The economic burden of Ebola virus disease: a review and recommendations for analysis

Figures & data

Table 1. Burden of disease.

First Author, Year, Country/Region	Objective	Perspective	Method	Results
Bartsch, 2015, Guinea, Liberia, Sierra Leone^19	To develop a computational model that estimates the costs of different types of ebola cases for the countries where major outbreaks are occurring	Societal and health care provider	Monte Carlo Simulation model to determine the direct medical costs and productivity losses of ebola cases	“The total societal cost of an EVD case with full recovery ranges from $480 to $912, while that of an EVD case not surviving ranges from $5929 to $18 929, varying by age and country. Therefore, as of 10 December 2014, the estimated total societal costs of all reported EVD cases in these three countries range from $82 to potentially over $356 million”.
Bowles, 2016, Liberia^20	To provide evidence on the extent to which economic activity declined and jobs disappeared in Liberia during the outbreak.	Societal	Panel data set of registered firms surveyed by business-development non-profit organization (Building Markets) and comparison of change in economic activity during the outbreak, across regions of the country.	Decrease in economic activity and jobs during the Ebola outbreak, with a worse decline in Monrovia. Persistence of this decline will require an economic recovery that rebuilds and supports the healthcare system for Liberia to regain its footing.
Da Costa, 2020, Liberia^21	To quantify the impact of EVD‐related mortality on individual and total welfare in Liberia.	Societal	Using a WTP approach to determine welfare losses due to EVD	The total welfare loss due to EVD‐related mortality ranges from around $90 to $190 million, depending on the bound of the survival estimates used. The costs appear to be slightly greater for females than for males.
Elmahdawy, 2017, West Africa^22	To examine the response to an EVD outbreak in West Africa, identify direct and indirect treatment costs, present key economic challenges and learned lessons, and highlight policy recommendations to further assist an already stretched health system in Africa.	Public health system	Discussion	EVD poses a challenge, in terms of significant medical and economic implications, to Africa where the health system is weak.
Huber, 2018, West Africa^23	To review all currently available estimates, identify social components missed by these estimates and generate a comprehensive cost of the 2014 EVD outbreak.	Societal	Systematic review	The economic burden of EVD was estimated to range from $2.8 to $32.6 billion in GDP losses. A comprehensive economic and social burden was estimated at 53.19 billion, with the most significant component ($18.8 billion) resulting from deaths from non-ebola causes.
Kirigia, 2015, West Africa^24	To estimate the future productivity losses associated with EVD deaths in the West African region, to encourage increased investments in national systems.	Societal	Cost-of-illness method to calculate future non-health gross domestic product losses associated with EVD deaths and discounted at 3%.	The discounted non-health gross domestic product loss (NHGDPLoss) due to the 11,234 deaths associated with EVD was estimated to be INT$155,663,244. The average NHGDPLoss per EVD death was estimated to be INT$17,473 for Guinea, INT$ 11283 for Liberia, INT$ 25,126 for Mali, INT$47,364 for Nigeria and INT$14,633 for Sierra Leone.
Kirigia, 2019, Democratic Republic of Congo^25	To estimate the monetary value of human lives lost through EVD in DRC	Societal	Human capital approach was applied to monetarily value years of life lost due to premature deaths from EVD. The future losses were discounted to their present values at 3% discount rate.	The 1286 deaths resulted in a total MVYLL of Int$17,761,539 assuming 3% discount rate and DRC life expectancy of 60.5 years. The average monetary value per EVD death was of Int$13,801. About 44.7 and 48.6% of the total MVYLL was borne by children aged below 9 years and adults aged between 15 years and 59 years, respectively.
Kum, 2019, Sierra Leone^26	To investigate the effect of Ebola outbreak on government capital expenditure of the Sierra Leonean government.	Government	World Bank Data Repository, International Monetary Fund an Endogenous Growth Model of Public Expenditure, which assumes that Gross National Income (GNI) growth is determined by forces governing the production process rather than by forces outside it.	EVD impacted negatively on government capital expenditure in Sierra Leone.
Morrison, 2023, Africa^27	To evaluate the relationship between outbreak size and economic impact among countries with recorded Ebola outbreaks and to quantify the hypothetical benefits of prophylactic Ebola vaccination interventions in these outbreaks.	Government	A synthetic control method (SCM) was used to identify the causal effects of past Ebola outbreaks on per capita GDP at PPP. Disease incidence was calculated using illustrative vaccine deployment scenarios to estimate upper and lower bounds of the potential cases averted by prophylactic Ebola vaccination. The output from the prior two steps was used to predict the economic benefit of reduced Ebola cases in the context of a prophylactic vaccination program.	EVD outbreaks led to up to 36% decline in GDP, which was greatest in the third year after the onset of each outbreak and increased exponentially with the size of outbreak (i.e. number of reported cases). An aggregate loss estimated for Sierra Leone from its 2014–2016 outbreak is estimated at 16.1 billion International $.
Olugasa, 2015, Nigeria^28	To determine the social and preventive cost implications of EVD among selected public institutions in Lagos, Nigeria.	Societal	Descriptive cross-sectional study that used questionnaires and key informant interviews.	Respondents declared a total cost of approximately N5,019,379.80 only. The mean expenditure on these institutions translated to an approximate N1, 027,094,756.10 on all related institutions (hospitals, hotels, and schools) in Lagos state during the study period.
Onyekuru, 2022, West Africa^29	To explore the impacts of EVD, government and institutional interventions and their nexus towards effective management of health crises	Government	A critical review of empirical literature was adopted for the methodological approach and narrative synthesis used for analysis.	EVD had diverse impacts on West Africa; economically through the loss of income from economic activities due to widespread sickness among workers and movement restrictions. EVD also had significant social impacts, such as reduced community cohesion, school, and business closures, job losses, food insecurity, and high morbidity and mortality.
Zacharowski, 2015, Germany^30	To describe the costs of managing an Ebola patient.	Healthcare institution	Cost analysis	The overall costs (direct and indirect) of patient transfer, treatment, and management of exceeded €1 million, a high proportion of which was composed of health and safety measures for personnel. These costs could be considered a high price to pay for treatment and care of one EVD patient.
Zeng, 2023, DRC^31	To estimate the unit costs of key EVD control interventions.	Healthcare system	Cost analysis using top-down approach	The unit costs for essential EVD control interventions were as outlined: $66,182 for sustaining a rapid response team per month, $4,435 for contact tracing and surveillance per identified EVD case, $1,464 for EVD treatment per case, $59.4 per EVD laboratory test, $120.7 per vaccinated individual against EVD, and $175.0 for mental health and psychosocial support per beneficiary.

