Managing the Ebola Crisis

An Interview with Anthony Banbury, United Nations Assistant Secretary-General for Field Support


The Ebola outbreak in West Africa presented an enormous global challenge. Although more than 26,000 suspected or confirmed cases and 11,000 Ebola-related deaths were recorded as of May 2015, the crisis could have been far worse had governments, aid agencies, the private sector, and major foundations not contributed their time, money, goods, services, and expertise—and had not the UN stepped in to manage the crisis.

Anthony Banbury was appointed head of the United Nations Mission for Ebola Emergency Response (UNMEER) in September 2014. Under his leadership, UNMEER provided the operating framework, unity of purpose, and coordinated action needed to rapidly end the global health emergency. He and his staff had to set up operations in the three most heavily affected countries—Guinea, Sierra Leone, and Liberia—as well as recruit staff, work with the local governments to start the new mission, put various means of transportation in place, collect and analyze information, conduct a needs assessment, and create a crisis management plan. All of these activities had to be done simultaneously—and quickly. But the ongoing human and economic damage caused by the outbreak was powerfully motivating.

Banbury recently sat down with Trish Stroman, a partner in BCG’s Washington office and a core member of the firm’s Health Care practice. Edited excerpts from that conversation follow.

First off, Tony, thanks so much for being here with me today. I really appreciate it.

It’s absolutely my pleasure.

You were named the UN’s special representative of the secretary-general for Ebola at the height of the crisis, and at that point, in many ways, the international response had already failed. What were some of your early priorities?

The highest priority was to try to understand and figure it out. What was the true nature of the crisis? What needed to be done to end it? In a crisis response, there’s such a high propensity to act, and action is required. But in order for the action to be effective, you need that understanding. We had to understand and act at the same time. We had to gather information, assess, analyze, and plan while acting and pursuing results on the ground.

And you’ve done this before: you’ve worked on many emergency humanitarian efforts. What was different in your mind about Ebola?

One, it was a global health emergency, not a sudden-onset natural disaster. In a disaster response, the damage is very bad—or can be—but it happens quickly, and it’s over. Then it’s really about picking up the pieces. The extent of the damage and what’s required can be ascertained fairly quickly. In the Ebola response, not only did we have very poor information about the true extent of the disaster, it was getting worse every day. We knew that as we started to deploy and figure out how to end it that in fact tomorrow would be worse than today, and the day after would be worse than the day before.

There was also the fear element with Ebola, the uncertainty. In an earthquake response, you may be somewhat afraid of an aftershock, but there’s very little that inhibits relief workers from rushing to the disaster zone. In the case of Ebola, there was a lot of fear and uncertainty—of not knowing—and that made it hard for us to recruit people.

Can you talk a little bit about why, within the UN in particular, the model needed for Ebola had to be different from what was used in other humanitarian responses?

Time was so much our enemy. In any disaster response, it’s always important to get the aid in as quickly as possible, but here the math was so inexorably working against us: the exponential growth of the case load. The way to end Ebola was to get people in isolation. That meant Ebola treatment, its beds, teams to staff the units, et cetera.

But when we started the response, the outbreak was speeding ahead so fast, and we were starting from such a dead stop that there was a risk. Real risk. The numbers, because of the rate of growth, were going to be such that we would never be able to bend the curve. And the director of the Centers for Disease Control and Prevention, Tom Frieden, said there might be 1.4 million cases by mid-January. We could never have built that many beds, so we didn’t know how we would turn it around. There was such, on our part, a propensity for speed, decisions, and actions even if they were imperfect and not thought through in their full dimension. We did not have the—it wasn’t a luxury—the ability to wait. We had to just move without information, without knowing, without having every aspect of the planning worked out.

Can you talk about some of the other challenges that you faced in setting up a new mission, as you did, and in dealing with the international community?

What was really missing when the UN Mission for Ebola Emergency Response, UNMEER, was established was a crisis management approach. There was a lot of work being done, some of it very good, by United Nations Children’s Fund (UNICEF), World Health Organization (WHO), Médecins Sans Frontières (Doctors Without Borders), and governments, but those activities were really isolated actions of good intentions that may have had some positive effect where they were occurring. However, there was no overall approach to ending the crisis. It was like, what has to be done to end Ebola? No one had identified that and then put in place the plan to make it happen.

And so for UNMEER, that was our main goal. It became apparent that that was what we really needed to do, and I think, in the end, that was our most important contribution.

So many people were affected by this crisis. Are there particular stories or cases that stick in your mind that might make the situation real for people who weren’t there?

There were so many, but there was one case in particular in Sierra Leone, where we went to visit an Ebola treatment unit. The facility, which was very well run by the Red Cross, was next to a graveyard, where the graves were marked with names and the dates of birth and death. We could tell that there were a lot of people who’d died in the prime of their lives. Ebola really hit a lot of people in their twenties and thirties, which, of course, was very sad. And it was quite reasonable to expect that many of them had spouses and children. But what was even more heart wrenching were all the empty graves that had already been dug. Big empty graves with the loose dirt next to them ready to be filled. And we had just visited the Ebola treatment unit, so we knew that there were people in there who were going to fill those graves. But there were also people in the community—in the town that we had come through—who were healthy on that day but were going to fall sick the day after or the day after that. That was very hard to deal with, but it was also very motivational.

Tony, many people say that we were almost lucky this time around, which is hard to imagine. In the end, however, Ebola wasn’t that contagious. It hit in places that weren’t necessarily the most connected to the rest of the world, so transmission out of West Africa happened in a very limited way. What’s your advice? What do you think we can we do to be more prepared the next time around—in particular, if we’re not so “lucky”?

The most important thing is to prevent the next crisis of this nature—not simply to prepare for it. And that means good community-based surveillance and early detection. Because when we completely end this Ebola outbreak in humans, the virus will still exist out there in bats or elsewhere. It certainly can come back into the human host at some point. And if it’s not Ebola, it will be something else. What’s important, though, is that it is detected early and responded to quickly. And clearly that’s where the international community failed this time.

We’re much better off focusing on the early end with prevention. And that, I hope, is where the people now looking at this will focus their attention and the eventual resources.

Thank you, Tony.

Thanks very much.

About Anthony