I am a happy woman today,” she told IRIN. “When the border was closed, we never had any other options. But now we are going back to business as usual and our lives are improving. Things are getting better for us once again.”

    While wages fell, food prices went up, particularly in the border communities, where people were forced to travel further to get food from big-city markets. The price of rice, for example, was 35 percent higher in January this year than it was a year earlier, according to the latest figures from the World Bank. 

    Sixty-five percent of surveyed households told the World Bank in late January that they were not able to buy enough rice to meet their needs during the previous two weeks. A lack of money was the main reason cited by more than 88 percent of respondents.

    “When Ebola hit Liberia, my boss asked all of us to stay home,” said 38-year-old Tina Cooper, who works for the Ministry of Education. “I went out of money completely. I never had a cent to feed my family. Things were very rough [because] I had no income at all.”

    Trying to cope

    As a result of lost wages, high unemployment and higher prices, more than 85 percent of families say were forced to use negative coping strategies since the outbreak began, according to survey data released by the World Bank on 24 February. This includes things such as selling assets, slaughtering livestock and borrowing money, in order to feed themselves and their families.

    “Ebola affected me so much to the extent that I sold all of my living-room furniture,including my children’s television, our radio and dining room sets,” said John Tamba, who lives in Goborchop Community, a suburb east of Monrovia. “I had to do this because I needed money to feed my family when things were hard during the Ebola war. It was the only way me and my kids could survive the crisis.”

    More than 80 percent of families living in rural areas and three-quarters of households in urban areas now report being food insecure, the World Bank says. Many households say they have had to reduce portion sizes during the past few months and cut down on the number of meals they eat each day. 

    Gradual recovery

    Economists say that in order for people to get back into the working sector, it is vital that they have access to credit and capital, to restart their businesses. Graham said that this should be a key component of the post-Ebola recovery plan that the government is now working on.

    According to Liberia’s acting Minister of Information, Isaac Jackson: “Bit by bit we are working to revitalize the economy.” 

    This has included things such reopening the airports and ports to allow tourists and business people to come in, trying to attract both new and old investment partners into the country, resuming the salaries of civil servant employees and reassuring Liberians that they can return to work, as proper safety and health measures are in place. 

    Liberians say they hope these initiatives will be as quick and helpful as the reopening of the borders. 

    “We don’t blame the government for closing the border,” said Lain Trawalley, a trader in Bo-Waterside Market. “But we felt the pinch of it. We were stranded. We really suffered. So thank God it is all over. We feel like we are finally out of prison.”

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    Ebola's lasting economic impact
  • Working to keep the peace: The impact of job schemes on ex-rebels

    Job-creation schemes are the traditional way to tackle the post-conflict problem of unemployed ex-fighters and to reduce the threat they can pose to peace and stability in fragile states.

    The theory - encapsulated in most demobilisation, disarmament and reintegration (DDR) programmes - is that jobs can be generated through training and capital inputs; that employment decreases the risks of re-recruitment; and once armed with a pay cheque, ex-combatants settle down and reintegrate more easily into society.

    Those assumptions were tested in a recent study exploring whether employment could reduce lawlessness and rebellion among high-risk men in Liberia. Of those who took part in the training scheme that was studied, 74 percent had fought in Liberia’s traumatic 14-year civil war.  The study concluded that training and cash incentives did encourage lawful employment, and as a result the men resisted being signed up by mercenary recruiters during a neigbouring conflict.  But there was no evidence employment improved their societal reintegration – they remained violent and anti-social.

    The NGO Action on Armed Violence (AoAV) works with ex-fighters and other troubled young men, typically involved in illegal mining and logging in remote “hotspots”, providing agricultural training and farm inputs. The income-generating scheme gave the researchers - Christopher Blattman of Columbia University and Jeannie Annan, of the International Rescue Committee - what they described as a unique opportunity to study employment-led rehabilitation.

    Their study found that even the highest risk men where “overwhelmingly interested in farming” as a result of the AoAV training. But although they spent 20 percent more time on farming, they didn’t abandon their illicit activities. Instead, they adjusted “their portfolio of occupations”, and saw a modest rise of $12 a month in earnings. Crucially the men reported “24 percent less engagement” with mercenary recruiters when Cote d’Ivoire’s short war erupted in 2011 – and none went to fight.

    The study’s findings were published in the Social Science Research Network.

    DDR employment programmes generally have a low success rate: Often the primary goal is to get a peace agreement signed, not sustained economic reintegration – a failing witnessed from the Central African Republic to the Democratic Republic of Congo.

    The study suggests that the single-trade focus of most DDR programmes fails to appreciate how, in the real world, the poor use multiple streams of income to mitigate risk. Liquid capital is key. The AoAV scheme demonstrated, almost accidentally, the power of cash incentives. As a result of a supply problem, roughly a third of the men expecting a second farm input installment were told to expect instead a cash payment – conditional on them not taking up mining or mercenary work. This financial inducement worked. 

