 in West Africa and beyond, we are going to feature in this some slides that David has prepared. Those slides, if you are coming on online, you can go to the CSIS.org site or to smartglobalhealth.org site and go to the event page for this today's event on Ebola Economic Impacts and you can click on that and pull up the slides and roll through those as David is presenting them. I'll say a few words of welcome and context for this and then introduce our two speakers. Before that, I want to highlight that on December 16th, we will have here at 3 p.m., 3 to 5 p.m. on December 16th, we'll have a session focused upon the efforts to accelerate the development of vaccines, therapies, diagnostics for use in the fight against Ebola. We'll have Dr. Tony Fauci from National Institutes of Health here with us and we'll have Montsef Slaoyee from GSK and likely one to two other folks coming. So please join us if you can. I want to thank my colleague Sahil Angelo for his help in pulling this event together and Travis Hopkins for helping us organize the technical side of things today. The IMF and the bank have played a very critical leadership role in responding to this unprecedented crisis that Ebola's created in this year and it's been something that has derived in part from the analytics, special analytic capacities that these two institutions bring to the table but also the special leadership that we've seen from both Jim Kim and Christine Lagarde as the crisis has unfolded and the response and mobilization has taken shape. Just to illustrate, the World Bank has today an emergency response commitment of up to 500 million has dispersed over 117 million and has also put in place 450 million in IFC commercial financing for use in trade, investment, employment and the recovery phase. Actually that 450 in the near term emergency phase and 200 million in the recovery. IMF crisis lending was announced in September of 130 million to cover the financing gap and at the G20 this past weekend announcement of a further $300 million in concessional loans, debt relief and grants. These are integral components, these commitments have become very integral components of the international response combined with the very sizable commitments made by the United States, by the EU, by the UK and others and I think it's a recognition that has emerged from the leadership of both institutions of the dire need for emergency stabilization and also looking downstream to recovery in both of their outlooks and a recognition of the special frailty of these states and their economies. The economies as we'll hear in the presentations, the economies have shown growth and promise in these last several years but it's easily reversed and it's fragile and the prospect of major decline continues to loom and that's something we wanted to begin to delve into today. And so it's been I think a very encouraging that the IMF and bank have both brought their special assets, their analytic capacities to the fore and that David and Abebe have been willing to join us here today. Just one other comment about the G20 this past week, Jim Kim was there joined with the UK Prime Minister Cameron, President Obama, Christine Lagarde from IMF. Ebola was put on the agenda as an item despite resistance to that. It was entered into the communique. It demonstrated the resolve to make sure that this was understood as a crisis with a significant economic and global economic component and meaning. And it was interesting too that Jim Kim in particular put a focus on trying to combine the idea of a pandemic and the economic risks associated with that and tabling the idea of a special pandemic facility, of a pandemic relief fund built on an insurance model that might tap bond markets in the future and that's something that's now in active development in the next six to 12 months, but has been put on the table as a topic of discussion and show some promise. We're still in a highly uncertain phase. We'll hear more about that. The epidemic itself remains quite difficult to predict and how it will be contained or will it spread and the downstream knock on effects, which is the subject here really on the economic side and the implications for governance and basic stability. These are all subjects of considerable debate and that's why we've asked David and Abebe to come and present their outlook to us. David's a senior economist in the chief economist office for the Africa region of the World Bank. He was one of the principal authors of the World Bank report that was first issued in the first week of October and as I learned from David today is coming out and published form this week today. So congratulations on that. He holds a PhD in economics from Harvard University, has been involved across multiple regions within the bank working on a range of impact evaluations in agriculture, education, health, social protection, all of the sort of sectors that come into play here in this particular problem set that Ebola poses for the three principal regions in question. Abebe Szilassi is the deputy director of the IMF's Africa department and comes with a special expertise in background in crisis management. He led the teams working on Portugal and South Africa as well as the regional economic outlook for sub-Saharan Africa. 2006 to 2009 was the IMF resident representative in Uganda and prior to that worked in the government of Ethiopia. So what we're going to do here this morning is David's going to lead off with his presentation and he'll walk us through a number of slides that he's kindly prepared for that and then I will turn to Abebe to offer his remarks, his prepared remarks. Then we'll start a conversation and we'll move fairly rapidly to engage those of you who are here for comments and questions. So welcome, David. Thank you so much, Abebe. Thank you so much for being with us this morning. Floor is yours, David. Thanks so much. Thanks to Steve and to CSIS for putting this together and I'm looking forward to hearing your comments. I just want to set the stage this morning in terms of the latest information that we have on the economic impact of the Ebola epidemic. Obviously the first concern when we think about the Ebola crisis is the sickness and the mortality that come along with this and that's the first tragedy. But unfortunately it's really just the first of many scars that the epidemic leaves in its wake and although sometimes it may feel a little bit cold to be thinking about the economic impact in the context of such a health tragedy, in fact this economic impact that we're talking about this morning has a very, very human face. We're talking about children missing meals and women and men unable to provide for their families a very real effect beyond just the impact on health. So if you've been following this at all, you'll be familiar with this concept that most of the economic impact of the Ebola epidemic comes not from the direct health impacts but rather from what they call aversion behavior. So the health impacts are principally how we estimate the economic impact of many other health challenges. So for example with malaria, tuberculosis, with child diarrhea, the way we figure out the economic impact is we count how many people get sick and how many people die and how much time they lose from their jobs, their places of employment, their fields and then we add that up and we get the economic impact. Ebola is completely different. It's much more similar to SARS or to HIV in its early days in that regard. And what this, the way this translates is that the vast majority of the economic impact comes from people taking action to avoid any exposure to the epidemic. So this aversion behavior includes both rational action, right, so where it might be prudent to avoid going to certain places or doing certain things where you have direct exposure to fluids of someone who's infected and also behaviors that don't make as much sense. For example, canceling a safari in South Africa or Kenya, which is, you know, as far from the outbreak as Europe. And so these both, these all fall within the aversion behavior and rational or not rational, they all have economic impacts. So the World Bank has economists on the ground and field teams on the ground. And the first thing that they've done in trying to figure out these economic impacts is try to look at a number of leading indicators. So data in the quality of data in these countries absent the Ebola epidemic was pretty sparse. And so you introduce the Ebola epidemic, it's much more difficult to gather data. And so all of these estimates should be taken with a significant grain of salt. But that said, what we see is very clear. For example, if you look in Sierra Leone, visitor arrivals going into the height of, or at least the, you know, the beginning of the height of the epidemic in July and August, you can see the visitor arrivals have basically plummeted. This isn't just tourism. These three countries don't have large tourism industries, although they've been working on that. But this is all kinds of travel. This is trade. This is industry mining. Likewise, in terms of internal travel, so internal trade of which there's a significant amount, we have in Sierra Leone significant drop in diesel fuel sales volume. We see the same kinds of things in Liberia and Guinea. Likewise, if we look at construction, which is a significant leading indicator in the economy, we see huge drops. And so Liberia cement sales, you can see them here over a number of years. And just over this second half of 2014, once again, they've dropped majorly. And then likewise with the cement sales in Sierra Leone, we see the exact same pattern. So there's a huge drop in industry here. And this is completely disproportionate to the number of sick and the number of dying. In fact, so when we initially worked on these economic impacts, we started doing this work adding up, you know, the number who passed away from Ebola. And