International donations to the Ebola virus outbreak: too little, too late? Karen Grépin examines the pledges made to the Ebola crisis, how much has actually reached affected countries, and the lessons to be learnt Karen A Grépin assistant professor of global health policy New York University, New York, UK The World Health Organization was first alerted to the current outbreak of Ebola virus disease on 23 March 2014, 1 but it was not until 8 August, after a meeting of the International Health Regulations Emergency Committee, that it declared a public health emergency of international concern. 2 This official declaration set into motion an international response to contain the outbreak. The international response has been called both too small and too slow, and this may have contributed to the ongoing spread of the disease. 3 In this article, I examine the level and speed of the international donations to tackle the Ebola epidemic and how they aligned with evolving estimates of funds required to bring the epidemic under control. Understanding what has and has not worked well in the early phases of this crisis can help us learn from it and prepare for future humanitarian and public health emergencies. My analysis considers only international donations captured in the UN Office for the Coordination of Humanitarian Affairs’ (OCHA) financial tracking system (http://fts.unocha.org, box), which does not capture all resources that have been pledged to the outbreak. Funding needed for Ebola Guinea’s Ministry of Health notified WHO of a “rapidly evolving outbreak” of Ebola virus disease in the southeastern part of its country on 23 March 2014, with 49 reported cases, including 29 deaths. 7 Within a week of the notification, WHO sent an initial donation of protective equipment and other medical supplies to Guinea. 7 By early April, WHO had made an initial appeal for $4.8m (£3m; €4m) to the international donor community, which typically includes international governments, international agencies, non-governmental organisations, and private corporations. Donations exceeded this target, with the European Commission’s Humanitarian Aid and Civil Protection department (ECHO), Italy, South Korea, the United States, Canada, Germany, Japan, the United Kingdom, the African Development Bank, and a handful of private companies pledging a total of $7m. 8 On 1 August, WHO, along with the presidents of Liberia, Sierra Leone, and Guinea, announced the Ebola virus disease outbreak response plan and called on international donors to provide $71m to support the control of the outbreak. 8 As the epidemic continued to spread out of control, in late August WHO released the Ebola response roadmap, which provided guidance on how to “stop Ebola transmission in affected countries within 6-9 months and prevent international spread.” It estimated that $490m would be required to implement the roadmap. 9 Less than a week later, Margaret Chan, the director general of WHO, and other UN leaders revised this estimate up to $600m. 10 On 16 September 2014, roughly six months after the start of the epidemic, OCHA released a report which estimated that nearly $1bn in humanitarian assistance would be required, based on the assumption that up to 20 000 people would have been infected with the virus by the end of 2014 and that it would take 6-9 months to end transmission. By mid-November, after the creation of the United National Mission for Ebola Emergency Response, the official request for funding was estimated at $1.5bn. Clearly, international leaders have found it challenging to estimate the financial requirements to tackle this rapidly spreading outbreak. Although we still do not know what the total funding requirements will be, there seems to be consensus that at least $1.5bn will be required during the early phase of the response. Long term needs, which will include recovery and rebuilding efforts, are likely to be much higher. Funding pledged and delivered for Ebola Like the international response, contributions to fight the epidemic were slow to take off. Figure 1⇓ provides an overview of the total resources pledged and delivered to deal with the Ebola outbreak from August 2014 until 31 December 2014 according to OCHA’s financial tracking system as well as the amount requested. Because there is uncertainty about the dates at which pledges are actually paid in the tracking system, the lower line represents an optimistic estimate of actual transfer kag12@nyu.edu For personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe BMJ 2015;350:h376 doi: 10.1136/bmj.h376 (Published 3 February 2015) Page 1 of 5 Analysis ANALYSIS