    “The potential policy implication is that one-time transfers will not fully deter future criminal or mercenary opportunities. Ongoing incentives, such as cash-for-work programmes or other conditional transfers, could be important compliments,” the study noted.

    Despite the men’s relative economic success, the programme had “little effect on aggression, participation in community life and politics, or attitudes to violence and democracy” – in other words, little progress in terms of social integration. Furthermore, although AoAV’s intervention had a positive impact, an additional $12 a month earned was “not a high return” on the investment. 

    “Cost-effectiveness thus hinges on the hard-to-quantify social returns to lower crime and violence,” the study noted. In a fragile country recovering from conflict, that may well be a price worth paying.

    For further reading on DDR see:

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    How to help ex-rebels adjust to peace
  • Three words of advice for WHO Africa's new chief

    The World Health Organization says the number of new Ebola cases per week rose twice this month for the first time since December.

    This rise in incidence of new cases - if proven to be a trend - will be just one of the challenges facing WHO’s new regional director for Africa, Matshidiso Rebecca Moeti, as she attempts to overcome the multitude of criticism launched against WHO in recent months for its failure to act earlier and more competently during West Africa’s ongoing Ebola outbreak.

    “This is a critical moment for the WHO,” said Michael Merson, director of Duke University’s Global Health Institute. “It’s a real crossroads as to whether or not they’ll be able to reform and become an effective and efficient organization, particularly at the regional level.”

    Moeti, who officially took office 1 February, has vowed to make fighting Ebola WHO’s “highest priority,” while supporting countries to develop strategies to build up their health care systems, and reduce maternal and child mortality, tuberculosis, HIV/AIDS and non-communicable diseases.

    Many international observers say they have high hopes for Moeti, a medical doctor who has more than 35 years of experience working in the national and global public health sector. But she has a tough road ahead – particularly as the number of Ebola cases continues to rise, nearly a year after the outbreak was first declared.

    Here’s some advice from a few experts as Moeti begins her five-year term:

    1. Think Local

    Having competent and qualified staff on the ground, whose skills and expertise are matched to the needs of the country, is key to effectively implementing WHO policies and recommendations.

    “Everyone tends to discuss WHO at the global level and the regional level, but I don’t think this is where the problem lies,” said Fatou Francesca Mbow, an independent health consultant in West Africa. “It really lies in what the WHO is meant to be doing at country level. It is of no use to have very technical people sitting in Washington [D.C.] or Geneva, and then, where things are actually happening, [they become] politicians.”

    Mbow said that despite a wealth of technical documents being produced at headquarters, very often the staff from the field offices are appointed based on political motives. Country and field-level office meetings are often dominated by talk that, while politically correct, says “nothing of real meaning”.

    Staff reform at the local level will require both investing in employee development, including recruiting new and existing talent to the field offices, as well as making posts in “hardship” countries more attractive to the most qualified experts.

    “What often happens is that when people in-country are seen as being quite effective, they tend to get headhunted by the headquarters of the institutions that represent them,” said Sophie Harman, a senior lecturer in international politics at Queen Mary University of London. “So we see a type of brain-drain among people working in these sectors.”

    She said that improving salaries and offering more benefits, as well as taking into account what these people have to offer, could go a long way in incentivising them to stay at their field-level posts.

    “Good documents are interesting,” Mbow said. “But unless you have people at country level who understand them, who participate in writing them, who are able to implement them, who are passionate and committed to doing so, they’re just going to be reports.”

    2. Strengthen health systems

    There were many factors that contributed to the unprecedented spread of the Ebola outbreak, but inherently weak local health systems in the three most-affected countries meant that local clinics did not have the capacity, resources or expertise to handle even the smallest of caseloads.

    WHO must now work with local governments, partners and other on-the-ground agencies in all African countries to train and employ more doctors and nurses, implement universal health care coverage, and invest in better vigilance and surveillance measures.

    “I think the real test will be… how the WHO turns this outbreak into an opportunity to use our energy and thoughts and actions to build health systems that will not only help people [day-to-day], but will be able to respond to health crises like this in the future,” said Chikwe Ihekweazu, a managing partner of the health consulting firm EpiAfric.

    Increasing the number of health workers will be particularly important post-outbreak in Guinea, Liberia and Sierra Leone, where more than 400 health workers have died from Ebola, including some of the countries’ top doctors and nurses.

    “The WHO also needs to help minimise the knock-on effect that the Ebola outbreak is having on other health priorities in the region, such as HIV/AIDS and maternal health,” Harman said. “What we are seeing is that because of Ebola, people are afraid and so they are not accessing health facilities, which might actually reverse some of the many gains we’ve seen in the MDGs [Millennium Development Goals].”

    3. Rebuild credibility

    Despite WHO having, admittedly, acted much too late, both in terms of identifying the Ebola outbreak and then mobilizing resources to contain it – and losing much of its credibility in the process – experts agree that WHO remains a much-needed and relevant global health body, particularly when it comes to technical expertise.

