By Jarrod Goentzel

Fear of an Ebola outbreak in the United States has spurred two key proposals for preventing the spread of this deadly disease: travel bans from West Africa and stockpiling Personal Protective Equipment (PPE).

These measures have merit, but they could also severely disrupt the supply chains that deliver the workers and supplies that are critical to fighting the Ebola virus.

PPE stockpile in Ohio (Photo: Ohio Department of Health)

Stockpile of personal protective equipment in Ohio (Photo: Ohio Department of Health)

Travel Bans

Many public officials are calling for travel bans from countries most affected by the disease: Guinea, Sierra Leone and Liberia. Some countries and individual airlines have already implemented such measures.

Flight restrictions are fairly easy to implement, but have broad implications. Mid-August cancellations implemented in Senegal provide a good illustration. Brussels Air – one of two airlines continuing flights into Liberia – had to suddenly halt flights because it was using the airport in Dakar, Senegal, as a stopover en route to Monrovia. Brussels Air was able to rework its timetable and resume flights after several days. This temporary outage not only delayed arrival for aid workers booked on these flights but also critical cargo of medical supplies, including supplies sent by our lab.

Advocates of bans argue that special charters can replace commercial air for humanitarian purposes. But the decision in Senegal also halted service provided by the U.H. Humanitarian Air Service (UNHAS) on August 22 until a special facility could be built; flights resumed again on September 25, over one month later. To stay ahead of an outbreak, alternate transportation capacity for aid workers and supplies must be fully in place prior to implementation of any travel bans.

Establishing new air transportation networks takes time and significant funding. As of October 5, the UN had transported a total of 655 passengers with its air service and had recently added a 737 between Ghana and Liberia twice a week. Privately funded air bridges, such as Airlink for cargo from the U.S., are providing additional capacity. Finally, it takes time for humanitarian organizations to piece together a supply chain spanning new networks of donated services.

The public health debate regarding the effectiveness of travel bans will no doubt continue. In making decisions, politicians must also consider the supply chain impact of eliminating commercial air capacity that has been shaped by market forces and made reliable by years of execution.

PPE Stockpiling

Recent Ebola cases in the U.S. have heighted awareness of the Personal Protective Equipment (PPE) that is critical for health workers. Fueled by health sector preparedness as well as rising personal panic (sales on Amazon are soaring), manufacturing capacity for PPE may be become constrained. Already, the State of Ohio is buffering its stockpile, and some distributors are citing supply concerns.

Capacity constraints or bottlenecks combined with volatile demand, such as that faced during an outbreak, escalate the importance of coordinated planning and prioritization. Fortunately, two international organizations took the early lead in matching PPE supply and demand. Médecins Sans Frontières (MSF) has led Ebola treatment on the ground in West Africa from the beginning, determining the standards for care and health worker safety and quantifying needs. In early September, UNICEF raised the issue of manufacturing capacity for PPE and began coordinating with key suppliers. Together with the WHO, MSF and UNICEF have sent clear requirements to manufacturers, which have responded. DuPont added shifts and has more than tripled production since March.

However, a few more high-profile cases could rapidly escalate stockpiling efforts in the public and private sector and across geographies. With manufacturing already running at peak capacity, supplies may begin to fall short. Similar situations have been considered before, such as with H5N1 in 2005, where coordinated planning is critical in allocating limited inventories.

Supply chain research indicates that risk pooling – where vital global inventories are co-managed as a common resource – is critical in maximizing the impact of a scarce commodity. As an alternative to stockpiling locally, decision makers in the public and private sector should consider a pooled procurement process, led by the WHO consulting with health departments in affected countries (which includes CDC as the U.S. is affected), that allocates stocks to health workers most at risk.

Adapting public health strategies during an outbreak is critical in preventing the spread of deadly disease. However, hastily considered strategies to control movement and hoard supplies could dramatically impact the availability of our most critical resources – health workers and protective equipment – to fight the disease at its core.


By Lauren Seelbach

During my summer internship at the American Red Cross (ARC), I explored how social media can be used in the disaster context. Examples could range from identifying pockets of need to fostering communication with affected individuals.

PPE stockpile in Ohio (Photo: Ohio Department of Health)

President Obama touring the Red Cross Digital Command Center (10/30/2012) Photo: http://en.community.dell.com

My project focused on how decision-makers at the ARC are using social media. I interviewed thirty-eight individuals in disaster operations to understand (1) how they were currently using social media in disaster operations, (2) what specific decisions had been informed using social media, and (3) what functionality they felt was lacking in making the link between social posts and decisions.

