Where did the Ebola money go?


Though almost $3 billion have been pledged “pledged to support the international response to the Ebola outbreak”, only $1 billion (about 40%) “has actually been paid,” according to a report by assistant professor of global health policy at New York University Karen Grépin. It’s like someone told the World Health Organization “you should have your money working for you,” but the WHO decided to do all the work and let the money relax. ‘Cause you send your money out there – working for you – a lot of times, it gets fired. You go back there, “What happened? I had my money. It was here, it was working for me.” “Yeah, I remember your money. Showing up late. Taking time off. We had to let him go.”

Too be fair, the Ebola cash is indeed showing up late – right now there aren’t even enough patients left for a clinical trial of experimental vaccines and drugs – but that’s because the WHO was too slow in asking it in the first place. In fact, it was a case of ‘too little, too late.’ Although the Guinean ministry of health notified the WHO of a “rapidly evolving outbreak” of Ebola in March – a week later the agency sent protective equipment and medical supplies to the country – , the presidents of Liberia, Sierra Leone and Guinea had to wait till August for the WHO to declare the epidemic a public health emergency of international concern before they could ask for $71 million – a figure they revised to $1.5 billion by November, showing that “international leaders have found it challenging to estimate the financial requirements to tackle this rapidly spreading outbreak.”

“The problem has not been the generosity of donors but that the resources have not been deployed rapidly enough,” Grépin wrote in the British Medical Journal. In fact, she found that “donors were quite generous, but the problem was delays. It took a very, very long time for donors to engage. WHO was not calling on donors to make pledges until late in the game. The international response has been called both too small and too slow and this may have contributed to the ongoing spread of the disease. Had the resources reached the countries in a timely fashion the epidemic would not have reached the scale it did. It’s unlikely it would have gotten so far.”

The largest donor has been the United States – pledging $900 of which 95% has been delivered – followed by the UK, the World Bank, and Germany, who have promised $307 million, $230 million, and $161 million respectively. However, Grépin estimates “that it took until at least mid-October before the affected countries received $500 million and until at least December before they got $1 billion. Since late September, international donors have pledged more to the Ebola response than has been officially requested by international leaders. Actual disbursement of funds, however, still lags behind the total amount requested.”

Grépin acknowledged that it’s not rare for donors to pledge large sums and then not quite follow through, but she claims that the real problem is that “existing contracting mechanisms are too slow” to solicit money and then tie it up as a “firm commitment;” that is, money that has been pledged and is likely to be disbursed. This problem has plagued the WHO for years, and while “the data do not allow the speed of response to be compared with that for other humanitarian crises, they do suggest that we need a mechanism to enable more rapid disbursement of funds to fight public health threats such as Ebola, such as a dedicated fund that could be rapidly deployed for any emergency.”