Over the past couple of months, we’ve put some time into trying to understand the Ebola containment effort and whether it represents a strong giving opportunity. Our process has included conversations and correspondence with about 15 people including major private donors to the containment effort and representatives of the UN, CDC, WHO, and Doctors without Borders. We have also kept informed on the outbreak by reading updates from the UN, CDC, WHO, and University of Pittsburgh Medical Center. (More on our process)
Yesterday, we published a writeup summarizing the status of the outbreak and control effort, the picture of funding provided and needed, and our view on the cost-effectiveness of donations.
The key points, in our view, are:
- It has been very difficult – we think unnecessarily so – to get a picture of the funding needs and the likely impact of additional donations. It’s inevitable that a situation like this one will be difficult to understand and follow as it’s unfolding, but we’ve struggled to find even fairly basic information. We haven’t been able to find any consolidated estimate of how much total funding is needed for core activities and how much of that funding has come in so far. The closest we’ve found has been an appeal specific to UN partner agencies and major NGOs; this appeal doesn’t appear to account for the (significant) activities undertaken and funds provided directly by donor governments. (Note that Center for Global Development scholars have expressed similar sentiments about the lack of reliable information on donor contributions, in a post titled How Much Is Actually Being Spent on Ebola?) Furthermore, the description of planned activities for the UN partner agencies and major NGOs is very broad and high-level. We’ve found very little information on how additional funds would be spent. More
- Substantial funding has come forward, particularly from governments. As of November 28, over $2 billion in funding for immediate relief efforts had been tracked, and more recently the US Congress approved over $5 billion in funding “to contain and end the Ebola outbreak at its source in Africa, enhance domestic preparedness, speed the procurement and testing of vaccines and therapeutics, and accelerate global capability to prevent the spread of future infectious diseases.” (It appears that about half of this will be spent domestically.) We believe that this outbreak may have been less compelling for individual donors than disasters such as the 2010 Haiti earthquake and 2011 Japan earthquake/tsunami; on the other hand, it has attracted significant funding from governments, perhaps in part because of fears that the outbreak might spread beyond Africa. More
- There has been significant progress toward stopping the outbreak, though there are still areas with intense transmission. It’s hard to have high confidence in data about the containment effort, but broadly speaking, it looks as though the effort has ramped up significantly; that it has largely (though not completely) met its goals regarding safe burials and case isolation; and that the overall number of cases in Liberia (where the outbreak has affected the most people) has declined substantially and come in very far below projections made at the beginning of the outbreak. The situation appears to be worst in Sierra Leone, where there are still major Ebola “hotspots,” and it remains possible that the course of the outbreak could change rapidly. More
- On the margin, we don’t expect additional donations from our audience to be critical to stopping the outbreak. We see the current funding gap as hindering how far into the future the Ebola response team can plan (e.g. contracts for some employees lasting 2 months instead of 6) or leading to the use of lower-quality equipment (e.g. ambulances with a dial-up modem instead of a VSat) rather than as, for example, preventing work in some areas altogether. More funding may be needed in the future, but we are optimistic that government donors will come forward with the bulk of such funding. More
- We aren’t recommending additional donations to the containment effort in place of donations to our top charities, but we do feel the containment effort has been an outstanding use of funding. We estimate that the several billion dollar effort, taken as a whole, could easily have saved lives as cost-effectively as our top charities – something that we don’t believe is usually the case in a disaster. We doubt that additional donations from our audience – beyond what has already been committed and will likely be committed in the future from others – would have comparable cost-effectiveness. We see the commitments governments have provided as outstanding uses of funds and hope they deliver on their commitments and close any remaining funding gap. More
- We remain interested in opportunities to strengthen disease surveillance over a longer time frame, to prevent the spread of this outbreak and help contain future outbreaks at earlier stages. We previously argued: “The best opportunities to prevent or contain the epidemic were probably before it was widely recognized as a crisis (and perhaps before Ebola had broken out at all – more funding for preventive surveillance could have made a big difference).” In our conversations around this outbreak, we have heard that there may be opportunities to rebuild health systems with stronger general surveillance capacity, and we are interested in this as part of our work on biosecurity (a likely priority of our Open Philanthropy Project work on global catastrophic risks).
As is usually the case in a vivid and widely publicized disaster, a large amount of funding has come forward, and it’s been hard to understand the developing situation and the role of additional donations – two factors that generally make us unlikely to recommend giving. In this case, the size of the threat and the potential difference to be made by a containment effort were unusually large, and we believe that the funding that went to this effort has generally been money unusually well spent.