Table 2. Willingness to pay for EVD vaccine.

First Author, Year, Country/Region	Objective	Perspective	Method	Results
Huo, 2016, Sierra Leone^32	To understand the Ebola vaccine-related knowledge and attitude of the general population	Societal	Survey on knowledge and attitudes towards the vaccine.	Most participants (72.5%) were willing to take the vaccine if it was for free. If it was not free, only 26.6% were willing to pay for it. Monthly salary, monthly average income of family members and their interaction were found to be associated with charged vaccination uptake willingness.
Kpanake, 2018, Guinea^33	To map the different personal positions of Guinean people regarding vaccination against Ebola	Societal	Using vignettes depicting situations in which getting vaccinated will be possible.	Attitude toward vaccination depends on costs, neighbor’s attitude, risk, and mistrust of cheap vaccines.
Mudatsir, 2019, Indonesia^34	To determine the WTP for a hypothetical EVV in Indonesia	Societal	Cross sectional study of interviews in 5 cities in Aceh where participants were interviewed about socio-demographics, knowledge about Ebola, and WTP for a hypothetical vaccine.	288 participants out of 311 were willing to pay a mean of $2.08 for the vaccine. Proportion of participants willing to pay was high but the amount they were ready to pay was low.
Painter, 2018, USA^35	To examine factors associated with willingness to pay for an ebola vaccine among US national sample during the recent ebola outbreak	Societal	National survey measuring willingness to pay.	Among 1447 participants, 40.3% would not pay for an ebola vaccine, 59.7% would pay at least $1.
Ughasoro, 2015, Nigeria^36	To determine the public acceptability and willingness to pay for an EVV	Societal	Community based cross-sectional qualitative and quantitative study. Questionnaires used to collect information on respondents’ knowledge of ebola, and their acceptability and willingness to pay for a hypothetical vaccine.	Among those who accepted to be vaccinated, most would only accept after observing the outcome on others who received the vaccine. More than 87.5% were willing to pay for the vaccine although 55.2% thought it should be free.

Table 3. Cost-effectiveness analysis.