in terms of the total labor market, it's actually not a very big number. It's a tragedy, obviously, for those individuals in their households and communities. But really, these numbers that we're seeing in the economy are completely disproportionate to the actual numbers that are directly affected by the disease. So over the last couple of months, a team at the World Bank has been gathering data via a telephone survey in Liberia. So there was an ongoing household survey in Liberia and the household level enumerators weren't able to keep going around, but they had stored a number of telephone numbers. And so they've been calling households around Liberia to get a sense real time of the impact of the epidemic. So these numbers that I'm about to show you are just we're just released this morning and they come up as late as about two weeks ago. And so among those who were working in early 2014, including working in agriculture, so that's a lot of people just, you know, working on their own farm. So you can see at baseline that top row, you can see the blue are the people in the wage sector, the red are people in self employment, and the green are people working in agriculture. And then you can see round one, which was in October, you can see a significant drop in the wage sector and then also a very large drop in self employment. Agriculture seems to be a bit more resilient and then 42% of those people not working at all. And so when you think about self employment, the thing to think about, you have a lot of petty traders, a lot of people who are sort of moving around Sierra Leone selling rice, taking it from rural areas to urban areas and other similar work. And then in round two, when we're getting up to early November, we see, again, a more exacerbated pattern of the same. And so the wage sector continues to be affected. That's a relatively, you know, that's a lot, part of that includes civil servants, but then self employment, especially taking a massive hit. Then so one of the other questions that was asked was, why aren't you working? And so the, again, like the majority of these people, the place of business has been closed due to Ebola was the reason that they gave. And then we have a significant number also who say they can't travel, they can't transport goods. And another set of people who can't get inputs. So the little light blue sliver that you see over there on the right, that's the number of people who are not working because, for example, they themselves became sick or their employer became sick, some sort of direct effect. So you can see this is, again, we've got a very large economic impact affecting a large swath of the economy, but very little that directly related to sickness and death. One of the other striking things here pointing back to this aversion behavior is that these employment effects were not disproportionately larger in areas with higher rates of the epidemic. So it's not that if you have sort of higher rates of the epidemic, it's that the employment effects are so much larger. In fact, the employment effects are spread across the country. At the same time from both this survey and a survey that was released by the International Growth Center for Sierra Leone, a similar phone-based survey was released just last week. When we look at prices, which are a big indicator for food security, we see in Liberia that rice prices, so the last two columns on the right are the blue lines of rice prices this year relative to rice prices averaged between 2012 and 2013, which is the red line, rice prices up 20%, 70% of people saying that the combination of those prices and the drop in income means they don't have sufficient to purchase the same amount of food that they were purchasing before. In Sierra Leone, interestingly, we see a slightly different pattern where rice prices are relatively stable, but there's a significant drop in trader activity, which means reduced income for farmers. You've got a lot of cash crop farmers producing cocoa and coffee in Sierra Leone, but without traders because of reduced opportunity for mobility, able to come and able or willing to come and purchase the crop. Furthermore, these traders are an indicator of reduced informal economic activity more broadly. When we take these leading indicators and we put them together, so our country economists together with the teams from the IMF updated the projections for 2014 economic growth. What this translates into, what we're showing here is how much poorer these countries are in the context of Ebola than they would have been in the absence of Ebola. You can see for Guinea, we're looking at $130 million, Liberia 66, Sierra Leone 163. In each of the countries, this is between 2% and 4% of the national GDP. 2% and 4% is a significant number in and of itself. Also, in all three countries, poverty rates at the baseline are between 50% and 65%. When you've got a lot of households that are covering right at the cusp of poverty, a 2% to 3% decrease in GDP from what would have been in the absence of Ebola is a really significant sizeable impact. A couple of other things to keep in mind in terms of the economic impact. Aside from this fiscal impact that these countries are poorer than they would have been in the absence, there's also a very significant fiscal impact. Because there's a lot less economic activity, there's significantly less tax revenue, which is what of course the government uses to do all the other things that it does. So both Liberia and Sierra Leone have reported significant shifting of planned infrastructure investments, so improving roads, making trade more possible, shifting that into health emergency funding. And so we see not only the impact on reduced economic activity, but also reduced investment by the government, which would have facilitated future economic activity. So when we move beyond these three countries and we think about the impact for West Africa as a whole, we get into the realm, admittedly, where there's a lot more uncertainty. So we use a model of interlocking economies in economists talk, this is a computable generate delivery a model. And what it does is it simulates the relationships between all these different parts of the economy, the prices, the households, the governments, the firms and all of their choices. And we examine, okay, well, based on our information on the ground on these leading indicators, where is Ebola most likely to strike? What is strikes in domestic transaction costs, like we saw from the Liberia data, people are unable to travel around, and to carry out the trade they would normally do. In international trade costs, there have been significant border closings along the way. And also in labor supply, people staying home initially from from places. So we used a model that came out in the Plus Currents Journal in early September, which maps out the likelihood of spread of Ebola based on air connections. So initial direct air connections from the three countries, and then on from there, obviously, those three countries, there aren't a lot of direct flights from from free town Sierra Leone out to, to other parts of the world. But there's a lot of carry on. And from this, we can predict what is the where the places where they're most likely to have some cases. So for example, the United States, even though it doesn't have a lot of direct flights to these three countries, it's highly connected because there are a lot of flights that go on. And that's why it's not surprising that we've seen a few cases show up here in the United States. So we basically use that as a proxy for the likelihood of spread. And then we adjust that for the strength of the health care system in these in each country in West Africa and in a model of the global economy. And then we use that to scale down the effects, the shocks that we're observing in Liberia and the other most affected economies. So then we basically we come up with two simulations. So one simulation, what we call the low Ebola simulation, as is a scenario where there are about 20,000 cases before the epidemic is truly brought under control. The second scenario, the high Ebola scenario is where there are 200,000 cases. So the probable suspected and confirmed cases of Ebola to this point is about 14,500. And so right now we're much closer to the 20,000 scenario case, the low Ebola case. Now a number of projections historically have gone much higher than that. And, you know, the epidemic is far from being under control. So there's still, like Steve said in his introduction, a huge amount of uncertainty. Right now, it looks like we may be closer to the low Ebola scenario, which what that looks like is in terms of lost GDP, about a loss of 2.2 billion for the region this year, and an additional 1.6 billion next year. So in the high Ebola scenario where the epidemic spreads much more significantly across the region, then we get much larger numbers. We're looking at about 32 billion over the course of the two years. So how does that happen? That happens because Ebola moves significantly into economies with much larger, much more globally connected economies. And so that's really the question. So we've certainly seen some positive things both in the turning of the tide in Liberia, also in how effectively the epidemic has been was contained with initial appearances in Nigeria and Senegal, both larger economies that were able to contain it. And we're all hopeful for Mali. And so it's certainly plausible at this point that we could be closer to the low Ebola scenario where we've got an impact that is tragic and large for the three countries, but not enormous globally, simply because these three countries in and of themselves are not so well connected. But it really depends on both action and the shift of the disease from here on out. So a couple of long run considerations. I think it's useful. There's to take a lesson from Dallas. So in this is these are data showing the