World Bank launches ‘pandemic bond’ to tackle major outbreaks (Reuters)

Reuters
By Claire Milhench
June 28, 2017
 l
 l
 a
LONDON (Reuters) – The World Bank has launched a “pandemic bond” to support an emergency financing facility intended to release money quickly to fight a major health crisis like the 2014 Ebola outbreak.
KIM
World Bank Group President Jim Yong Kim delivers his speech during the Belt and Road Forum for International Cooperation in Beijing, China May 14, 2017. REUTERS/Lintao Zhang/Pool

 

 

 

 

 

 

 

 

 

 

The catastrophe bond, which will pay out depending on the size of the outbreak, its growth rate and the number of countries affected, is the first of its kind for epidemics. It should mean money is disbursed much faster than during West Africa’s Ebola crisis.

Ebola spread across the region in the early months of 2014. Michael Bennett, head of derivatives and structured finance at the World Bank’s capital markets department, said that if the pandemic emergency financing facility (PEF) had existed in 2014, some $100 million could have been mobilised as early as July.

In reality, money did not begin to flow on this scale until three months later, by which time the number of deaths from Ebola had increased tenfold.

“In the end about 11,000 people died in that pandemic and it’s estimated that the cost to the countries most affected – Guinea, Liberia and Sierre Leone – was about $2.8 billion,” Bennett said.

The PEF will offer coverage to all countries eligible for financing from the International Development Agency (IDA), the arm of the World Bank dedicated to the world’s poorest countries.

It covers outbreaks of infectious diseases most likely to cause major epidemics, including pandemic influenza strains; coronaviruses, including SARS; filoviruses, which include Ebola and Marburg; plus others such as Crimean Congo fever, Rift Valley fever and Lassa fever.

Bennett said the PEF as a whole would provide more than $500 million of coverage against pandemics over the next five years. This includes today’s $425 million transaction, comprising $320 million raised through the bond market and $105 million through swaps transactions.

The transaction was oversubscribed by 200 percent, attracting interest from dedicated cat bond investors, asset managers, pension funds and endowments, the World Bank said.

For the pandemic bond, the World Bank will pay bondholders a coupon that replicates an insurance premium plus a funding spread, in return for a payout if the bond is triggered.

“If a trigger event occurs, instead of repaying the bond in full, some or all of the principal is transferred to the PEF trust fund,” Bennett said. “So essentially the investors are acting like insurance companies.”

Under the swaps transactions, the swaps counterparty pays out if a trigger event occurs.

“The objective of offering the risk in both forms is that the bonds and swaps appeal to different types of investors, and therefore … we are creating the broadest possible investor pool for this risk,” said Bennett. That helped drive down prices. 

A replenishable cash window available from 2018 will provide funding for diseases that may not meet the activation criteria for the bond, whilst future donor commitments may be used to purchase additional coverage from the market.

Munich Re, which helped develop the insurance component of the PEF in conjunction with Swiss Re and catastrophe risk modeller AIR Worldwide, said pandemics were among the most likely uninsured risks to occur.

The annual global cost of moderately severe to severe pandemics is estimated at roughly $570 billion, or 0.7 percent of global income, the World Bank said.

Effects of Response to 2014–2015 Ebola Outbreak on Deaths from Malaria, HIV/AIDS, and Tuberculosis, West Africa (Emerging Infectious Diseases)

Emerging Infectious Diseases
By Alyssa S. Parpia, Martial L. Ndeffo-Mbah  Natasha S. Wenzel, and Alison P. Galvani
March 1, 2016
Author affiliations: Yale School of Public Health, New Haven, Connecticut, USA
 

 