    “We all recognize that the WHO has had a fairly good history in the past,” Ihekweazu said. “And while it was certainly criticized for its slow response at the beginning of the outbreak…the WHO is seen as the leading organisation that provides guidance for countries and I think…we are at a stage where [Africa] needs the WHO as a mutual partner who provides leadership for the continent going forward.”

    Mbow agreed: “What I would say is that when you are criticised, take the blame fairly, but don’t lose sight. And don’t lose confidence in the resources you do have to offer.”

    Restoring donor confidence in WHO will be particularly important, as the regional office for Africa has the largest budgetary needs, the most countries, and, in many ways, the most challenging health problems to deal with.

    “No one wants harm done to the WHO,” Merson said. “We will be a much better, healthier planet, if the WHO is strong and effective… But it is never going to have a huge budget and so I think its strengths should be in standard-setting, norm-setting and providing the best technical sound advice in health that countries need.”

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    3 tips for WHO's new director for Africa
  • AUDIO SLIDESHOW: Ebola: Back to school, but is it safe?

    More than two million pupils in Liberia and Sierra Leone are heading back to school after a six-month shutdown caused by the Ebola outbreak. Authorities have taken steps to prevent further transmissions but conditions in both countries leave room for concern.

    “I am afraid to go to school,” said Sam Joekor, a 15-year-old student in Monrovia. “We are still hearing news about Ebola in some communities. You don’t know who you will come into contact with on campus, so I am really afraid. I don’t want to die from Ebola,” he told IRIN.

    But according to local authorities, both countries are ready. Some schools in Liberia resumed class 16 February; the rest must open by 2 March, or face fines. Sierra Leone says it plans to reopen schools nationwide by the end of March.

    “We don’t think [the decision to reopen] is premature, because we now have the ability to adequately deal with any cases that are reported, particularly in the schools,” said Abdulai Bayraytay, government spokesperson in Sierra Leone.

    There and in Liberia, hundreds of teachers have been trained on how to limit transmission.

    Hand-washing stations have been installed at many schools across Liberia and will soon be in place in Sierra Leone. Before any child or teacher enters the classroom, he or she must disinfect their hands with a chlorine solution. The temperature of each student and teacher will also be checked each morning.

    At the first indication of fever or sickness, students will be sent to an on-campus emergency isolation room, before being referred to a local health clinic, as part of a newly created referral system in Liberia.

    Liberia’s Ministry of Education says parents have also been warned against sending their children to school if they show any signs of illness.

     

    Film by Ricci Shryock

    Nagging concerns

    In Liberia, more than half the schools don’t have a regular supply of water. Large quantities will have to be carried to the hand-washing stations each morning from neighboring wells.

    Some schools in in the more remote areas of Liberia, where schools were originally scheduled to open nationwide on 2 February, still have not received safety supplies, such as buckets, chlorine solution or thermometers, due to poor road conditions.

    “Imagine the practicality of 300 children washing their hands one by one…and then having each of their temperatures taken each morning,” said Steve Morgan, country director for Save the Children in Liberia. “There’s a real time factor for those children moving through and doing all those things before they even get into the classroom.”

    While teachers have been trained on how to prevent transmission, many complain that such healthcare duties will only add to the burdens of large class sizes and lack of assistants.

    “So there will be a lot of challenges and we are aware of these challenges,” Morgan said. “But that notwithstanding, it’s a great thing that kids are going back to school.”

    Fear and poverty

    Ramsey Kumbuyah, the deputy education minister for administration in Liberia said many children “have no hope of getting back this year [because] they lack the funding” for fees, uniforms and other supplies.

    Many were orphaned by Ebola, while the parents of others lost their jobs due to the outbreak.

    “My father died from the virus in August,” said 26-year-old mature high-school student Elijah Toby. “He was the only person that was responsible to pay my school fees. Now I have no hope…I have no money and my Mum is not working…. Ebola has put me way behind.”

    Experts IRIN spoke to warned that many of these older students, such as Toby, will likely drop out altogether. Some, even the younger ones, may have had to take on work to help their families during the outbreak and will also not return.

    Other students will be forbidden by their family to go to class for fear of catching Ebola.

    “I am really worried about the safety of my children,” father Samuel Tar told IRIN, in Monrovia. “I still have doubt that they will be safe. I don’t trust the school.”

    There is also concern that ongoing stigma problems could keep children who are Ebola survivors out of the classroom.

    Education lag

    Despite the creation of ‘teaching by radio’ programs in Liberia and Sierra Leone, which allowed students across the country to listen to daily lessons and complete exercises in their homes, not everyone participated and the lessons were often generalized to include more than one class level.

    “What they probably have done is help to continue to whet to the appetite to learn and continue to ensure that children were engaged in the education system,” Morgan said. “So in that sense they played an important role. But it could never be more than a bridge.”

    Sierra Leone’s Inspector Directorate of the Ministry of Education, Mohamed Sillah Sesay, told IRIN: “The Ministry knew that such programs would not have a very huge impact. But we had to do something to help the students.”

    Teachers, who themselves were also idle for many months, say they worry that the long delay in “real” education will affect student’s school performance.