traffic to restaurants and bars in Dallas. So one key indicator of sort of ongoing, fast moving economic activity. And this shows the change in 2014 relative to 2013. So in September 2014, economic activity at bars and restaurants was exactly the same. So on September 30, the first case of Ebola was diagnosed in Dallas. And there was about a 2% drop in this traffic. So in the middle of the second week of October, there were two additional cases. The two nurses were also diagnosed and we dropped down to about a 5% drop in economic activity, which again, for the whole Dallas economy, this doesn't seem that that enormous, especially in a very short run. But still, it's significant. So by October 16, by the end of the second week of October, all cases, all these three diagnosed cases were out. The first case that unfortunately passed away. And the two nurses have been transferred to Atlanta and to Maryland. And so it hadn't been 21 days. You know, Dallas wasn't completely free and clear. And yet by the third week of October, restaurant and bar activity had essentially returned to normal. So what this points to is that there can be relatively quick return, especially in the domestic economies. Once people see that things have come under control, regardless of whether sort of objectively there's, you know, zero risk, economic activity can move back much more quickly. International reactions may linger. People who are less familiar with the context in the economy. So I think we can expect very differential relations reactions over the longer run with these three economies where domestically, we might see some relatively quick response once the epidemic comes more completely under control, whereas international reactions may linger. We also expect some variation across sectors. So in mining where there's a large fixed cost and so international companies, there's a real cost to them setting up mining operations in other areas. There's a real incentive to get things moving. And indeed in Liberia, the two major iron ore producing companies are both one of them stopped production briefly. The other one didn't stop production at all, slowed it down for a bit. And both are now back underway and are at their targets for 2014. And so the epidemic has not actually affected that sector very much in Liberia at all. Likewise with tourism, which is again a nascent but growing sector, we see we might expect that to have more enduring impact. So just one longer term thing to think about. Most of what we've been talking about here is talking about the immediate economic impact. But in terms of longer term, human capital investments are one indicator about longer term economic impact. So in Guinea, Liberia and Sierra Leone schools have been closed for over six months right now in Liberia. In Guinea, they're supposed to have opened any day now, but we haven't gotten reports that they've actually opened yet. In Liberia, they're scheduled to open in March, which will mean it'll be the better part of a year that they've been closed. In Sierra Leone, they're scheduled open in January, but it seems that it's likely that the ministry will update that given the ongoing challenges with the epidemic. So the returns to a year of primary education in Sierra Leone, where we have the most recent data on this, are five and a half percent. They're double that for girls. We have a lot of evidence that when kids are pulled out of school for a period of time, a lot of them don't return. And so what we're looking at here is not only the immediate economic impact, but we're also looking at some potential long term transitions in human capital investments, which could be really challenging. Likewise, there's been much talk about with the health sector. Obviously, people are less likely currently to go and seek treatment for other health challenges in, you know, at facilities where they have a fear of catching Ebola. And so there could be significant, significant impacts of that, as well as there's been significant health worker mortality in three countries that didn't have large supplies of health worker as it stands. So it's inevitable that there will be a sizable impact on these three countries. That said, our projections are that if it comes, continues to come under control in Liberia and in Guinea and then hopefully turns the tide in Sierra Leone, it's plausible plausible plausible that even by the end of 2015, we might see some rebound. So the losses will be will be less. And hopefully this will be an interruption in very active economic growth rather than a permanent shift. But without swift containment, the impact for the region could be very, very large. And so the number one way to restore economic, to limit the economic impact is to contain the epidemic. So we need to focus, include our focus on the economic impact, but also recognize that, you know, investors in economic activity are most likely to return once the epidemic seems to be under control. People have confidence that the government and partners have, are making progress on that. But at the same time, there's a need to provide fiscal support. Again, the governments have shifted huge amounts of resources over to health spending off a dwindling set of resources as it is. And so for the government to be able to continue to provide the services for the economy to function effectively or as effectively as possible, crucial to continue providing fiscal support, implement institutions which will enable the flow of commercial exchange, so encouraging trade with whatever surveillance is necessary to make people feel comfortable and confident that they can trade without while safeguarding their partners from contagion. And then investment so that over the longer run, we could be more confident that whenever the next epidemic breaks out, whether it's Ebola or something else, these economies are still safe places to invest in places where there'll be a quicker response and a quicker containment in the next epidemic than we have had in this one. And I'll stop with that. Thank you very much. Thank you, David. Thank you. So, you know, if you'll forgive me, I'll sit and I don't have a presentation like David's would have been a repeat of much of what David had to say in any event. What I will do is perhaps focus on, you know, the policy side of things and also accentuate and stress some points David made. So I want to make five points in particular and I'll try and be succinct. I think the first point to note is much is going to depend in terms of the economic outlook for these countries in terms of what economic outcomes you're going to see going forward. Much will depend on how quickly the disease is brought under control. A lot of the economic impact is going to be driven by the, you know, the epidemiological disease burden that countries are going to be impacted with. So I cannot stress enough about how important it is to eradicate this disease to bring this disease under control as quickly as possible. That's really what will allow these countries to recover fairly quickly. And, you know, again, I don't want to apologize too much for discussing the economic side of things, but, you know, beyond the human toll, beyond the impact that the disease is having on people at the moment, I think it's important to see the economic side because in the long run, I think if this disease is not eradicated, if the economic impact is not attenuated, then you're going to see even more devastation, even worse social outcomes, poverty outcomes than we have seen, than we're likely to see now. So, you know, we shouldn't really be too apologetic about needing to look after the economy of these countries in a very robust way and fairly promptly. So I think that's the first point I wanted to stress. Second, you know, I think the economic situation is very much as David highlighted in terms of the sectoral impact, but I want to also kind of suggest kind of a more differentiated story among the three countries, and within countries also there's significant differentiation on how activity is being impacted, and I've been really impressed by some of the granular data and work that's being done by institutions like the IGC, which are bringing, you know, using new technology, a lot of new information, which should hopefully inform policy making, and I think it's important to just making policy to be to be cognizant of the differentiated impact within countries, you know, within countries from region to region. So as David also highlighted, I mean one thing we noticed, for example, is when you look at overall GDP growth for 2014, in the initial projects that we provided in September, what you saw kind of the hits to growth was not as high given how devastating this disease is, but a fair amount, a fair degree amount of that can be explained by the differentiation between, you know, mining versus non-mining activity. Mining activity has continued to be strong in some of the, in some places at least, some might, some types of mining activity, so you know, you have to look when you're looking at this, assessing this economic impact, they have to look at mining versus non-mining, so that's really important. Perhaps the area where we are most concerned about the IMF is kind of the potential disruption to to markets that we've seen, so this includes all kinds of, you know, the trade, goods services, agricultural inputs and outputs, the disruption to that because of the quarantines that have been put into effect, because traders are not able to cross into the next region with their goods, is something that we're very worried about, and again underscoring the importance of bringing the disease under control, is you know, if this is not, if these disruptions are not alleviated quickly enough, you could see food and security rising, leading to potential food shortages and famine, so again it's going to be very important to to address these issues to avoid even the good