New phase of the Ebola battle

The JSDF is on the ground in Liberia, helping in the fight against the Ebola outbreak that has devastated western Africa. The JSDF in this case is not the Japan Self-Defense Forces, but the Japan Social Development Fund, a trust fund that operates through the World Bank and which announced Feb. 25 the launch of an effort to battle the psychological effects of the virus.

That announcement preceded by a day the announcement by the U.S. military that it is ending its mission to Liberia to help fight the disease. This two developments are welcome, but we should remind ourselves that this is merely one victory in a much wider war.

Since it began over a year ago, the epidemic that has spread throughout West Africa has become the worst Ebola outbreak in history. The World Health Organization reports nearly 24,000 cases and more than 9,600 deaths, although official numbers are thought to be low.

The countries of Guinea, Liberia and Sierra Leone have borne the brunt of the outbreak; nearly half the deaths — about 4,000 — have occurred in Liberia alone. This outbreak is the first to reach the status of an epidemic, overwhelming local health care systems and exploiting the seams at which modern societies intersect with traditional African cultures.

Ritual ceremonies for treating and burying the dead have proved to be deadly transmission belts for the disease in large cities, and uneducated populations have reversed the cause and effect of health care workers and disease outbreaks. Many of them believe that health care providers are spreading the disease, rather than containing it.

The initial international response to the outbreak was slow, with some observers warning of a global outbreak in the absence of a focused, forceful effort. Those warnings mobilized international opinion (creating some absurd threat scenarios as well). After some initial stutters in the global efforts to contain the Ebola, the spread of the disease seems to be slowing. The World Health Organization reported just 99 cases in one week in January, the lowest weekly count since June.

Liberia has reported just 15 new cases in the last three weeks, while Sierra Leone, which had as many as 500 cases a week in December, reported just 65 in the week before last.

Veterans of these campaigns are not declaring the battle over, however. In April of last year, Guinea went a month without a single new reported case, prompting some to claim that a corner had been turned. Soon after, however, there were new outbreaks. In the week before last, Guinea recorded just 30 cases — unfortunately, that is an uptick from the 20 cases reported the week before that.

The slowdown has meant that many of the new beds built for victims are now empty, a welcome development that has prompted the U.S. military to pull up stakes and return home. The mission, launched five months ago and which peaked with more than 2,800 troops, was originally anticipated to last a year, during which time soldiers built treatment centers, set up mobile testing labs and provided other forms of support.

Their efforts and those of other contributors helped overcome a shortage of beds that was one of the most significant bottlenecks to an effective response to the outbreak.

In September 2014, the WHO reported that Sierra Leone could meet just 35 percent of the need for beds, while Liberia was meeting only 20 percent of its demand. Perhaps the most significant contribution of the U.S. forces was training some 1,500 local health workers.

While the signs are promising, health professionals’ optimism is tempered by knowledge that the rainy season will soon start in West Africa and that the flooding that invariably follows will make travel into rural areas difficult if not impossible. Officials warn that failure to get the epidemic under control before the rains begin could mean another year of the outbreak. As one official conceded, experts have “repeatedly underestimated this pathogen.”

While getting to zero remains a distant hope, there is a need to begin the next phase in the response. That is the focus of Japan’s effort, a $3 million, three-year project in conjunction with Liberia, the World Bank and the Carter Center that will tackle psycho-social health. The program, intended to address mental health needs and help build social resilience, is anticipated to treat 18,000 Liberians.

The JSDF was established in 2000 by the Japanese government and the World Bank as a mechanism to provide assistance to the poorest and most vulnerable groups in World Bank eligible countries. According to the last available report for the fund, which was filed at the end of June 2013, Japan has contributed $660.5 million since establishment of the JSDF. A total of 111 grants were under implementation worth $260 million, and 330 grants in 85 countries had been executed in the 13 years since the fund was established.

These are not astronomical sums, but they are significant to the recipients. As Japan debates its role in the world, the experience in Liberia should remind us of the need to weigh the value of both JSDFs — and initiatives similar to the lesser known of the two — and not just the better known and more visible program that bears that acronym.