    “Ebola made our children forget lots of things in school,” said Mary Thomas, who works in Liberia. “Some of them have forgotten about basic math and hardly know how to comprehend. I am worried.”

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    Ebola: Back to school, but is it safe?
  • Who celebrity advocates are really targeting. And it’s not you.

    This week was a fanfare for celebrity humanitarians: Forest Whitaker appealed for peace in South Sudan alongside UN Under-Secretary-General for Humanitarian Affairs Valerie Amos; Angelina Jolie opened an academic centre on sexual violence in conflict with British Member of Parliament William Hague; and UNICEF Goodwill Ambassador David Beckham launched an initiative for children. 

    In recent years, aid agencies have increasingly used celebrity advocates to raise awareness and money for their causes. There’s just one snag: 

    It doesn’t actually work. At least not as much or in the ways we think. 

    According to research by Dan Brockington, a professor at the University of Manchester, public responses to celebrity activism are surprisingly muted. His work is the first quantitative research on the subject. 

    “Using celebrities for broader outreach, for reaching mass publics and attracting media attention is absolutely not the silver bullet it appears to be,” he told IRIN on the sidelines of a 6-8 February conference at the University of Sussex, where he presented research recently published in the book Celebrity Advocacy and International Development.

     

     
    In a survey he conducted with 2,000 British people, 95 percent of respondents recognized five or more of 12 charities listed to them, including the British Red Cross, Save the Children UK and Oxfam UK. But two-thirds of the respondents did not know a single “high-profile” advocate of any of the NGOs (In this case, music executive Simon Cowell and singers Victoria Beckham and Elton John respectively, among many others). 

    The realpolitik might not be that pleasant. But you'll achieve your goals. 

    Focus groups and interviews with more than 100 “celebrity liaison officers” and other media staff at NGOs further reinforced his findings. 

    What’s more, Brockington says, those who pay attention to celebrities do not necessarily know which causes they support. 

    “People who follow celebrities often do so because they are not political,” he said during the interview. “They are fun, light. You want to live their lives…[People] don’t engage with [celebrities] for the more worthy things.”  

    Celebrity stardom flat-lining 

    Despite the rise in the use of celebrity advocates (which, by the way, dates back to at least Victorian times), the mention of charities in broadsheet and tabloid articles about celebrities only increased ever so slightly between 1985 and 2010, according to a separate study by Brockington. “There has also been a decline in the proportion of newspaper articles mentioning development and humanitarian NGOs at all,” the study found. 

    The perception that celebrities engage the public in the first place may itself be overstated. 

    After a steady rise in coverage of celebrities in the British press over two decades, the percentage of articles mentioning the word celebrity (only a fraction of total articles about celebrities) stopped increasing around 2006 and is now hovering at about four percent of all articles studied, the research found, validating the findings of earlier studies on the same subject (The study looked at The Guardian, The Times, The Independent, Daily Mail, The Mirror and The Sun). 

    The magazine industry’s own statistics show a tapering off of readership in recent years after steady growth.

    Celebrities can be successful in engaging the public – Miley Cyrus made waves last year when she sent a homeless man to pick up her MTV Video Music Awards; Bob Geldof’s charity single on Ebola quickly rose to the top of the charts; and celebrity-driven telethons like the UK’s Comic Relief are generally quite successful. Leonardo DiCaprio’s speech at the opening of the Climate Summit 2014 garnered nearly 2 million views on YouTube – far more than many of the heads of state who also spoke at the summit.

    And the effectiveness of celebrity advocacy in non-Western contexts, which is much less studied, could well be higher. UNICEF, for example, uses more national than global celebrity ambassadors because they often resonate better with local audiences. Social media campaigns can also be extremely successful in some instances, though “not a game-changer”, according to Brockington (For a cold shower on this topic, see Paul Currion’s column on why KONY 2012 may have engaged the public, but ultimately failed).

    Influence without accountability 

    But on the whole, at least in the UK, public interest in celebrity appears to be lower than most people think, Brockington says. But the belief in star power - inaccurate as it may be - lingers: In his survey, 74 percent of respondents said they thought other people paid more attention to celebrities than they did. Statistically, this cannot actually be true, but it proves an important point: If people think that other people care about celebrities, it can become a self-fulfilling prophecy.

    Brockington found that while celebrities may not be as successful as we think in engaging the public, they are still successful at engaging politicians and decision-makers. 

    Why? 

    Because politicians - like most people - like being around celebrities. But also because politicians – also like most people - believe that celebrities express populist sentiment, even though, in fact, they often don’t. So they grant them access and influence. 

    Ben Affleck, for example, has briefed US Congress about the Democratic Republic of Congo and George Clooney has addressed the UN Security Council about Darfur.   

     

    For the small but growing number of academics studying the subject, the gap between celebrity advocacy and public engagement raises a major ethical question: If celebrities wield all this power and influence, yet do not represent popular sentiment, who are they accountable to?  

    “The celebrity is not beholden to his or her public in the same manner as the elected official,” writes Alexandra Cosima Budabin, of the University of Dayton, in an upcoming book: Celebrity Humanitarianism and North-South Relations. “Misguided proposals and ineffective interventions will not endanger a celebrity, whose position is assured by both financial and political elites.”  