outcome. And of course, you know, the quarantines, the disruption to economic activity has a very, very real and tangible impact on people's livelihoods, employment outcomes, you know, putting food on the table, so it's not, it's a very serious issue. A third point, you know, more forward-looking, so you know, 2014 we have, you know, much of 2014 is behind us, so the question is, what is the outlook for 2015? We are actually right now in the process of revising our economic outlook for next year, and unfortunately it looks like we are going to be, you know, looking at another extremely difficult year for all three countries, and this really, again, plays off the epidemic, the, you know, epidemiology outcomes that we're seeing or projections that we're seeing. It now looks more likely that the disease is not going to be brought under control before, until around the second half of next year, and that also will mean that economic activity will be impacted significantly next year. So we are in the process of doing some internal work, working with the governments, very actively at the moment, to try and do our, to try and do our revisions. And again, our first pass is that the recessions that we've seen this year in non-mining activity are likely to persist into next year. Again, but I want to go back, almost everything will depend on how quickly the disease is brought under control, so, and given the projections we now have of, of the disease not being brought under control until around middle of next year, we are likely to see much more depressed economic activity. Fourth item, you know, we have seen a really fantastic response from, from the international community to, you know, to, a lot of resources being directed at the Ebola response. I think it was delayed, but eventually things have, have, have, are falling into place. I wish I could say the same for budget support for, for these governments. The David's numbers showed with the slowdown in economic activity, we've seen very sharp drop-off in tax revenue collections. We've seen governments, on the spending side, government budgets under tremendous pressure to increase spending, but I have been forced to increase spending. And yet, you know, so all of these countries are facing bigger financing gaps, bigger deficits, but the amount of financing they've been getting, budget financing has not been as significant as it needs to be. So, you know, this was for 2014. And then move forward to 2015 and you're going to see an even bigger impact, first because economic activity is going to continue, remaining depressed, but also there's some technical reasons, like taxes payable next year are going to depend on, you know, revenues and turnover companies have this year, of course, a number of companies are going to be carrying forward losses that they incurred this year. Some companies are going to have to go out of business. So, the hit to the government's fiscal accounts next year are going to be even more pronounced than they were this year. So, you know, there's a big financing gap for governments. It's going to be very important to try and address that by the international community. You know, these government structures supporting governments right now is really imperative. And this links to the fifth point I want to make, which is kind of what is the appropriate policy response when governments are hit by a shock like this when economies are hit. And of course, you know, when you're hit by a negative exogenous shock like this, what you want to do is allow fiscal policy to respond to their deficits to increase, to accommodate this shock. So, you know, wouldn't make sense in a context like this to start cutting spending because revenues are defined because you do need to allow for bigger deficit. And this, you know, as I said, relates directly to the point I, to the need for external financing and ideally in the form of grants. What governments are losing right now is tax revenue, which is of course, you know, money that they don't have to pay interest on and, you know, so ideally you want to replace that with grants rather than loans. So, you know, grant type financing for budget support is extremely important. We are working with the governments very actively in the preparation of, you know, doing projections for the macroeconomic how to look for next year and teeing off that what the budget picture is likely to look at. And in all cases, you know, we are recommending, you know, fiscal policy stance that's going to be accommodative as much as the financing is going to be allowed. From our side, of course, we are, we did the first round of alteration last year and we are moving to provide additional financing, you know, as much as we are going to be able to. But I think a lot more financing than IMF is going to be able to provide is going to be needed for these countries. So, you know, to wrap up and kind of address this question of what can the international community do, which is I think probably the most relevant one. Governments are doing, you know, all that they can. I think there's a two pronged strategy that you're seeing in each country. Media strategy remains on, you know, trying to, you know, do everything that they can to control Ebola. And then, you know, and then focus on the rehabilitation effort of health sectors and economic recovery, you know, bringing back the medium-term growth development agenda that they have. The governments are doing really their level best under tremendous strain. I think from the international community side, I think again, I would stress again the need to continue supporting the relief efforts, the efforts directed at eradicating Ebola. I think that's, you know, just as much resources as necessary have to be allocated to that for such a dangerous virus like this. I think we cannot have a situation where a low level of disease persists. I think the recent case in Mali is a good sign. And, you know, it's a spillover, not from Seralion or Liberia, where there's a significant disease, but from Guinea, where the disease has been under control, you know, spillover into Mali, I think that just shows that international community we cannot afford to have even a low level of disease in the region. So everything that has to be done, I think, to try and eradicate, eradicate the disease in all three countries. I think that's the best investment that the international community can make. And, you know, and then not to even order the budget support side. I think that's really going to be very, very important in the coming months. That's international community steps forward and provides additional budget support. Thank you. Thank you very much. Let me start by asking a question around data. You've gone through this intensive period of trying to think through what's happening and collect what data you can and you've been using innovative methods to try and connect to different sectors of the economy and try to get a more accurate set of indicators of what's going on. What has that taught you about what you're going to need in 2015 as you move ahead in terms of methods and mechanisms for collecting data that will give you a closer and better view of what's going on? I mean, this is a very difficult problem set that you're facing here. You've made a great contribution in pulling together the analysis that you have. But based on that experience, what would you ask for or look for to improve the ability to track and understand what's going on? David, what would you say to that? So that's a great question. And I think that the lack of data has been a real challenge. These phone surveys, for example, that have been done in both Liberia and Sierra Leone, the Liberia one from the World Bank and Sierra Leone from the International Growth Center, the response rates for those are not the response rates that normally economists would say, oh, I feel confident that this is a deeply representative of the economy. They're indicative. I think moving, continuing with those activities, I think, especially in the immediate run, is crucial. I think it provides an insight into prices. And like Abebe said, the distribution within the country of the effects, which are actually very variant, very heterogeneous within the country, I think is crucial. I think as soon as it's possible and safe to send teams out to continue more representative household surveys, which were ongoing again in both countries, and to do the same in Guinea, where, unfortunately, there was no sampling frame. There was no way to do this kind of phone survey. And so we have much less data in terms of the actual household economic impact. I think getting that kind of, those kind of data back into the field as soon as possible in 2015 will be really valuable in terms of developing a nuanced response, helping governments to develop a nuanced response within countries. What do you see within the ministries right now in terms of collecting data on this? You know, again, a bit of a varied picture, but at least revenue authorities are collecting data. And so we have the bare bones of economic data for fiscal policy. Not as robust as it normally is. I mean, even that has been limited, but we have some data. I mean, we have budget execution data, but also some revenue data. But I think it's going to be very difficult at this difficult time when these are already countries with fairly limited institutional capacity to ask them to, in a very significant way, to extend themselves exactly to producing national accounts data on a quarterly basis. So I think, frankly, I mean, if I had a wish list and the thing that we're trying to push is a bit more focus on generating newer fiscal data that they haven't had, that they haven't been generated more in fiscal data in new ways. So they're getting a lot of support. I think it's going to be important. A lot of financial support, a lot of aid. It's going to be important to show that this money