Based on the analysis of these results, several key recommendations were made on how to apply social media data to operational decision-making. They are to:

  • Define and incorporate a process for using social media in decision-making in existing policies or develop new policies for this process, considering that:
    • The process should be defined for an operational role;
    • The process should be focused on identifying information on which an operational decision can be made;
    • The opportunity to work with any provider of a social monitoring service (e.g. Radian6, Dataminr, HootSuite) should include a process to further refine the software to address the unique needs of a decision-maker;
  • Develop or refine keyword groups in social monitoring software (if using) to pull posts focused on needs and client feedback;
  • Develop an operationally focused training module for social monitoring software platforms and encourage wide participation among staff in headquarters and regional locations;
  • If the organization is reporting social data, incorporate data that is regionally focused, as opposed to or in addition to the “big picture” reporting.

These findings represent actions that any organization can take to increasingly apply social media in operational decision-making, no matter the context. They are relatively simple policies and procedures that solidify the place of social media as a relevant information source in decision-making.

By Jarrod Goentzel

(Photo: European Commission DG ECHO/Flickr/Creative Commons)

Nine pallets of caps, gowns, boots, and masks are sitting at the JFK airport in New York City awaiting the next available flight to West Africa. This might appear to be a routine shipment delay, but it is not. The supplies are needed by doctors in the fight against the deadly Ebola virus, and the holdup highlights a worrying gap in the humanitarian supply chain.

The personal protective equipment (PPE) – shipped by our team of doctors and logisticians in Boston[1] – is destined for the Ministry of Health and Social Welfare in Liberia, which will then distribute supplies to locations at the front lines of the health crisis such as JFK Memorial Hospital in Monrovia. PPE is essential in the fight against the Ebola virus, protecting the brave doctors and nurses who continue to diagnose and treat patients every day at their own peril.

Our “freight forwarder” collected the pallets on August 18 for consolidated air freight service, which normally means airport-to-airport delivery within three to five days using space available on commercial (passenger) airlines or dedicated cargo flights to the destination. By consolidating cargo from various shippers, freight forwarders reduce the cost of air shipment significantly from express services, which is important when shipping multiple pallets.

And here is the rub. In spite of repeated statements from the World Health Organization (WHO) advising against travel bans to and from affected countries, commercial airlines have suspended service. Clearly this constrains the ability for the international humanitarian community to send aid workers. But due to the role passenger flights play in providing air cargo capacity, these travel restrictions are effectively quarantining critical medical supplies outside Ebola-affected regions.

As of August 25, with our pallets still sitting at JFK airport, there are only two options remaining for commercial air service to Liberia: Royal Air Maroc (with service three times per week from Casablanca) and Delta (which is halting service August 31). Most of the flights to Liberia, and their air cargo capacity, were suspended:

  • Arik Air: Banned flights to Liberia and Sierra Leone beginning July 28. Flights to Guinea are continuing, with passengers screened for symptoms.
  • Asky Airlines: Stopped flights to Liberia and Sierra Leone on July 29.
  • British Air: All routes suspended to Sierra Leone and Liberia on August 5.
  • Gambia Bird: Suspended routes to Sierra Leone and Liberia on August 15.
  • Kenya Airways: Suspended commercial flights to Guinea, Liberia, and Sierra Leone on August 19.
  • Brussels Airlines: Cancelled flights to Guinea, Sierra Leone and Liberia beginning August 23.

Humanitarian aid organizations, familiar with responding to disasters where normal air service is disrupted, are chartering flights to cover the gap in air service. However, even humanitarian flights are subject to travel bans, as Senegal recently demonstrated by canceling UN Humanitarian Air Service flights to Ebola-affected countries.

Flying cargo in the space unused by passenger luggage (especially as baggage fees encourage a shift to carry-ons) has long been an efficient option for time-sensitive freight. Travel bans, which at face value seem to prevent the spread of disease, actually constrain the crucial human and material resources required to manage the Ebola outbreak.

Fortunately while writing this blog entry, news broke that Brussels Airlines is resuming flights to Liberia. Let’s hope this is a trend, reconnecting health workers in West Africa with global stocks of critical supplies. Maybe soon our nine pallets will be moving rapidly from airside at JFK airport to patient-side at JFK hospital.