    Celebrities’ increasingly powerful voices on issues of humanitarian aid, poverty reduction and famine has allowed them to “often decide for the suffering receivers” and eliminate public scrutiny and debate, according to Ilan Kapoor, a professor at York University in Canada and author of Celebrity Humanitarianism: The Ideology of Global Charity. 

    “…Mostly unelected, private individuals and organizations have, for all intents and purposes, taken over what should primarily be state/public functions,” he writes

    A Machiavellian approach?

    Perhaps even more interestingly, Brockington found in his interviews with staff of NGOs with celebrity advocates that liaison officers know the impact on the public is limited, but use celebrities anyway because they can access and influence not the general public but decision-makers. 

    “The realpolitik might not be that pleasant,” he told the University of Sussex conference, “but you’ll achieve your goals.”

    UNICEF’s announcement of a new initiative for children by its Goodwill Ambassador David Beckham may reflect a clear understanding of this precise point. It reads: “David will use his powerful global voice, influence and connections to raise vital funds and encourage world leaders to create lasting positive change for children,” the statement said. 

    Malene Kamp Jensen, of UNICEF’s Goodwill Ambassador Program – one of the first and largest of its kind, acknowledges that sending a message to policy-makers is a “very, very important role” of celebrity ambassadors: “They do have certain access and platforms.” 

    But she says it is important to engage all segments of society: “You communicate to as many people as possible… I don’t think you can just say: ‘Forget the public; let’s lean on the policy makers. It’s very much a collective effort.” 

    For Jeffrey Brez, of the UN’s Messenger of Peace Programme, the target audience depends on the specific goal in that instance. 

    “Is there a treaty about to be ratified and you need a few extra votes? Is it a humanitarian crisis and you need a bump of visibility to help Congress push through appropriations for humanitarian aid? There are so many moments when they can come in and give you a little boost. It depends … what you’re trying to achieve.”

     

    Celebrity advocacy "industry" 

    Brez and Jensen both challenge the suggestion that celebrities are seen to be a silver bullet to public engagement, insisting they are just one tool in the toolbox. 

    “We’re always looking just to incrementally move the needle,” Brez says. But he complains that he and his colleagues lack real research to assess just how much impact their outreach has. 

    When Project Runway All Stars shot its Season Finale at UN Headquarters, 2 million fashion fans – not the UN’s traditional audience – were exposed to its work in a positive light. But how much did they retain? Did their perceptions of the UN change? 

    Brockington cautions not to read too much into his findings: celebrity advocacy can work, he says, but must be used strategically, for example to influence elites or fundraise among existing supporters. 

    But he says celebrity liaison officers are themselves frustrated by their NGO colleagues’ expectations that if they just throw a celebrity at something, the organisation will be instantly successful at captivating the public imagination. 

    Could the bubble eventually burst if more people become aware of the limits of celebrity advocacy? Unlikely, Brockington says, given what has now become a celebrity advocacy “industry”, in to which NGOs invest a lot of time and resources.  

    “There is a fair bit of smoke and mirrors in this… [but] a lot of people are vested in this. They want it to work. There’s all sorts of strong collective interests in sustaining it.”

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    Does celebrity advocacy actually work?
  • Ebolanomics - the search for a vaccine

    When Ebola hit West Africa last year, it was a disease with no sign of a vaccine or cure. To those affected that may have been an indication that the wider world didn't care about them or the diseases that affected them, but in truth there has simply been no incentive for anyone to develop these therapies. Yet now pharmaceutical companies are racing to produce an effective vaccine, and on 23 January the British company GlaxoSmithKline shipped the first 300 doses of its candidate to Liberia to start phase II trials.

    At an event in the UK Houses of Parliament to discuss the economics of developing such vaccines, Jon Pender, a vice president of GSK, said he had been surprised, in the circumstances, that companies had any possible candidates at all on their shelves which could be developed and tested. He challenged suggestions that this was just because Ebola epidemics happened in poor countries where there was little scope for profit.

    A recent priority

    “That isn't the reason why we don't have vaccines for Ebola. The reason we don't have a vaccine is because it wasn't a priority for anyone, and there are understandable reasons for that.... The number of people affected each year was very small and the overall disease burden, in comparison to other disease like malaria or HIV, is tiny. The fact is that in the forty years that we have known about Ebola, including the present outbreak, there have been about 24,000 known cases. There are that many cases of malaria every hour.”

    Now, clearly, it has become a priority. So if it isn't just about money, how do you persuade the pharmaceutical industry to work on a normally obscure disease like Ebola? Adrian Thomas is a vice-president at Janssen Pharmaceutical Companies, which is also now working to get an Ebola vaccine to market. He says, “The first question is, what is the strength of the science? The second thing is to what extent there is a reward for innovation or a willingness to risk-share. And the third is, will we actually reach people? I think we have to understand what are the clear priorities for global health... 