is being put to the use for which it's being provided. So I would focus, I think the first order thing really is to try and get generate data on effectiveness and where resources are being directed on the fiscal side. I think that would be the priority for 2015 at least. And then to piggyback off all of the non-governmental data sources that have been emerging. We've all been even the central bank in Liberia. We all use the same data sets in terms of monthly economic indicators to try and figure out what's happening by way of activity. I think continuing to use those monthly fuel, diesel sales, cement construction, consumption of beers. So being innovative and trying to get this field for those things. We also have, I would say, bordering on the decent data on financial sector, on the financial sector. So currency and circulation, of course. And then some price data, exchange rates, etc. So I think a mixture of those should be adequate. So I would, for our policymaker there, focus really would be a bit more on generating more fiscal data. Thank you. There is this, before Congress right now, the administration's request for 6.2 billion dollars, a very big ask and multiple component parts to that. But part of it is looking at the recovery phase and looking at food security, food insecurity as a major component, looking at the recovery process across several sectors. So presumably that, if that moves forward, that's something where there's going to be a lot more investment in the analytics to understand what's going on by definition. And I would think that Unmira, in its own operations as it gets going, will itself be able to begin doing some of this itself and will have more of an on-ground presence as it matures. One issue that is particularly acute to these three countries is question of malgovernance and corruption and incompetency across the government in many cases. And I think people have been very surprised at the level of public distrust and skepticism in the course of this epidemic. The degree to which folks, the epidemic went underground, the degree to which as money was coming forward in the first phase of response, a great skepticism publicly in certain quarters that this was going to actually reach the beneficiaries. And certainly on the response, on the disease side, this has been a sensitive issue. It's one that's led to a pretty heavy reliance on the non-governmental providers and the like. In the case of budget support, in the case of trying to avoid government seizing up because of an acute finance gap, you have no choice. You have to be supporting governments. You have to be providing with them with the basic ability to function. But how do you foresee dealing with this problem of really a pretty exceptionally poor record of some of these governments in the management of external resources in a period when the external dependence is going to rise dramatically in this next phase? Because in a way, it means the bank and the IMF are going to be vulnerable to some criticism if these downstream, if it turns out that a lot of these resources don't accomplish what they're meant to accomplish. And we do see indications of instability related to this epidemic that derive from popular lack of confidence. Tough question. This is exactly why I made the point earlier that we recognize why there are these concerns. These are countries with weak state capacity to begin with. And you're throwing your kit by a huge economic shock, which atrophies that capacity. And then what do you do in that context as an international community? But I think stepping back, it's really important to look at the reason why kind of economic outcomes, why state capacity is weak. It's not just poor governments. It's also very limited human capital, not having human capitalism, not having enough qualified people that are working there. So, and the temptation, I think there is a strong temptation to always ascribe the ineffective outcomes or poor use of government resources always to malgovernments. But sometimes it really is the lack of human capital that's behind it. So, I think the best thing you can do in an environment like this, even in normal circumstances, much less when you're pushing more money into these weak systems is to bring about transparency. So, this is why kind of I was making that point, kind of you know, it's really going to be important for these governments to step up and show kind of how these resources are being used, tracking those, showing the donors that are providing these resources that they are indeed being directed to the uses that they are intended to. I think, you know, transparency, I think is probably the best thing that can be done here. Thank you. So, I think, so one point that's a little bit adjacent to your question, but one of the things we saw, we've seen initially in the countries is distrust of the government about the disease itself. And one of the things that I think it's useful to keep in mind is that we're not immune from that, you know, here in the U.S., where, you know, for example, the government has a clear and the scientific community on vaccination and yet we have large communities where they push back against that. And so, you know, this isn't a unique thing to these West African countries or their institutional status. This is a global phenomenon where people have some of this mistrust. I agree with Abebe about, I think the transparency is key. I think that applies both to the governments and then also to the donors. We saw this in the reconstruction in Haiti post-earthquake where, you know, there were a lot of pledges and there was some money coming in, but in a lot of cases, no one was really sure where the money went. Sometimes that was actually had to do with a lack of transparency on the partner side as well as on the government side. From what I've seen, as I've seen, you know, the World Bank, as you said, has already dispersed more than 100 million and there's a much larger commitment there are significant safeguards in place to keep the money from disappearing and what I've seen so far instills really confidence that the principal challenges have to do, to some degree, more human capital challenges and actually getting the money out the door and getting it to the recipients not because it's disappearing but just because it's work and it takes data and organizational capacity to put this out and so insofar as the international community can support these governments, not just with providing the financial resources but also the human resources to help put these funds to work the way they're supposed to, I think we can expect to see the impacts we're hoping for. In the picture that you're paying about the next year of continued struggle with the disease, likely continued stress on the economies but the entry, if these pledges that are coming forward arrive in the time frame in which they're pledged, we're talking about three to four billion dollars of resources coming into these three countries on the mobilization side, on the response side, which, you know, maybe you can comment on what impact. Don't forget kind of a lot of that money is actually in kind support, right? That's coming in. Right. So, you know, three, four billion includes my guess is the military support that the, you know, the DOD support for me and what the UK government are doing, the military side of reparation there. So, it's not actually money, three, four billion, the cash that's going into budgets. What this does is reduce, defraig some of the expenses that the government would otherwise have to make by way of creating, you know, setting up treatment facilities, et cetera. So, that's how it helps the government. But, you know, we shouldn't forget kind of the amount of budget financing that's coming to the government. It's actually a tiny fraction of that. No, I agree with you on that. So, what it looks like, though, is quite similar to the experience that Sierra Leone and Liberia both went through where they had international peacekeeping forces come in in a post-war setting in which that was a dominant feature of the economy for a couple of years. And what I'm suggesting is we're entering a situation where, for at least a transition period, you're going to have this introduction of a military-style relief operation with a very heavy civilian component to it that's going to be reasonably well resourced. But it will just further distort things, but it will be a significant share of the economy in that period. So, I think that's absolutely, you'll definitely see that to a degree. And I think, that said, it's important to, if you look at a graph of the Liberian economy over the last 25 years, you have sort of growth, growth, growth, and then you have the war, which looks like a giant hollowed-out bowl, a tragic one. And then you go up and then you have Ebola, which is relatively, the economic impact, relative to the war, for example, is just very, very small. And so I think what I would expect and at the same time, the response from the world is much smaller than sort of the post-war kind of UN presence. And so what I would expect is that we'd actually see this as a stimulating factor. We've got economies that, again, previous to the Ebola epidemic, were all growing, especially Sierra Leone, but all growing at healthy speeds. And Ebola hasn't destroyed capital the way the wars have. There's been some loss of labor, but again, that hasn't been enormous. And so essentially what, insofar as there is an external presence and internal investment, we should expect that to act as a real stimulus to this economy that's had what hopefully looks like a temporary shock rather than substituting for capital and labor in the country, which we may have seen in sort of the post-war setting. I think the only thing I would add to that is, I mean, we shouldn't, much depends. I mean, we shouldn't forget kind of barring Ebola. These, you know, Guinea, for