Institute for Development Impact (I4DI): COVID-19 Response and Recovery: What are we missing?

Apr 24 2020

As public health and development experts who evaluated select Ebola post-response recovery activities in West Africa in 2018, we at I4DI offer some considerations for COVID-19 response and recovery. We call on policymakers around the world, to reflect and take collective action because prospective thinking is critical for an effective and comprehensive management of, and recovery from, the COVID-19 pandemic.

Lesson 1 – At-scale identification and testing

Many have underscored the importance of testing and the ability to bring tests to the community, particularly to facilitate disease containment1. We anticipate early and effective identification of COVID-19 survivors to be a critical component of future waves of the response and of the post-response recovery. Survivor identification can help to lessen impact on the economy and prevent additional community spread if survivors are among the first to be put back to work, following their full recovery and development of immunity. In West Africa, Ebola survivors were redeployed to their work posts or other essential services as possible, which helped lessen the negative impact of the disease on severely affected communities. Strategies used by communities to reintegrate survivors should be adjusted to their specific situations2.

Lesson 2 – Prepare now for post-response recovery with robust Monitoring and Evaluation (M&E) systems

Prospectively identifying the learning and information needs for the post-response recovery is critical, in conjunction with designing and deploying a strong monitoring, evaluation and learning (MEL) system that can predict secondary outbreak waves and inform adaptive management during the recovery. During the Ebola epidemic, traditional epidemiological approaches were used to forecast changes in infection rates and geographic spread with subsequent use of big data that had limited impact at the time. Across localities and countries, current COVID-19 data collection efforts are primarily oriented towards establishing basic facts such as the number of confirmed cases and known outcomes. We need a common learning agenda that will drive data collection to better manage the response and recovery. For example, to predict where the potential seasonal resurgence of the virus might have the highest impact, what do we need to collect now? What kinds of data are necessary to inform the recovery strategy and its implementation? Should we be collecting population data on immunity? Now is the time to identify and prioritize what we will need to know, for what purpose, and where to find the answers.

Lesson 3 – Early identification and deployment of support services

In West Africa, registered Ebola survivors, their families and other affected individuals benefited from having access to a range of health, psychosocial, and economic recovery services, which could similarly be envisioned for COVID-19. We must rapidly begin identifying the range of support needs that survivors might require and determine the extent to which existing service providers will be able to absorb new cases or whether new interventions and programs are needed. Additionally, a robust referral mechanism would be helpful in enhancing service uptake and long-term outcomes.

Survivor stigma was a prominent feature of the Ebola epidemic, prompting a variety of efforts to reduce internalized and enacted stigma in the community and in healthcare settings during the post-response recovery. The extent to which COVID-19 survivors may face stigma remains unknown, but proactive anti-stigma efforts could help to avert long-term negative impacts on survivors’ mental health and general wellbeing — and, ultimately, their ability to effectively engage in the re-stimulation of the economy3.

You can find detailed explanations of each of the lessons mentioned above, on our website here.


1Rapidly mobilized, frequent, and widespread testing was a driver of South Korea’s successful outbreak response, which has dramatically lowered its infection rate in a matter of weeks.
2We caveat these ideas with an acknowledgement that the microbiology and epidemiology of COVID-19 differ in many ways from Ebola, as well as from COVID-19’s close relatives SARS, MERS, and the other coronaviruses that cause the common cold. As information about COVID-19 rapidly evolves, so too does understanding of the duration of infectivity in symptomatic and asymptomatic patients and the period of immunity following infection — fundamental insights on which hinge the potentiality of some of our ideas.
3The World Health Organization has issued guidance for government, media, and local organizations to prevent and address COVID-19-related social stigma. In addition to knowledge campaigns, other interventions may be required to target the specific needs of individuals, such as individualized counseling, peer support, or interpersonal group psychotherapy.