What should we learn from the Ebola outbreak?

I’m at a conference where researchers are looking back at the consequences of and lessons from the West Africa Ebola outbreak. Videos should be online later this week, but in the meantime some miscellaneous highlights.

First, paraphrasing Dave Evans, at the World Bank:

  • 60 seconds after releasing the high and low estimates, people forgot there were low estimates. In future, what he would do is run thousands of simulations, not two, and report the average and distribution rather than the high and low.
  • But this is inherently difficult because the size of the economic impacts depended wholly on whether and how far the disease spread. And this was incredibly different to predict.
  • In the end, the economic damage was much closer to the low end estimates than the high end ones, largely because the disease didn’t spread outside the initially-affected countries.

My own sense: when an Ebola case was found in a minimally functioning state, with advance notice this could happen, it was generally contained. This is what has happened with most Ebola cases in Africa over the last 15 years or so.

Second,paraphrasing Rachel Glennerster from JPAL:

  • Going around shouting “the sky is falling” was great for raising money but was very damaging to the local economy. It drove people to hold back their spending, and firms to shut down, and those hit hardest are the many, many people in the informal urban sector who no longer have a business.
  • It can also make the disease worse. Possibly the most damaging act was the WHO reporting that the death rate from Ebola was 90%, when the survival rate was actually much, much better (especially with treatment). To contain the disease, one of the main things you needed people to do was go to a clinic when sick. And yet who would go to a clinic if you told them they’ll die anyways.
  • So these messages were incredibly counterproductive for controlling the disease and the economic fallout, even if the hysteria was correct.

All of this might be excusable if you thought that hysteria was needed to raise money. I don’t happen to believe that’s true, and if it is, shame on us.

Finally, paraphrasing Lily Tsai and Ben Morse from MIT political science:

  • People affected by the crisis—from losing their job, to knowing victims, or seeing dead bodies—trusted the government less, at least temporarily
  • This is a problem if you need the state to believe and cooperate with a government in order to contain the crisis. So how do you build trust?
  • The government of Liberia hired community outreach workers to communicate public health measures, and where these workers went trust in government rose. Compliance with curfews, safe burials and quarantines were higher as a result. Later they now support everyday laws like taxation.
  • Working through the government, even though it was more difficult in the heat of the moment, paid off in terms of trust and state capacity after the crisis.

What’s interesting is that the outreach workers probably did relatively little for people. Information was important but they were not the vanguard of a huge aid or health effort. How much of his effect was the illusion of a state, the ritual of a state? What mattered was shaping people’s beliefs about the intentions and capacity of the government.

Perhaps an overall takeaway: to contain an epidemic, build trust and hope not fear and suspicion.