[1] Pallets of critical medical supplies were assembled and shipped by a team from Boston Children’s Hospital (BCH), the University of Massachusetts Medical School (UUMS), and Massachusetts Institute of Technology (MIT). Doctors at BCH and UMMS have been working in Liberia for over seven years developing training programs for physicians and nurses. During this crisis, these doctors are supporting their Liberian colleagues by gathering in-kind donations from medical suppliers and transporting them using crowdsourced funds with logistical support from the MIT Humanitarian Response Lab.

By Thomas Henry Marcil

All industrial sectors of the economy—from insurance to wireless telecommunications—operate in a state somewhere between full competition and monopoly. The same applies to the non-profit services sector, including charities involved in humanitarian and international relief operations. Though it can be uncomfortable to imagine non-profit organizations, built around the kindness of individuals and governments, fighting for revenue and market share, this spirited battle is very much the case in the humanitarian sector.

Since it is difficult to directly measure competition in an industrial sector, economists and policy analysts (carefully) use concentration as a rough corollary. High and low sectoral concentration, depending on the nature of the industry, can offer either benefits or drawbacks to consumers. Industries that are highly concentrated—for example, automobile and cigarette manufacturers—can pass on savings to consumers given superior economies of scale and network effects, yet may also encourage needlessly high barriers to entry for other firms wishing to enter the market. On the other end of the spectrum, highly unconcentrated industries—like the residential and commercial construction sector—can benefit consumers by incentivizing superior quality at the expense of providing consumers an excessive quantity of choices.

Curious to understand more about humanitarian efforts, I wrote a paper for a class last fall identifying macro trends of non-profit international relief firms, including the concentration of this sector and implications for humanitarian aid delivery. All charities that file for tax exemption in the United States – including those who identify as international relief and humanitarian organizations – must file an IRS form 990, providing a useful source of information regarding this market. I used these data for my paper.

The chart included here plots the total revenue accrued by this sector and its Herfindahl-Hirschman Index (HHI) – a commonly used measure of industrial

Total revenue accrued and HHI Index over time for the international relief sector

Total revenue accrued and HHI Index over time for the international relief sector

concentration – as a function of time. Since 1989, when the Berlin Wall fell, there have been three major developmental stages in this sector in regards to the quantity of revenue humanitarian organizations acquire from donors, and where this revenue is being allocated.

  • From 1989 to 1998, humanitarian organizations went through a stage of capacity expansion, corresponding to the end of the Cold War, which saw a rapid increase in the number of humanitarian organizations. The HHI decreases during this period, reflecting the increasingly fragmented market.
  • From 1998 into 2008, the market saw a period of volumetric revenue expansion, where humanitarian organizations experienced a five-fold surge in funding. The corresponding rise HHI indicates this surge in funding was increasingly concentrated among the larger organizations.
  • Finally, from 2008 to today the market has experienced a period of volumetric revenue contraction, a result of the financial crisis of 2007 and 2008, and more competition.

Not being a seasoned expert in the sector, I was not sure how to interpret these results. I present them here as an observation about the relationship between the amount and the concentration of humanitarian funding. Further study to understand the state of competition in the international relief sector could help improve governmental policy, organizational strategy, and ultimately the quality of aid delivered to beneficiaries.

Survivors collect water from a broken water pipe in an area devastated by Typhoon Haiyan on November 12, 2013 in Leyte, Philippines. Four days after the Typhoon Haiyan devastated the region many have nothing left, they are without food or power and most lost their homes. Around 10,000 people are feared dead in the strongest typhoon to hit the Philippines this year. Photo: Dondi Tawatao, Getty Images

Survivors collect water from a broken water pipe in an area devastated by Typhoon Haiyan on November 12, 2013 in Leyte, Philippines. Four days after the Typhoon Haiyan devastated the region many have nothing left, they are without food or power and most lost their homes. Around 10,000 people are feared dead in the strongest typhoon to hit the Philippines this year. Photo: Dondi Tawatao, Getty Images

By Dr. Jarrod Goentzel, Director of the MIT Humanitarian Response Lab

After Super Typhoon Haiyan struck, I saw several images, videos, and anecdotes that made my gut ache. People in crowded clinics waiting for medicine to arrive, others congregating around scarce water pipes filling containers for family and friends, and saddest of all, survivors mournfully searching through makeshift morgues to identify loved ones.

