Strengthening Supply Chains for the Next Epidemic Response, evidence from the 2014 West Africa Ebola Outbreak

By Emily Gooding, winner of the HUMLOG best Master’s thesis Award 2017


The response to the 2014 West Africa Ebola outbreak consumed hundreds of thousands of boots, examination gloves, and liters of chlorine. The supply chains that brought these critical relief items to Guinea, Liberia, and Sierra Leone relied on a series of manufacturers, transporters, governments, non-governmental organizations (NGOs), and international organizations (IOs) to move items from storage and manufacturing sites around the world to the affected countries. In humanitarian crises, as demonstrated by the 2014 Ebola outbreak, public, private, and humanitarian actors must work together to form these supply chains that deliver relief items.

In the 2014 Ebola outbreak, the supply chain of personal protective equipment (PPE) – gloves, masks, coveralls, and other items that protect healthcare workers – was made up of NGOs, IOs, public actors, and private companies who had never before worked together. Humanitarian organizations were procuring items they had never purchased. Governments were procuring items in larger quantities and with stricter specifications than they ever had. And these items were procured from private sector companies who had little-to-no experience responding to public health crises.

As a result, the supply chain was built hastily and relationships between actors were quickly forged. There were big obstacles to doing so, and even bigger challenges in coordinating the supply chain that emerged. These challenges led to an excess supply of PPE in some affected areas and a PPE shortage in others.

We interviewed 17 actors across the supply chain and found that all types of actors were frustrated by the response. But coordination – the flow of information and the development of trust – improved over time. Before the next epidemic, these supply chain actors must work together to share their relative expertise, build trust, and establish ways to coordinate in the face of another crisis.

Our study found that during the Ebola outbreak, many humanitarian and government actors made decisions solely to avoid the upfront cost of holding excess inventory, while private sector actors utilized more sophisticated inventory decision-making and contracting tools. And many private companies excel at collecting and using supply chain data to inform their decision-making.

Private companies should partner with humanitarian organizations to share their supply chain expertise in inventory management and contracting, and to train supply chain officers in these skills.

We also found that there are ways in which humanitarian supply chain actors excel during a health crisis. We found that despite the threat of a supply shortage, humanitarian respondents did not frequently report being overwhelmed by the crisis. Humanitarians execute operations with few resources and overwhelming human need all the time. Private sector supply chain actors, however, indicated that they were overwhelmed by the severity of the crisis. This was not due to any drastic change in their operation, but rather due to the fact that they were responding to a humanitarian emergency.

Humanitarian organizations should partner with private companies to teach them how to operate in a crisis and how to handle the stress of an emergency response, because the private sector will likely be involved (as manufacturer, distributor, or transporter) in the response to any future epidemic.

Our study found that government actors, often located centrally in the supply chain, had fewer problems accessing data than downstream humanitarian organizations or upstream private manufacturers. Accordingly, governments should create systems that can collect, aggregate, and share supply chain data with other actors in emergencies.

We also found that conflicting, evolving standards slowed procurement efforts and frustrated responders. Efforts should be made to clarify product standards and specifications, which were critical problems in the PPE supply chain, before a crisis hits.

Despite the challenges initially, our study found that the relationship between supply chain actors improved throughout the Ebola outbreak. Between August and November 2014, respondents reported an improvement in the working relationship between various public, NGO, IO, and private actors, due to the development of business relationships and the clarification of PPE standards. This pattern was repeated in other operational activities throughout the crisis, and it demonstrates how building these relationships can improve a supply chain’s response.

Supply chain actors have a lot to learn from each other. In an epidemic, there will always be a mismatch in supply and demand that places stress on the supply chain of relief items flowing into an affected area. But that stress can be managed and reduced if we do the work now to share knowledge and strengthen relationships between the supply chain actors who will respond to the next outbreak.

Emily Gooding is a Fulbright U.S. Student currently studying health commodity supply chains in Nigeria. This thesis project was advised by Drs. Maria Besiou, Jarrod Goentzel, and Marianne Jahre. The team is now using this qualitative data to develop a quantitative system dynamics model of the PPE supply chain during the Ebola outbreak.