Getting ‘to zero’ in the fight against Ebola

This year’s Ebola outbreak has claimed the lives of more than 6,800 people, according to the World Health Organization. “If you leave a single case untreated and then if you let that transmission continue, it could explode again,” Dr. Jim Yong Kim, president of the World Bank, tells the NewsHour. Kim joins Judy Woodruff to discuss challenges of wiping out the disease.

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    Now an update on the Ebola outbreak in West Africa.

    As of yesterday, the World Health Organization reported nearly 18,500 confirmed cases in Liberia, Sierra Leone, and Guinea, with more than 6,800 deaths. And while a newly published study finds that the number of unreported, and therefore undercounted, cases may not be as high as once feared, health officials say that, to halt the outbreak, every infection must be traced to its source.

    Here to talk about that and more is the president of the World Bank Group, Dr. Jim Yong Kim. He is a medical doctor, and he has just returned from West Africa.

    Dr. Kim, thank you for being here.

  • DR. JIM YONG KIM, President, World Bank Group:

    Thank you, Judy. Thanks for having me.


    So you wrote while you were there that this is the worst epidemic you have ever seen. Of course, I guess, to many, that wouldn't be surprising, considering the numbers, but what did you see in West Africa?


    Well, when I say it's the worst, I spent a lot of my life fighting AIDS in Africa. And that was pretty bad, and drug-resistant tuberculosis.

    The reason this is so bad is because it is so deadly, and we have to get to zero. There's no getting almost to zero. Each one of the epidemics in the three countries started with a single case. And what we now know is — especially in this epidemic, is that if you leave a single case untreated and then if you let that transmission continue, it could explode again.

    I'm very, very worried about this, because we still don't have in place plans to get to zero in each of the three countries.


    So what is it going to take? You wrote — in the column that you wrote the other day, you said it's not just money, it's more local control over what's happening there.




    What do you see that needs to get done that isn't getting done?


    Well, let me tell you about two countries, Senegal and Nigeria. And I had a chance to talk with the presidents of both of those countries.

    In Senegal, they had one cross-border case. It was a Ghanaian student. And it took just about everything they had, at a cost of $1.3 million, and they had to do contact tracing; 78 people had contact with him. They had to provide food for them. They had to take their temperatures twice a day. And it was $1.3 million for the one case.

    In Nigeria, same thing, more than 200 physicians, more than 600 other health workers, 19,000 home visits for 19 cases. Now, just get that in your head, $13 million. We're going to have to do that in each of the three countries for all the cases in order to get to zero.

    That's a level of rigor and discipline that is very hard to get even in the United States. To do it in those three countries is going to be a challenge, but we have no choice. We have got to do it.


    It sounds impossible.


    It's not.

    And it's because the Senegal and Nigeria examples really gave us a sense that it is possible. But the health systems in those two countries are much more developed. So we now have to bring in experts who can on a day-to-day basis make the judgments. These are really virus hunters. These are the people who shut down the SARS epidemic.

    We now have them on board. And they're in these countries working. And they have to work with local people. We're hoping that one of the things we can do is to hire local people to be the contact tracers.

    And so while, on the one hand, we're doing all the work that you need to do from a public health perspective, we hope that it will also be an employment program and put some badly needed cash into the economy.


    What about the organization, just the idea of pulling it all together and making sure it happens, the follow-through? Is that in place in these countries?


    Not yet, but especially the U.S. and the U.K. have done a lot of fantastic work in putting some of the infrastructure in place.

    So, up until now, the idea has been, is there anything we can do to just take some of the heat out of the epidemic? Can we knock down in any way the rapid increase in the number of cases?

    We did that in Liberia. In Guinea, it's — the numbers aren't going up as quickly. In Sierra Leone, we're still in very rapid growth. So we have to on the one hand do all the things we need to do, safe burials, and just identifying people to slow down the rapid rise in the number of cases, but then, after you do that, you take on this next stage, which is every single case has to be traced.