During a massive disaster response, news reporters always find these stories that sadden me…and frustrate me. Inevitably, journalists ask affected people why the government and aid agencies cannot coordinate the response to meet the dire needs of victims. Interviewees usually do not know why the response is slow, but they rightly assert that the problem needs to be solved.  Reporters then find their way to the airport to find aid items – some of which may have helped the people they just interviewed – sitting on the tarmac. They ask airport officials and aid agencies why more goods are not being moved to the disaster area quicker. The response is that the situation is very dynamic and complex.

The picture is complete for the news articles and broadcasts about the disaster: needy residents are unable to understand why aid is slow, and officials are not able to clearly explain why.

Leaving the story at that point is what frustrates me. Having worked actively with humanitarian organizations on logistics for over ten years now, I know the good work that is done after these tragic situations to explain where and why aid was too slow. I see the passion of aid workers who are just as frustrated as the affected residents that the system does not work better. They identify issues and propose solutions. Then I see the incremental progress implemented during the next big disaster. The cluster approach1 proposed after the 2004 Indian Ocean Tsunami has been implemented and improved over the years.

We need both narratives during a disaster – those tracking the unmet needs and those following the coordinated response efforts . There are good sources of information about how the system is working and how many people are being served during a crisis. I have listed several of my usual sources below (note that they do have a logistics angle). These sources may be a bit dry – they are aimed to disseminate facts to other responders, not stories for the public – but they provide the information for the media consumer who is left asking: what is being done for that needy survivor Anderson Cooper just interviewed?

I also want reporters to continue finding the people whose needs are not being met appropriately (as long as their planes do not block the flow of any essential commodities). Although frustrating to me in isolation, these stories identify the service gaps in order to focus the response efforts and mobilize the resources we need to find solutions.

The aid community is just as motivated by the sad stories as the public. And they are just as frustrated when the complex system of humanitarian response does not do enough. Aid workers and the concerned public need to continue following both storylines and demanding improvements.

Information Sources for Typhoon Haiyan

Philippines National Government
http://www.ndrrmc.gov.ph – the National Disaster Risk Reduction and Management Center (NDRRMC) leads the response efforts for the Philippine government; frequent and lengthy situation reports track the impact (with several large tables of numbers), the national emergency response management efforts, and international humanitarian assistance

UN Office for the Coordination of Humanitarian Affairs (OCHA) and sector clusters
http://www.unocha.org/crisis/typhoonhaiyan and http://philippines.humanitarianresponse.info – portals with links to each of the clusters where you find more details about that sector; a key document is the Typhoon Haiyan Action Plan (12 Nov 2013), which lists the strategic objectives and key projects, with their funding requirements, for over 20 organizations

International Red Cross and Red Crescent Movement
http://www.ifrc.org/en/publications-and-reports/appeals – archive with early information bulletins; the appeal (12 Nov 2013) outlining actions planned to meet the immediate needs of the people affected and support the Philippine Red Cross in delivering humanitarian assistance; operation updates to track the progress of activities

http://reliefweb.int/disaster/tc-2013-000139-phl – an independent portal that archives documents spanning various organizations

Logistics Cluster
http://logcluster.org/ops/phl13a – portal with various documents and maps describing logistics efforts; meeting minutes and situation reports offer the best overall picture of efforts to move critical supplies; the Concept of Operations outlines the coordination mechanisms (among response organizations and with government, military, etc.), information management (e.g. customs, local transporters, infrastructure status), and common services (e.g. transportation, warehousing) to fill identified gaps in logistics capacity

http://fts.unocha.org – tracks donations made toward the UN OCHA Typhoon Haiyan Action Plan; note some donors have portals with their own situation reports and assistance efforts.


1 The Inter-Agency Standing Committee (IASC), involving the key UN and non-UN humanitarian partners, established the cluster approach for inter-agency coordination around focus areas such as shelter, nutrition, health, logistics, etc. For more information see http://www.humanitarianinfo.org/iasc.

By Dr. Jarrod Goentzel

Companies continually tinker with incentive programs for their employees to align individual behavior with business goals. Visiting a relatively new venture in Zimbabwe, I found a unique incentive scheme to drive efficiency…literally.