Abstract

Response to the 2014–2015 Ebola outbreak in West Africa overwhelmed the healthcare systems of Guinea, Liberia, and Sierra Leone, reducing access to health services for diagnosis and treatment for the major diseases that are endemic to the region: malaria, HIV/AIDS, and tuberculosis. To estimate the repercussions of the Ebola outbreak on the populations at risk for these diseases, we developed computational models for disease transmission and infection progression. We estimated that a 50% reduction in access to healthcare services during the Ebola outbreak exacerbated malaria, HIV/AIDS, and tuberculosis mortality rates by additional death counts of 6,269 (2,564–12,407) in Guinea; 1,535 (522–2,8780) in Liberia; and 2,819 (844–4,844) in Sierra Leone. The 2014–2015 Ebola outbreak was catastrophic in these countries, and its indirect impact of increasing the mortality rates of other diseases was also substantial…(read full article)

Unreported Cases and Asymptomatic Infection in an Ebola “Hotspot” (Conference on Retroviruses and Opportunistic Infections)

Conference on Retroviruses and Opportunistic Infections
February 22–25, 2016
Author(s): 

Eugene T. Richardson1; J. Daniel Kelly2; Mohamed B. Barrie3; Annelies W. Mesman3; Komba Quiwa3; Sahr Karku3; George Rutherford2; James H. Jones1; Megan Murray4; Paul Farmer4
1Stanford Univ, Stanford, CA, USA;2Univ of California San Francisco, San Francisco, CA, USA;3Partners In Hlth, Freetown, Sierra Leone;4Harvard Med School, Boston, MA, USA

X
Abstract Body:
 X

Evidence for asymptomatic Ebola infection is limited to the extent that, during the 2013-15 outbreak, it was not considered epidemiologically relevant to published epidemic models or projections of intervention effects. We conducted a cross-sectional IgG serosurvey in an Ebola ‘hotspot’ village in Sierra Leone, eight months after reported transmission ceased in that location. The surveyed village had a population of approximately 800 individuals distributed among 110 households. Throughout the entire outbreak, there were 25 cases (18 deaths and 7 survivors) reported by the District Ebola Response Center.

We sampled a total of 227 individuals in 30 of 31 previously quarantined households in the village. We assessed anti–glycoprotein IgG responses to Zaire Ebola virus by means of a commercial ELISA kit (Alpha Diagnostic International [ADI]), according to the manufacturer’s instructions, with plasma diluted at 1:200. Optical density was read at 450 nm (subtracting OD at 630nm to normalize well background) on a ChroMate 4300 microplate reader. We used Welch’s t-test to determine if mean antibody concentrations differed by exposure history. To discriminate between positive and negative IgG responses (cutoff), we used the mean concentration for individuals without direct contact with a confirmed case plus three standard deviations. We then performed a log-binomial regression using this seropositivity cutoff as the dependent variable and gender, age, occupational activity, and schooling as predictor variables.

We identified an antibody concentration cutoff of ≥ 1.7 U/mL (roughly equal to 5.1 micrograms per mL).  All 7 documented survivors demonstrated positive responses (range 2.1 – 6.3 U/mL). Plasma IgG was positive in an additional 30 of 227 quarantined individuals not known to have Ebola virus disease (Figure 1), 27 of whom denied being symptomatic during the period of active transmission in the village. Only having a higher level of education was significantly associated with seropositivity.

This is the first systematic exploration of asymptomatic infection in an Ebola ‘hotspot.’ These data support the hypothesis that the actual number of infections in the 2013-15 outbreak in West Africa is significantly higher than the reported cumulative incidence. The phenomenon of asymptomatic infection has implications for the management of future Ebola outbreaks, as well as for the definition—and treatment—of survivors.

2014-2015 West Africa Ebola Crisis: Impact Update

The World Bank
May 10, 2015

KEY FINDINGS

This update presents the World Bank’s final analysis of the economic and fiscal effects of the 2014-2015 West African Ebola epidemic and commodity price shocks across the three most affected countries of Guinea, Liberia, and Sierra Leone.  In relation to the Bank’s April 2015 update, this report provides an updated overview of the status of the three economies. 