    “Some companies do it for the reputation, others do it for the science or for alternative incentives. Other companies do it for direct financial reward, and I think you have to understand what are the different incentives that are necessary across that spectrum.”

    Profit may not be everything, but the companies are not setting out to lose money. In this case they have been incentivized with public money – American, Canadian or European – to pay development costs, and assurances from the global vaccine alliance GAVI that there will be a market for any successful vaccine they produce, with up to $300 million available to pay for it.

    Blank cheques

    Médecins Sans Frontières has been campaigning on the high and rising price of vaccines and the lack of transparency in the pharmaceutical industry, and earlier this month it published a new edition of its campaign document, the Right Shot

    Rohit Malpani is director of policy and analysis for MSF's Vaccine Access Campaign. He told IRIN that despite substantial sums of public money poured into the development of an Ebola vaccine, very little was being demanded of the companies in return. “These vaccines are being developed with full public funding,” he says, “compensating the manufacturers for whatever investments they have to make, and for the cost of the clinical trials. Yet at this stage it is very non-transparent what the costs of development are, and not clear what guarantees there are about the outcomes and how they will ensure affordability. Governments are just writing them blank cheques.”

    MSF welcomes the fact that GAVI has earmarked money to buy any successful vaccine, since that sends a signal to the manufacturers that there is a market, but thinks that GAVI should also be more demanding. Malpani says, “We are still not sure at what price it will be sold to GAVI. MSF would prefer that it is sold at or near cost. And if any cost is not covered by public funding, it's better for that to be compensated directly, rather than through higher prices for the vaccine. The idea would be to de-link the cost of development from the final price.”

    GAVI negotiates lower prices for the vaccines it buys for developing countries, but it is likely that the US or European governments will also want to stockpile some of these vaccines for their own use, and they are likely to have pay more. Malpani says MSF accepts that, but remarks that “if these countries have already paid for the development, it does seem inappropriate that they should pay all over again through high prices.”

    MSF is certainly not against the development of Ebola vaccines, and intends to take part in some of the phase II clinical trials, probably at its facilities in Guinea. Julien Potet, their policy advisor on vaccines, says that planning the trial has been "a bit of a moving target". 

    “Cases are declining a lot, and to demonstrate a protective effect is more difficult in a setting where there are limited or no cases. But we hope to vaccinate two groups - health workers because they are particularly exposed to the virus, and also to ring-vaccinate people who have been in contact or have a case in their neighbourhood. This is the plan today, but of course it could change.”

    Panic has led to a lot of short cuts

    Others working on the response to the epidemic have more reservations about the vaccine programme. Mukesh Kapila, professor of global health at Manchester University, has just returned from West Africa. He found the affected countries alive with all kinds of stories and rumours, and he worries that time isn't being taken to prepare people for the idea of the vaccine trials. “I am afraid they are going to think, 'Oh, all these companies are coming to test some half-baked vaccines on black people here in Africa'. And the impact might be to put off people at risk from coming to get help, because they think, 'Oh God, I'm going to be vaccinated'. When we do these trials for antibody response, it's important that we do them on white people as well as black people, partly because it is important scientifically, but also because it's important for public perception.”

    More widely, Kapila thinks the rush for a vaccine may be counter-productive. “The panic associated with this epidemic has led to a lot of short cuts, with people rushing through the early phases so that human trials can start quickly. Everything may be fine, but we still don't know how effective the vaccines are going to be. Are they going to give 90 percent protection? 80 percent? Or only 50 percent? That wouldn't be enough."

    Kapila told IRIN: “People are expecting a vaccine to be the solution to this epidemic and it can't be. A vaccine is no substitute for the laborious public health measures of identifying index cases, tracing and isolating contacts. By looking to a Promised Land where a vaccine is going to come and solve all our problems, we risk undermining these more important public health efforts. A huge amount of public money is going into vaccines. Once we have started we might as well finish, but I am sceptical whether it is a useful effort, on either public health or social and economic grounds.”

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    Ebolanomics - the search for a vaccine
  • After Ebola: What next for West Africa’s health systems

    As rates of Ebola infection fall in Guinea, Liberia and Sierra Leone, planning has begun on how to rebuild public health systems and learn lessons from the outbreak.

    Nobody is declaring victory yet. But in Sierra Leone, the worst-affected country, there were 117 new confirmed cases reported in the week to 18 January, the latest statistics available, compared with 184 the previous week and 248 the week before that. Guinea halved its cases in the week to 18 January – down to 20 – and Liberia held steady at eight. 

    The epidemic is not over until there are zero cases over two incubation periods – the equivalent of 42 days. “It’s like being only a little bit pregnant – there’s no such thing as a little Ebola. We have to get to zero, there can be no reservoirs of Ebola,”  Margaret Harris, spokesperson of the World Health Organization (WHO), told IRIN. 

    But after 21,724 cases and 8,641 deaths in nine countries since the epidemic began in Guinea last year, there is some light. And health workers are already starting to look at what’s next. “Right now important meetings are going on in each country to work out what needs to be done to rebuild - in some significant respects to build health systems almost anew - and to build back better,” said Harris. 