A Pulse employee prepares his new truck

A Pulse employee prepares his new truck

Pulse Pharmaceuticals began distributing medicine in the capital city of Harare in 2009. It started small, with only one product line and ambition. By the time I visited in January 2013, the company had grown to around 40 employees and $20 million in sales. As the company grew, some employees had earned a particularly generous company perk – a company vehicle. Note that I did not say company car, because all company vehicles are pickup trucks.

Why no cars? Because this employee incentive scheme aligns with the company’s distribution system. Orders in by noon are delivered the same day, and many pharmacies are open until 8pm. Pulse employees live in various areas of the city. They can make deliveries, which are primarily small pharmaceutical products, on their commute home. Even the CFO is engaged in logistics on a regular basis.

Besides the obvious logistical advantages, this incentive scheme works on several levels. While receiving a company

Cars await distribution to Pulse employees in Zimbabwe

Cars await distribution to Pulse employees in Zimbabwe

vehicle is a notable acknowledgement of an employee’s past contributions, it is also encourages loyalty for key employees to the company. The perk also fits with my observations about the corporate culture at Pulse, which is very entrepreneurial and focused on growth; Pulse rewards individuals with assets that enable them to continue investing their time, particularly their commute, in growing profits. Finally, the perk is not insignificant; tangible assets are highly valued in a country where recent experience with hyperinflation diminished confidence in monetary incentives.

I’m not sure this is the start of a trend. Walmart does not give its top performers a Peterbilt with sleeper cab. Even UPS, where managers often help out temporarily by delivering packages during peak seasons, is not sending its execs home with a brown truck for their personal use. But for a hungry startup in Zimbabwe, this creative incentive scheme aligns personal, cultural, AND logistical goals in a unique way to really deliver the goods.

By Tim Russell

I recently started working with the World Food Programme (WFP) in Khartoum, Sudan. The project we are collaborating on is designed to build a predictive model that can be used to assist with voucher programming as WFP considers expanding the percentage of food assistance fulfilled with vouchers. The plan is for me to split time between Khartoum and the United Arab Emirates (UAE), where I’m currently living with my family.

In December I was able to spend three weeks with WFP in Sudan. I experienced normal “working a new country” issues such as how to get around without a car, should I flag down that rickshaw, inability to speak the language, and gaining access to local currency while facing US economic sanctions and high inflation.

The sanctions render credit cards useless and force you to carry cash into the country. In the three weeks I was first there, the unofficial exchange rate dropped  by 10%. I quickly learned to exchange small amounts to reduce losses.

After a few starts and stops, security cleared a trip for me to visit the North Darfur office in El Fasher. I was cleared to stay in the guesthouse, visit the office, and go to a camp in the city limits. This trip was the best part of my visit to Sudan.  I was able to talk to people redeeming vouchers and traders providing critical food commodities. It felt as if the traders enjoyed explaining how their operations worked. I was also able to spend time with fantastic WFP staff that built and maintained the successful voucher program in El Fasher – professionals through and through. To top it all off, the cook at the guesthouse in El Fasher is known as the best in WFP and put the restaurants near my hotel in Khartoum to shame. We even had fresh baked cookies.

Things I learned during this trip to Sudan…

1) I am a distraction, no matter how much I try not to be. In the past, while working on network optimization at Pepsi, I had to make time for consultants in my schedule. Now I am the one asking others to put aside their work to help me do mine.

2) WFP has supply chain thinking in its DNA. It was refreshing to ask questions about transportation and warehousing and not have people blankly stare back at you. Everyone from human resources to drivers understand the importance of a supply chain frame of mind.

3) It gets COLD in Darfur at night – extra blankets and a room heater kind of cold.

4) Khartoum is very friendly, and no one I spoke to held me, as a US citizen, personally responsible for US sanctions.

5) Darfur is beautiful. It is a desert but with wild cereals growing after the rains and black rocky hills.

6) I was struck by how long people have been living in the camps outside El Fasher and how permanent they looked. To my untrained eye, they appeared as a suburb of the city. Houses made of mud brick are surrounded by well-established hospitals, thriving schools with kids running all around, and active markets inside the camp.

I will be heading back to Sudan soon to continue the research project. Next we will focus on data gathering. I hope get out of Khartoum and see more of Sudan, specifically the growing regions around Gedarif. I also am looking forward to talking to more people involved in the food value chain. Those conversations have been my favorite part of the work to date. Everyone has been excited to share his or her expertise.