Summary. The overall impact of the Ebola crisis on Guinea, Liberia, and Sierra Leone has been estimated at $2.8 billion ($600 million for Guinea, $300 million for Liberia, and $1.9 billion for Sierra Leone). This includes the shocks in 2014 and 2015, and the projections for 2016 as the economic impact is outlasting the epidemiological impact. The shock has been worsened by the large decline in the world price of iron ore and other commodities, and specifically for Sierra Leone, corporate governance issues in mining.

  • The economic and fiscal impact has outlasted the epidemiological impact due to severe shocks to investment, production, and consumption throughout the region, coupled with commodity price shocks. The mortality from the pandemic of those infected has been 60 percent. The mortality per capita has been 5 per 10000, and the GDP impact per capita has been reduced by an average of $125 per person in the three countries.
  • The decline in the international price of commodities has impacted the three Ebola countries. Prices of bauxite, iron ore, and gold have declined by 30 to 60 percent compared to their peak values in recent years, exacerbating the Ebola impact. The management of volatility has been challenging for the three countries, especially in light of the adverse effects on fiscal revenue from the commodity price shortfall.
  • Mobile phone surveys conducted during the pandemic convey a pernicious effect on households and labor markets including significantly higher unemployment, lost incomes, lower schooling, and less food consumption, which will create substantial challenges. In Liberia, there was a 40 percent decrease in those working since the onset of the crisis (particularly high for women who were working pre-crisis). Close to 10 percent of Guinean households have withdrawn their children from school, with the large majority citing Ebola as the main factor. In Sierra Leone, 9,000 wage workers and 170,000 self-employed workers outside of agriculture are no longer working, while the recovery process starts.  
  • Economic recovery will be slow due to significant contraction in GDP during the crisis, and will be exacerbated by the global decline in commodities prices. Real GDP growth for 2015 is projected at 0.3 percent for Liberia, 0.1 percent in Guinea, and -21.5 percent for Sierra Leone.
  • The overall fiscal impact of the pandemic has been high, leading to declining revenues, increasing Ebola-related and health expenditures, and exacerbation of fiscal deficits. The deficits in 2015 are estimated at 8.5% of GDP in Liberia, 9.4 % in Guinea, and 4.8% in Sierra Leone.
  • Large and timely aid inflows have been successful in cushioning the fiscal impact of the pandemic in 2015 amounting to 8.7 percent in Liberia, 1.3 percent in Guinea, and 5.4 percent in Sierra Leone.
  • Despite disruption to supply chains as a result of the Ebola crisis, inflation was contained in high single digits in the three economies due in large part to monetary management, resilience in the agricultural sector, and low international prices for fuel and food.  

IMPACT ON GDP GROWTH AND INFLATION in Guinea, LIBERIA, and Sierra Leone

  • Liberia GDP Growth:  Real GDP growth slowed to 0.7 percent in 2014, from 8.7 percent in 2013 (Table 1a), reflecting the twin shocks of Ebola and lower commodity prices. The economy has been very slow to recover, with stagnation in the mining and services sectors. Growth is projected at 0.3 percent in 2016. Over the medium term, the boom in the services sector, together with the restart of public and private investment in infrastructure, will contribute to faster growth. Risks stem from adverse developments in the global economy linked to slower growth in China and possible depressed rubber and iron ore prices.
  • Guinea GDP Growth:  Real GDP growth in 2015 was 0.1 percent, compared to a pre-Ebola forecast of 4.0 percent (Table 1b). Services had very low growth, while mining contracted, and only agriculture displayed some resilience.  In 2016, growth is projected to accelerate to 4.0 percent. Agricultural production should continue to grow at the rapid pace of the previous years, and manufacturing and services should benefit from the resumption of international and domestic travel and trade and the improved electricity supply in Conakry. There are risks due to uncertain policy in the mining sector, low international mineral prices, and investor aversion.
  • Sierra Leone GDP Growth:  GDP growth of 4.6 percent in 2014 was driven by expanding iron ore production, just as in 2013 when real GDP increased by 20.7 percent (Table 1c).  Non-iron ore GDP growth in 2014 slowed sharply on account of the Ebola outbreak to 0.8 percent, from 5.3 percent the previous year.  Real GDP in 2015 is estimated to have contracted by -21.5 percent. This is mainly due to the shutdown of iron ore operations and a nascent recovery in non-iron ore GDP led by agriculture, and buoyed by a partial resumption in services especially construction, including the resumption of donor financed capital projects.  The recovery is expected to be very slow in 2016 with a projected 0.1 percent growth.  Risks relate to the global outlook with a focus on China.