example, had very high hopes that the big Asimado iron ore deposits would be exploited. That's huge investment that's in progress. So that has been delayed somewhat, is my guess. Hopefully not put off. So, you know, the question about this international effort and how much of a boon this will be really has to be seen in that broader context. Serranione was growing at 12, 14 percent for a couple of years. Liberia itself was expanding at 6, 7 percent. Fairly brisk face. So, you know, if you think of the growth trajectory that these countries were on, what you've seen is kind of a slump. And maybe there will be a bit of a bump there from this. But overall, you know, these economies are much bigger. I'm not sure that the footprints that, because it is, will be as dominant as, say, the unmilled presence had before and continues to have to some degree now. So, I think one sort of, one pin that I would put on that is, I think it will be important to look carefully at food security over the next year. So, the epidemic sort of hit its rise right as we were going to harvest season in all three countries. Very end of rice planting in Sierra Leone, but the most part where we've been, over the last few months, is harvest. And in terms of, you know, own consumption crops, like again in Sierra Leone, almost all rice is sort of consumed by the households that plant it. You know, in that case you won't, we won't see a big food security problem in the immediate run. But part of the support that the international community is bringing is food support, which is really important. We have these reports from all the countries that that's an issue right now. But as we come into planting season in the first half of 2015, it'll be important to sort of keep an eye on any potential distortionary effects that we could have from food support and, you know, farmers anticipating differences in prices to crops. And so that'll be an important thing to take, to keep an eye on over the course of the next 12 months. Why don't we open up for some questions and we'll go, we'll start over on this side. And let's take three or four. Matt, and then in front of, and then two gentlemen in front. We'll come back, yes. Matt is right behind you. And then we'll come to the other three hands right afterwards. We'll bundle together. So Matt. Thanks, terrific presentation. Matt Goodman here at CSIS. It's been about a decade since the SARS outbreak in a few years since the H1N1 and related avian flu epidemics. Can you talk a little more about the lessons learned from those outbreaks and, you know, to the extent that those didn't seem quite as devastating as initially feared, was that because of the nature of the disease, the epidemiology, the local economic conditions in the affected countries, especially China or, you know, the response. Thank you. Right. There's a gentleman right here and then in the front row and then the woman in the back. My name's Mead Over. I'm one of the co-authors of the World Bank Report with David. Hi, David. Most of the discussion that you've elicited here, Steven, has been about the three of most affected countries and that's, of course, appropriate. But I think that the larger question is whether West Africa as a whole will really experience this $32.6 billion hit, which is the worst case scenario that David presented. And in particular, the question is whether international aversion behavior will have a deep and long lasting effect on West African economies. And I'm wondering whether the gentleman from the IMF can speak to whether there's any early evidence of investors shying away from Africa and, you know, going back to that what we thought was an obsolete view of Africa as being the dark continent where it was too dangerous to be involved. Thank you. Sir. Sahil. Yeah, thank you. Dr. Marga from Mali. So I am not very optimistic and I think that definitely that we are going to face a more serious situation, not only epidemic, but also economic situation. Because we are facing three abnormal behavior. One first is related to the sick patients, say, boiler patients. And we have seen in Africa that many cultural habits and so are encouraging people not to go away from the patient but to be closer to the patient. This is a very abnormal situation. The second is an abnormal situation in the community itself. While people tend to ignore and to neglect the patient or the family who are affected by the disease. And the third abnormal is the reaction of governments. Generally in West Africa the health structure is very weak and particularly in the rural side. And this gave ways, I would say, highways to spread the disease. And also I would say that the government should continue to think about what type of policy. I mean budgeting policy. Most of West African countries are facing rebellion. And so they tend to invest more in militaries than in health sector. And what is the reaction of the international community to push those governments to invest now more in the health sector than in the military sector. Because I'm talking is not only a question of three countries Liberia, Sierra Leone and Guinea. We should think about building a belt, security belt around these three countries in order to avoid the propagation of the infection to the world. If this is not done then the economic impact and the epidemic impact is not only for West Africa but also for the whole world. Thank you. Let's back here. Then we'll come back to you. The doctor just stole my thunder. That was exactly the question I was going to ask. What changes if any, oh I'm sorry, T.I.G. Salam Blight the Congressional Research Service. The question was going to be what changes if any. Do you think the outbreak might bring in terms of the how governments invest in health systems themselves. Health tends to be the stepchild of government budgets in part because of external pressures but also just internally. What changes if any do you think this will bring in terms of health investments. Thank you, T.I.G. I think on the lessons learned from SARS and H1N1 what we saw with SARS certainly was there was a projection of an enormous economic impact and then ex post estimates of the actual economic impact were significantly lower. It's important to remember that doesn't mean the initial economic projections were wrong. It just means that the epidemic was contained and I think a lot of what happened with SARS and with H1N1 is that they were contained relatively rapidly. Also part of the driver for the very large impacts that we saw there is that with SARS for example we're looking at Hong Kong and China sort of very large economies. I think the lesson for here really is about quick containment again. Like the key to curbing the economic impact is containing the epidemic. In terms of activity the evidence that we have is that necessary for example putting a quarantine around the countries and this kind of thing. Historically that hasn't been an effective policy. These are their porous borders and so there are ways for opportunities for people to cross and historically we haven't seen a lot of a positive effect of that kind of travel ban. In fact it makes it more difficult to monitor who is crossing and check for symptoms and keep track of people. And so rather I know what the World Bank is doing in other organizations working with partner countries and neighboring countries to try to help make sure that they're ready. Now it's true that most of that investment like you say hasn't been necessarily in a rural clinic in Nigeria for example or that sort of thing. That said there's a reason that our biggest fear is about spread in the urban centers where you've got where it's just much easier to spread. You've got far more people concentrated in one location. Probably the response that I've heard most in the context of the epidemic is the need for better investment in health systems. And so that is certainly what's on everybody's mind right now is to is not just to respond to the epidemic but then also put systems in place over the longer run. Now I think both nationally and internationally memories can be short and sometimes we're kind of drawn to the next crisis and if it's not a health crisis then that can pull that away. But I definitely think that it is true. Historically the health sector has been seen to a degree as something separate from the central economic sectors and I really think that the Ebola outbreak in West Africa has broken the thinking on that and shown that for the false dichotomy that it is. And so I think we can hope that both national governments and international partners can maintain this in memory long enough to make some sustained investments in these health systems. Okay, so we also looked at economic output in a very granular way actually around the SARS epidemic in Hong Kong, Singapore it's reached as far as Canada and what struck me was that when you look at industrial output data or other price data it's just very flat. I mean it's very difficult to discern any impact at all of the SARS epidemic but again as David touched on it stands to reason because these are SARS hit countries which have much much stronger economic institutions health institutions so the disease was contained quickly and the risk, the aversion behavior that we are seeing in our countries didn't spread as much as they did. Even then there was some impact. You saw kind of companies, banks in Hong Kong moving their employees to Australia and stuff like that but it was very attenuated, very brief and it was all contained. Key lesson there, it hit countries with much stronger institutions than the countries in West Africa. On the question about whether we've seen kind of impacts, you know risk aversion by investors elsewhere it's really very difficult to discern any impact like that. I mean first of all kind of beyond these three countries we have seen some impact in other areas so I think a good example is the Gambia where