As we are experiencing now with the COVID-19 pandemic, an infectious disease outbreak can have a dramatic effect on economies in both developed and developing countries. In the latest World Economic Outlook, the International Monetary Fund (IMF) projects that the current pandemic will shrink the global economy by 3%, with regions such as Sub-Saharan Africa being hit particularly hard. Some countries in this region, such as Liberia, are only just recovering from other outbreaks, including the 2014 Ebola outbreak in West Africa.
Of the three countries (Guinea, Liberia and Sierra Leone) affected by the 2014 Ebola outbreak, Liberia was the most impacted in terms of number of cases, number of deaths and scale of economic losses. In 2015, Guinea, Liberia and Sierra Leone lost a cumulative $2.2 billion in GDP, affecting not only the macroeconomic situation but also food security and health care services.
In this blog post, we share information about Liberia’s efforts to recover from the Ebola outbreak, including information presented by Bernice Dahn, Vice President of the College of Health Sciences at the University of Liberia, at FHI Clinical’s dinner event held at ASTMH (not officially affiliated with ASTMH).
New Public Health and Research Capacity in Liberia
National Public Institute of Liberia (NPHIL)
Liberia’s leadership recognized the need for improved health capacity to prevent a similar impact during future outbreaks, resulting in establishment of the National Public Health Institute of Liberia (NPHIL) and Partnership for Research on Ebola Vaccines in Liberia (PREVAIL).
NPHIL was modeled after the U.S. Centers for Disease Control and Prevention (CDC). It is tasked with improving national core capacity for preparedness and response and providing leadership, direction and coordination for evidence-based public health and medical research in Liberia. Its core functions include:
- Prevention, detection and response to disease outbreaks and public health threats
- Active disease surveillance
- Public health diagnosis (labs)
- Epidemic preparedness and response
- Public health and biomedical research
- Environmental and occupational health
- Global health
Partnership for Research on Ebola Vaccines in Liberia (PREVAIL)
In situations where health and research capacity is limited, public-private partnerships contribute much-needed resources and are essential to ending epidemics. During the Ebola outbreak, these collaborations involved the Liberian government, foreign governments (including the U.S. government) and other international partners. PREVAIL was established out of the partnership between the U.S. Department of Health and Human Services and the Liberian Ministry of Health (MOH).
Within 12 months of being established in 2014, the PREVAIL team rapidly opened four sites and initiated three studies on Ebola therapeutics and vaccines. The partnership has since shifted focus from an emergency response to a sustainable, long-term research network with an expanded scope to include other diseases of public health importance in Liberia.
The PREVAIL Executive Committee includes:
- Liberian MOH
- NPHIL
- University of Liberia
- JFK Memorial Medical Center
- US National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases (NIAID)
- US CDC
- World Health Organization (WHO)
Since the beginning, FHI Clinical has played an important role in PREVAIL’s Finance Management Center, overseeing the financial responsibilities of the network. Recently, this role was expanded to include the management and maintenance of the PREVAIL network operational support. The goal is to support PREVAIL research while the network advances toward long-term self-sustainability. Over time, the FHI Clinical PREVAIL team will help establish an ongoing, proactive clinical research enterprise led by Liberian staff working to strengthen health policies and practices, improve overall health and respond to future outbreaks.
Research Capacity Training
To help equip Liberia with the ability to respond to ongoing health issues and potential outbreaks, an FHI Clinical team also contributed to training for local leaders in Liberia’s clinical research infrastructure network, including leaders from the NPHIL and the Liberian Institute of Biomedical Research, University of Liberia students and faculty, Liberian MOH officials and PREVAIL staff members. A U.S. government contract funded this training, which covered the basics of clinical research, including designing studies and writing protocols, Good Clinical Practice (ICH-GCP) and the operational nuts and bolts of clinical trial implementation.
At the same time, new public health programs have been initiated at the University of Liberia to equip emerging public health professionals with the required knowledge and skills to address important public health issues.
Sustainable Research Capacity
With the increased research capacity and learnings from the Ebola outbreak, the country is in a much better position to address other public health needs, including neglected tropical diseases (NTDs), emerging and zoonotic infectious diseases, HIV, tuberculosis, malaria, the increasing prevalence of non-communicable diseases, and now, COVID-19.
NPHIL, the University of Liberia and PREVAIL are all involved in various studies focusing on these public health priorities. They share common networks that span the globe, including the NIH Laboratory of Malaria Immunology and Vaccinology (LMIV) for the Propel Malaria Project, Joint West Africa Research Group (JWARG) Austere Environment Consortium for Enhanced Sepsis Outcomes, EcoHealth Alliance PREDICT (conducting research on wildlife that carry zoonotic diseases) and the VectorLink Project.
These networks provide the foundation for research that will address ongoing and novel outbreaks in Liberia and the surrounding areas, and FHI Clinical is proud to contribute to these projects and to the maintenance of the country’s research capacity.