    A European Union donor conference is due at the beginning of March in Brussels. “What we want to see as a country is a resilient health system that can withstand shocks,” Liberia’s Assistant Health Minister Tolbert Nyenswah told IRIN. “Our plan [to be presented in Brussels] will be finalized by the end of February. It will be well costed with tangible goals.”

    Ebola tested the public health systems in the three West African countries to near destruction – most places in the world would have also struggled. But where the three failed was at the basic “nitty-gritty” level of “standard surveillance, testing and monitoring, the containment of cases, the bread and butter of public health”, said Adia Benton, a social anthropologist at Brown University in Rhode Island.

    Citizen and state

    A successful malaria campaign in Sierra Leone last week, which reached 2.5 million people, and a planned polio and measles vaccination programme in Liberia, are positive signs for the health services. But the list of necessary reforms is long: stronger surveillance; healthcare that will work after the international partners leave; access to affordable services. The list must also embrace longer-term structural changes, including the relationship between citizen and state.

    According to Antonio Vigilante, Deputy Special Representative for the Consolidation of Democractic Governance in the UN Mission in Liberia, and Resident Coordinator, “there is a golden opportunity to have a different start, to have a more balanced development that leaves outcomes in the hands of the people. It’s a very delicate stage, full of opportunities, which should not be missed.”

    Liberia is one of the world’s poorest countries and Ebola has been a tragic addition to the burden. It has destroyed livelihoods; already dizzying rates of unemployment have worsened; and food prices have soared. Both rural and urban communities are suffering.

    Vigilante is worried the economic impact of Ebola, and the interruption of immunization and reproductive health services during the crisis, could put more people at risk than the virus itself did. “A number of [social protection] measures in the recovery phase would need to be universal,” he said. One example would be if Liberia scaled up its pilot Social Transfer Programme, launched in 2009, to provide just US$40 per year to two million children. There would be sizeable “knock on effects on local markets and entrepreneurship” at minimal cost, according to the Washington-based Centre for Global Development

    Lesson learned: “Community, community, community. Engagement, engagement, engagement”

    Schools are due to re-open on 2 February in Liberia, and a strong case could be made for a universal school feeding programme to attract and retain children in class. “Even before Ebola many children were out of school,” UNICEF spokesman in Liberia, Rukshan Ratnam, noted.

    Money matters

    But will the donors come to the party? Donors pledged $1.5 billion to a UN coordinated appeal for Ebola last year, but $500 million is still unpaid. “If we cannot close that funding gap we will snatch defeat from the jaws of victory. It’s as simple as that,” Bruce Aylward, WHO assistant director-general in charge of the Ebola response, told reporters on 23 January. 

    Wasted dollars can be expected in a crisis when the priority is effectiveness - stopping the outbreak - rather than efficiency in how the money is spent. That equation will change if Ebola does not come roaring back with the rains in April, and donors begin to look at competing needs.

    There is potential to re-purpose Ebola infrastructure - some of it now idle with a glut in treatment facilities - if donors are willing to be flexible, said Vigilante. Laboratories used for testing could be incorporated into national laboratory services; some of the more permanent treatment units could be re-launched as community-based health facilities; contact tracers could be used as community mobilizers. 

    “We certainly lost staff as a result of Ebola. But the converse of that is there was a very rapid upskilling as people were trained to work in the treatment units or as contact tracers. It’s a group we should build on,” said Harris. “It’s really important we don’t lose them in the transition to a normal service.”

    Local heroes

    Among the lessons learned across the region has been the importance of consulting, engaging and empowering local communities: their lack of trust in central government was a major handicap in tackling the epidemic. “Community, community, community. Engagement, engagement, engagement,” said Harris. “We need to listen more. We need to do a lot of work with sociologists and anthropologists.”

    Liberia in particular has a highly centralized system of government, but local communities have emerged as critical players in the response with a new can-do attitude. “People given a chance can do a fantastic job,” said Vigilante. 

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    101046
    After Ebola
  • Nice and dirty – the importance of soil

    Be it laterite, loam, peat or clay, soil is life. It's the foundation of food security, and so the UN has declared 2015 as the year to draw attention to the stuff.

    As much as 95 percent of our food comes from the soil, but 33 percent of global soils are degraded, and experts say we may only have 60 years of nutrient-rich top soil left - it is not a renewable resource. 

    Africa is especially hard hit. Land degradation denudes the top soil, shrinking yields and the ability of the earth to absorb harmful greenhouse gases. In sub-Saharan Africa, an estimated 65 percent of agricultural land is degraded. That costs the continent US$68 billion a year, and affects 180 million people - mainly the rural poor, already struggling to eke out a living.  But better land management practices could deliver up to $1.4 trillion globally in increased crop production. 

    So how to implement sustainable policies that protect the food security of future generations? The uptake of sound soil management approaches is currently low. Farmers are under pressure to abandon effective traditional methods in favour of practices that deliver quicker, short-term, returns. 