you've seen a lot of cancellation of hotel bookings and of course we keep hearing a lot about kind of people canceling trips safaris to Ngorongoro in Tanzania or visits to the Cape Town or you know my favorite one is kind of some Brazilian investors apparently don't want to go to Namibia and I think Conakry may be closer to Brazil than to Windhoek but anyway so we have seen those kind of behaviors by and large because tourism sector other than kind of Kenya, Tanzania, South Africa are not very big parts of the economy I think the adverse impact of that will be limited. Now in terms of investor behavior if you look at price data for sovereign bonds, bonds and the like we haven't seen much at all closer to the likes of Nigeria and Ghana at least not directly because of this there's other things that are going on in those economies of course oil price impact, fiscal issues in Ghana which have had a bearing on investor behavior but it's very difficult to discern investors fleeing the region far from it and our projections show that for the vast majority of countries in the region the strong economic outlook strong economic outcomes have been enjoying recently looks set to continue they tend to be driven by fundamental factors and they're persisting and so the overall picture is a good one so you said kind of you're not optimistic I would hate to think that we painted an optimistic picture you know it was a fairly difficult one that we painted but you know I am hopeful with all of the effort that's underway now that you know the disease can be brought under control but you know by no means do we want to give the impression that it's going to be easy you know I think 2015 is going to be really a very difficult very grim year for all these economies for all these countries for the people in them so you know and I you know the points that you highlighted I think show exactly why it's going to be you know it's going to take a bit of time to overcome and bring the disease under control and then lastly on what governments can do you know what's you know outsiders what institutions like ours can do I think first and foremost I mean you know I just want to say kind of you know we at the IMF in particular kind of you know we when we discuss with governments on you know on fiscal issues we really almost always end up just you know by and large kind of looking at the overall envelope and of course we want as much as possible we will have views on protecting investment spending avoiding kind of unproductive spending but the decision on how much to give to health versus education versus you know subsidies in other areas really almost always falls for governments for parliaments you know so this is not a decision that we privy to and of course kind of governments have to make a lot of trade-offs really difficult trade-offs I mean you know much like congress here has to make trade-offs with that administration and the like and the outcomes the allocations to health we see are you know an outcome of all of the trade-offs the politics the economics that's behind that but I think as David also said I think what Ebola has done is to really underscore the you know that health is an area that they cannot trifle with and that can come back to haunt them so we've seen countries like you know particularly neighboring countries Côte d'Ivoire is a good example which has stepped up massively it's prevention preventive support they've asked for some additional support for us which we are going to be providing so Burkina is also working on preparing you know putting in place diagnostic labs so you are seeing kind of much greater sensitization and I wouldn't be surprised if we also saw kind of a bump in health spending in the rest of the region you know given what's been going on in these three countries so I'm fairly optimistic that we'll see that that's one last point I want to make on health spending overall and what trends there have been in that I think you know you know this is a really really complicated area I'm not a health expert but you know I lived for three years in Uganda and it was at the time when the U.S. effort PEPFAR, GAVI initiative all of the health spending that was going on to you know address AIDS there was a massive ramping up of AIDS sorry health spending by NGOs by the donor community and wouldn't surprise me at the period like 2006-2009 to have seen government allocation you know government spending there having been declined so just the mere fact that you see government spending to health declining doesn't mean that the resources that are going to the sector overall are declining and it's part of kind of you know a discussion the dialogue that many of these governments have that you know if donors are going to be providing more money there so money will be allocated to health to agriculture to building roads so you know this is a picture kind of you know to really get a picture on what's happening that's really a very complex issue and not as as linear and simplistic as just looking at government spending thank you Matt's question around the earlier pandemic outbreaks and SARS those did not really hold out the possibility of the diseases becoming endemic in the way that the threat exists today right in West Africa the possibility of having having Ebola endemic in both urban coastal settings and rural ones where you could have reignition on a sort of routine basis and we don't know if that's going to happen or not but it's certainly something that's weighing on folks mind I think those earlier outbreaks also that the attention level and expenditure on them ramped up rapidly and ramped down rapidly you know and I think this is one where the pattern is going to be quite different for the reasons that you outlined it's it's going to be a longer fight and you know Ebola came in I mean SARS came and went in what six months why don't we get some additional questions in Christine please identify yourself and then pose your question then we'll gather three or four comments yes please Hi Christine So from the Global Health Council thanks very much for this I just have a couple of comments on David's presentation on your economic impact and mentioning in the health sector I think one of the areas that we really need to be making sure that we underline where there is going to be an economic impact and a social and familial impact is the indirect morbidity and mortality due to aversion from health facilities and so we know for example that we're going to see increased maternal mortality rates we're going to see increased morbidity and mortality due to diseases like malaria because people are either not able to or not willing to access health facilities so I think that's an important area of economic impact to be considering in your analysis and to be underlining I also just wanted to make a comment about the SARS dynamic and I think you mentioned the idea that the Hong Kong economic situation was much more resilient and resistant in the wake or in the face of SARS at the same time I think we need to recognize that the desire for swift action by the economic and business community was very pronounced because they knew of the impact that could be made on the economic community and we did not see that kind of response in West Africa and we really need to be thinking about the reasons why that is the case and I think that there are human rights components to this there are leadership global leadership components to this and in any sort of after action review I think we really need to be underlining how we make sure that in the future when faced with these kinds of global crises or threats that places are not allowed to drop off the map or be victim to slow response because they may not have the perverse advantage of having a strong economy in the face of a global threat thank you Christine right in front of you just hand that yes thank you very much and Roseberg with global health international advisors previously World Bank and Global Fund I'm going to piggyback on you I think you miss one thing that makes it different which is it affects the rich that affect the poor and I think that that is something something to be very much taken into consideration I mean the fact that in Ebola I may be wrong here I'm not a specialist but it's basically the same age as age give or take a couple of years we have a we have people to not die anymore of age as long as they have money they do die of Ebola and I think that has to do with who is affected rather than the nature of the disease so that that I think is a point that need and the reason I'm raising this is because I think this is something where the international community can do something because you can orient the destination of your funding to doing this versus that and I think that's a point that number one and number two what David I wanted to reinforce the issue of systems with all the previous epidemics okay there is an issue of immediate attention of people who are dying of course very important but we should not live from emergency to emergency when it's very pointedly clear that if you have a decent system it does not become an emergency so that that I think that we have failed to translate that into economic terms so the Minister of Finance understands that it's worth funding this type of arrangement thank you thank you there's a hand in the back very far back there Dane Erickson with the University of Colorado my question is about the international response and particularly bilateral engagement and support it seems as though the U.S. has taken the the lead or done the most in Liberia the UK has done the most in Sierra Leone France has potentially or at least been suggested that they should do the most in Guinea it seems that's because of historical and political reasons I was wondering if you guys agreed with that and also if that's the case are there longer term recovery implications in each one of those countries