FISCAL ANALYSIS: REVENUES and EXPENDITURES

  • Fiscal. Ebola and lower commodity prices have had adverse fiscal effects on the three countries leading to falling revenues, increased Ebola-related spending and widening deficits.  The deficits in 2015 are estimated at 8.5% of GDP in Liberia, 9.4 % in Guinea, and 4.8% in Sierra Leone.  In all three countries, government revenues declined across the board, including direct taxes on companies, VAT receipts, and indirect taxes, reflecting the generally lower levels of economic activity and reduced levels of compliance. The decrease in private and foreign investment forced governments to step in. Current transfers increased, particularly to finance health care workers and recurrent expenditures. The decline in investors’ confidence put pressure on scarce budgets in all the Ebola countries. Financing gaps for the three core countries reached more than $ 600 million over the two years. The deficits as a share of GDP are estimated at 9.4 percent in Guinea, 8.5 percent in Liberia, and 4.8 percent in Sierra Leone in 2015.
  • Aid. Much of the impact of the pandemic and commodity shocks was softened by the relatively large aid flows.  In Liberia, grants reached close to 19 percent of GDP for 2014 and 2015, while in Sierra Leone, it was close to 10 percent and in Guinea, it was about 5 percent. Grants helped finance the deficits, especially for Liberia, but it will be unlikely to have similar levels of aid in 2016.

   Screen Shot 2016-11-01 at 10.55.17 PM.png

This update was prepared by a World Bank team comprising Ali Zafar (Senior Economist, MFM), Cyrus Talati (Senior Economist, MFM) and Errol Graham (Program Leader, AFCW1) under the strategic direction of John Panzer (Director, MFM) and Seynabou Sakho (Program Manager, MFM). We would like to thank Yanina Budkin (Senior Communications Officer, ECRGP) for her guidance. The work is part of MFM’s ongoing macroeconomic monitoring efforts since the onset of the Ebola crisis in the three countries.  The team is grateful for recent discussions with the Ministers of Finance and key government officials in Monrovia, Conakry, and Freetown. The team is also grateful to representatives of international organizations, including WFP, WHO, IMF, and UN and government officials from both central and line ministries. 

UN Establishes Ebola Recovery Tracking Initiative

New York, 10 November 2017

In response to the Ebola crisis, donors generously pledged billions of dollars to support recovery efforts in Guinea, Liberia and Sierra Leone. In July 2015, the United Nations hosted the International Ebola Recovery Conference, convening governments, multilateral and philanthropic partners to solicit their support to both end the Ebola outbreak and to implement the national recovery strategies presented by all three affected countries at the conference.  At the conference, donor governments, multilateral organizations, and private foundations pledged $4.5 billion.

In 2017, the United Nations established the Ebola Tracking Recovery Initiative in partnership with the governments of Guinea, Liberia, and Sierra Leone.  This tracking effort is currently led by the United Nations Office of the Special Adviser for Community Based Medicine and Lessons from Haiti, with the support of the United Nations Development Programme.  The methodology used for this initiative was first developed by the United Nations Office of the Special Envoy for Haiti in response to the 2010 earthquake in Haiti.

Every effort is being made to encourage all donors who have pledged support to affirm their commitment and provide regular updates detailing their disbursement, including how their disbursements support the national plans.