    Further reading on the issue
     2015 – International Year of Soils
     FAO Soils Portal
     Agriculture for Impact
     The Comprehensive Africa Agriculture Development Programme
     AGRA
     United Nations Convention to Combat Desertification
     Africa Soil Information Service

    But a report - No Ordinary Matter: Conserving, Restoring, and Enhancing Africa’s Soils - released in December 2014, points to potential pathways. These include combining targeted and selected use of fertilisers alongside traditional methods such as application of livestock manure, intercropping with nitrogen-fixing legumes or covering farmland with crop residues. The goal is an ambitious - if contradictory sounding - “Sustainable Intensification” of agriculture.

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    101019
    Nice and dirty – the importance of soil
  • Uneven Distributions: What we talk about when we talk about Ebola


    IRIN is introducing an occasional series of "Open Forum" guest columns to broaden the
    space for debate and discussion. Argument, opinion, comment,
    conversation, constructive rant. In the first of his irreverent takes on all things humanitarian - which
    we have dubbed "Uneven Distributions" - humanitarian consultant Paul
    Currion asks what it would take to keep the public's attention on Ebola. 

     

    Film critic Roger Ebert wrote that pandemics were “one of the great scare stories of our time, the notion that deep in the uncharted rain forests, deadly diseases are lurking, and if they ever escape their jungle homes and enter the human bloodstream, there will be a new plague the likes of which we have never seen”. Thankfully, this Ebola outbreak isn't that specific apocalypse. But in terms of holding public attention, that's part of the problem.

    I wanted to impress the hell out of you in this first column, so I made a graph (Fact: graphs have been scientifically proven to impress the hell out of you.) Look how quickly public interest in the Ebola epidemic has fallen away. People aren't talking about Ebola as much as they used to – definitely not as much as they should be, considering the worst-case scenario is pretty much the dictionary definition of “worst case”.

    Diminishing interest in Ebola – despite better public information than ever before, such as the World Health Organization’s semi-interactive map, the Humanitarian Data Exchange dashboard or EbolaDeeply’s aggregation – is worryingly familiar. A 1989 Los Angeles Times  article pointed out: “The drop in concern about AIDS [was] due largely to lower concern among whites and people over age 40 that they personally will be affected by the epidemic,” (Thanks, old white people!)  The same dynamic is playing out with Ebola, to the extent that even those in affected countries are living (and dying) in denial.

    The media focus on easy numbers, but cumulative caseload (18,603 confirmed cases as of 17 December 2014) and fatality rate (hovering at around 70 percent like a peculiarly malevolent hummingbird) are terrible metrics to measure the epidemic's impact. Economic figures paint the bigger picture: on 2 December, the World Bank issued a report revising growth projections for countries affected by Ebola, with both Sierra Leone and Guinea moving into the negative in 2015. On one of those rare occasions when economists agree, a report from the UN Economic Commission for Africa also laid it out clearly.

    Across the three countries suffering the brunt of the epidemic, lost income in 2014-15 is estimated to be more than US $2 billion. Financial projections aren't always reliable – the World Bank updates its predictions more often than Beyonce changes wardrobe – but the message is clear. Any economic contraction in already poor countries means big decreases in the quality of people's lives.  But the second-order impacts are where the real action is, because they show how this type of epidemic can fatally wound countries:

    - The impact of Ebola is gendered – 75 percent of fatalities in Liberia have been women, because women do most of the caregiving when a relative falls ill.

    - The group with the highest fatality rates are health workers themselves, hollowing out already under-resourced health systems.

    - Schools have been closed in Ebola-affected countries for varying amounts of time. The longer children are out of school, the less likely it is they'll return.

    - Closed markets mean food shortages for all, with farmers eating their seeds – which means no seeds for planting next year.

    - More resources for Ebola translates into fewer resources for other diseases – even threatening the welcome progress made in fighting malaria.

     

    We live in an attention economy in which most of the world stopped worrying when it became clear that they weren't going to be overrun with Ebola zombies. Yet the zombie television series The Walking Dead has managed to keep people's attention for five years now – about five years longer than WHO managed to keep people's attention after the 2009 H1N1 misfire – so maybe we should be thinking more about zombies?

    Well, no. Treating Ebola victims like zombies is a stupid idea, even by my low standards. Now that the Ebola Fighters have been named Person of the Year by Time magazine, how about a new TV franchise? Mighty Morphin Ebola Fighters could be huge – one from each of the Ebola-affected countries in West Africa and when they combine forces they turn into a giant David Nabarro.

    The struggle isn't going badly, all things considered, but this isn't going to be the last outbreak we'll have to manage – we're still waiting for that big influenza pandemic, remember? To avoid catastrophe next time, we need to be better prepared, which means that we need a longer-term commitment: to re-examine the logic of the global public health system, to focus on a more holistic approach and to invest in health systems in at-risk countries. What we talk about when we talk about Ebola needs to be a much more compelling narrative than Roger Ebert's scare story

    If you want to contribute to "Open
    Forum”, contact [email protected]

    101001
    How we should talk about Ebola

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