based on that thank you sir right here thank you Hamid world vision I'll be interested in some more comments and coordination particularly at the country level part of the reasons for some of these skepticism mistrust you know confidence in government is that from an epivio point of view we're not often sure what the government has what resources are available to government so we can either compliment or support and could you speak to the coordination or particularly the country level just for some clarity thanks let's take one more right in front of you there please hi Jessica Taff World Bank um you guys have talked a little bit about comparing the current Ebola outbreak to other global pandemics or outbreaks that went on and I just want to be clear about it you talked a little bit with SARS not having the same economic impact and it being not really substantial mostly because it's more resilient and we addressed it really quickly so I just want to be clear on this in terms of numbers and the overall economic impact regionally and globally is Ebola larger than any of the previous outbreaks we've had with MERS or SARS or any of the influenza outbreaks thank you okay let's come back to our speakers David do you want to lead on sure that's the issue of you know I think one of the challenges with moving from living from emergency to emergency shifting to investment systems is that I think we need to do more to play up systems where we've had success in investing and systems ultimately being being stronger so I've seen numbers where people say oh this is how much it would take to you know to get us the health system we need in Liberia or and you know I think there's all of their skepticism in the face of those kinds of members simply because you know building a good health system isn't just about money it's about a lot of other things too and so I think it will be useful in helping to shift the dialogue in that direction to highlight where the international community has been successful in supporting governments in strengthening their health systems on the whole issue of bilateral you know this bilateral assistance you know I think you know obviously the World Bank and the IMF the IMC you know are focused you know across the countries I have you know anecdotally observed the same pattern that you're observing I think it'll be interesting to see what there's longer term impact but that's not something that we kind of thought about in the very precise and I think it's very interesting an important question I know you know our colleagues on the ground are each of the three countries are meeting closely with government and there are coordination teams between the U. Land missions which are kind of leading operations and the government teams and that is happening I know with the support that we've been providing there's been a lot of cooperation from governments in terms of sharing budgets of what resources they have with the IMF so you know I think in every development situation one of the things that comes out is we should be coordinated there and that's true and it's always true but what I've observed so far in the context of this crisis now maybe not sort of early on is that that's certainly moving certainly moving in the right direction you know in terms of the actual John Jessica's question about the sort of the overall size of this epidemic I think at this point the global size of the Ebola the economic impact of the Ebola epidemic is still not as big as some of these other these others but I think the real trick is that you know this hasn't played out yet and there's huge uncertainty about exactly how this is going to play out like Abebe I'm hopeful and I think there is a path towards mitigating some of these big global economic impacts but there's a big question mark that depends on national international Abebe okay much like David said I think I agree with many of the points I'm not a health sector expert so I defer to to your judgment on what's important you know what kind of priorities need to be to be given the only thing I would say is kind of a little bit of a plea for ministers of finance they they you know at the end of the day it rests on their shoulders how to prioritize you know within a limited resource constraint the same appeals that the health sector makes every year the education sector is making water and sanitation sector you know agriculture sector and you know having worked with you know a number of ministers of finance I think they're the most stressed the most difficult people that you know trying to juggle this and the outcome is not always just you know it's a political outcome I think I wouldn't underscore I wouldn't underestimate kind of how in each country how much money goes to help is ultimately you know an outcome of the political process the governance structures countries have so you know I say all of this to just not underestimate how how deep tense those discussions are and you know we have to you know you know there are a lot of constraints and it's not that I think as much as we would like to see more spending on health education I think there's also another dimension a very important dimension that goes on in countries which we shouldn't lose sight of the only you know country-level coordination or sorry first on kind of the the fact that we have this alignment of the UK and the U.S. and Liberia etc I think frankly from my side kind of I you know whoever is ready to provide the resources I'm happy I mean I just want robust response to be in place as quickly as possible whoever provides it I think I'm a bit agnostic and I think we shouldn't under you know I've been incredibly impressed also frankly by the private sector MSF for example how much work they've been doing I've just been incredibly moved personally by it and impressed by how much work how much leadership they've provided at this juncture so you know I would underscore also kind of of course they've been getting some official resources also you know so I think getting the disease under control is first and foremost most important country-level coordination I think David said it all you know you know not not having sectoral people we don't get involved in sector-wide donor committees and the like but I think you know not even normally I think coordinating is a huge challenge for governments I've seen this at first stand both on the government side you know having worked for my government but also also being you know on the other side it's a huge challenge even under normal circumstances for countries with even better capacity much less kind of an environment like this where you know government capacity has weakened a great deal and also of course facing a lot more donors on the other side of the table so you know I think it's going to be a big big challenge to to coordinate a response at that level I think I'll end that thank you we're getting to the end of our time here perhaps each of you could just close by offering some thoughts around what's on the horizon in terms of next moments when these issues get an intense focus we've had the G20 we've had those the fall meetings we've had various studies come out that all of those have sort of stirred an interest and a focus looking ahead and into the end of the year and into the first quarter of next year what can we expect around these economic matters in terms of new insights or new concentrated focus are there things on the calendar that you can point to yeah baby okay so I don't know whether the right term is expectation or hope I mean what I would hope to see is I mean we've seen you know the the numbers in library infection rates come down I would very much hope to see a stabilization and reduction in Saralion I mean that's really what I'm hoping to see in the coming in the coming weeks and of course you know in Guinea where it's been at a low level hopefully further progress you know so just the disease burden being under control is really my biggest worry focus and and that's that's the outcome I would like to see in terms of the fund you know we as I said we're doing a lot of work at the moment as I speak with the governments to try and revise the micro economic outlook we hope to have some new numbers on the outlook for 2015 and the not too distant future and on the basis of that you know to start providing support you know disbursements in place by early 2011 that's what we're working towards so thank you David so in terms of when the economic impact really comes to the to the four one of the places where in the course of it the epidemic so far where we've seen it come is when there have been cases that have jumped to the US to Spain and so in that sense I hope that we don't see another moment like that in the sense that hopefully that the tide is turning that said there is ongoing there's ongoing work that we'll see coming out you know the World Bank continues to disperse the resources in addition to that what I shared today there were two simulations simulations of two scenarios of the impact for West Africa obviously that's a dramatic oversimplification of the array of impacts that we could see that we could see you know meet over is here from the Center for Global Development one of the co-authors and he and I and the rest of the team are working on developing a larger set of simulations so that we can get a better sense of the the array of possible impacts for West Africa as a whole we hope to have those over the course of the next six weeks to to two months and then there's ongoing survey work so the World Bank will have its own survey results from Sierra Leone come out within the next three weeks and then ongoing results from Liberia and Sierra Leone which hopefully we'll see positive changes but I we just have to see thank you please join me in thanking both of them David that was terrific thank you so much hope we can come back together in the new year and revisit some of these