    Talk about the World Bank's role in all of this. People think of the World Bank as a place that looks — it's economy-focused and you focus on developing parts of the world.

    And you have noted that, in these countries, there had been some economic advances made, but that this Ebola outbreak has set them way back.


    Well, just as an example, Sierra Leone in 2013, its GDP grew by 20 percent, among the highest rates in the world.

    And, in 2015, we think it's going to contract by 2 percent. So there were the discovery of minerals, for example, in Liberia. Despite the fact that the rubber industry had not come back from before a — the civil war, it was beginning to come back. There were mineral discoveries. Guinea, of course, has bauxite and iron ore.

    So, there were a lot of very positive signs. This has really set them back. But the bigger issue, Judy, is that we have to sit back and ask a deeper question: What if this weren't Ebola? What if it were an even worse virus? What if it were a faster-moving virus? What if it was pandemic flu?

    These are fundamental downside risks to not only the local economies, but to the global economy. And we didn't have a mechanism in place that would immediately disperse literally billions of dollars to tackle the epidemics in the way that we need to.

    So, now what we're putting on the table, the World Bank is one of the institutions that has to protect the global economy from these downside risks that are very real, but for which we don't have buffers. So, not only are we responding in these three countries, but we're now looking to the future and saying, what can we do to make sure that this spiraling of an epidemic out of control never happens again?


    So, can you make that assurance now?


    Not right now.

    But one of the things we're doing now — we just had a meeting at the Institute of Medicine, where we brought the people who led the smallpox response and other responses, H5N1, and we sat down and said, what would it take to build a system that would truly protect the world from an even more devastating pandemic?

    For example, if we had a flu outbreak that was as deadly as the one in the early 1900s, percentages of global population died in that particular outbreak. We need to be ready right now to respond much more quickly and much more effectively the next time Ebola or any other virus breaks out.


    But it sounds like you're saying you think it can be done?


    Well, we know it can be done. It is going to be extremely difficult. It's going to take everything we know about public health. It's going to take groups like the World Bank Group using our balance sheet.

    And the good news is that we're a bank. And so we can actually put our balance sheet to use in putting together innovative instruments, like insurance policies almost, that, when something happens, boom, it will fall into place.

    But, you know, we have been humbled by this, every single one of us.


    As the head of the World Bank, you're someone I have to ask about the segment we just — Jeffrey Brown just did that interview about what has happened in Russia, the collapse of their currency, the ruble, the effect of the falling price of oil.

    How worried are you and other folks who look at these issues about what's going on in Russia right now?


    We're worried. But contrary to what was said before, I think that we sort of could have seen this coming.

    The supply of oil had been going up for quite some time, and these prices do go up and down. We have seen this in the past. And in this particular case, there are winners and losers. And so, for example, even the countries that are dependent on remittances from Russia who are oil importers are going to see — are going to have problems with their economies.

    So it's a very complex picture. The currencies of Brazil, of Norway have also gone down. So it's not just Russia. But the Russia case is a little bit more dramatic than some of the others.

    Our role is to really think about what are the macro-fiscal measures that can be taken? We're especially concerned about the poorest countries. But if you look at other countries, for example, Indonesia, Indonesia is an importer. And, in this case, their price of oil is going to go down. They may be able to actually take off some of the fuel subsidies that they have been wanting to take off for quite some time.

    So the hope is that some good will come out of this in countries, for example, taking action now because it's easier to do, removing fuel subsidies, which will have a positive impact, we hope, on climate change.

    Now, the other part of it is that, if the demand for renewable energy goes down, then it makes it even more complex.


    Tough for some, but you're saying a possible opening for others.



    Well, we really have to watch this carefully. I mean, the situation is very worrisome right now in Russia.


    Dr. Jim Yong Kim with the World Bank, we thank you.


    Thank you.

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