First Author, Year, Country/Region	Objective	Perspective	Method	Results
Obeng-Kusi, 2021, Democratic Republic of Congo^37	To determine the cost-effectiveness of an EVD vaccine and a vaccination program at large in a hypothetical population of 1,000	Payer	Cost-effectiveness analysis using a dynamic transmission model	Vaccinating 50% of the population at risk prevented 670 cases, 538 deaths, and 22,022 disability-adjusted life years (DALYs). The vaccine was found to be cost-effective with an incremental cost-effectiveness ratio (ICER) of $95.63 per DALY averted.

Table 4. Cost-benefit analysis.

First Author, Year, Country/Region	Objective	Perspective	Method	Results
Kellerborg, 2020, Sierra Leone^38	To estimate the costs and health effects of earlier interventions in Sierra Leone	Societal	Deterministic and a stochastic compartment model describing the EVD outbreak was estimated using a variety of data sources. Costs and Disability-Adjusted Life Years were used to estimate and compare scenarios of earlier interventions.	Investigators found that four weeks prior to their study, interventions would have averted 10,257 cases and 8835 deaths, implying 456,000 DALYs and million $US saved. The greatest losses occurred outside the healthcare sector.

Table 5. Cost of preparedness.

First Author, Year, Country/Region	Objective	Perspective	Method	Results
Kellerborg, 2020, Sierra Leone^38	To estimate the costs and health effects of earlier interventions in Sierra Leone	Societal	Deterministic and a stochastic compartment model describing the EVD outbreak was estimated using a variety of data sources. Costs and Disability-Adjusted Life Years were used to estimate and compare scenarios of earlier interventions.
Abraham, 2015, USA^39	To determine the overall cost of EVD preparedness in one county hospital ED.	No clearly defined- Cost to county?	Cost-analysis: Retrospective review of all emergency department expenditures associated with complying with the CDC recommendations for EVD for a large, urban, academic, county emergency department with annual census of greater than 170000 patients.	Total emergency department expenditure was $44,026. The costs of registered nurse management and registered nurse personal protective equipment training time were $4,716 and $5,005, respectively. Total PPE costs totaled to $28,098 while containment equipment amounted to $840.
Herstein, 2016, USA^40	To directly survey the Ebola treatment centers (ETCs) to determine the costs incurred to prepare their facilities to manage and treat EVD patients	Societal	Use of electronic surveys	45 ETCs reported total costs incurred to cumulatively to $53,909,701 (mean of $1,197,993/ETC) to establish the ETCs. The costliest activity was facility construction and modifications.
Herstein, 2020, USA^41	To determine whether additional costs have been incurred since a previous assessment of cost of establishing ebola treatment centers (ETCs) in 2015, as well as to assess hospitals’ sustainability plans for maintaining capabilities after federal funding ceases.	Health care provider	Electronic survey of representatives of 56 ETCs.	An average additional $225,000 has been spent per ETC. Even with the increased cost since the initial assessments (nearly $1.8 million compared with $1.2 million in 2015), there are still gaps in reimbursement from federal and state funding have also increased.
McCullough, 2019, USA^42	To estimate direct costs of mounting emergency preparedness and response activities to 3 major public health events, simultaneously.	Public health department	A cost analysis was performed from the perspective of the public health department using real-time activity diaries and retrospective time and activity self-reporting, wage and fringe benefit data, and financial records to track costs.	Total cost for measles-, Super Bowl-, and Ebola-related activities from January 22, 2015, through March 4, 2015, was $224 484, majority of which was for personnel ($203 743) and the costliest response to measles ($122 626 in personnel costs).
Morgan, 2015, USA^43	To examine costs and challenges associated with hospital ebola preparation by means of a survey of Society of Healthcare Epidemiology of America members	Health care provider	Electronic survey of infection prevention experts.	Hospital Ebola preparations required extraordinary resources, diverted from routine infection prevention activities.
Ripper, 2015, USA^44	To describe the necessary components for building and maintaining an Ebola extended treatment area and to present the predictable costs of implementation, maintenance, and care of a university hospital’s Ebola extended treatment area	Health care provider	Cost analysis	Costs of implementation of the hospital Ebola extended treatment area was $688,000; Costs of maintenance was $19,875 per month. Costs of care for a patient in the treatment area was $87,500 per 100 patient care hours. The total cost of implementation and maintenance of Ebola extended treatment areas with 100 patient care hours was $767,000.
Simonsen, 2017, USA^45	To analyze the attributable costs of EVD preparedness during the peak outbreak period at a freestanding children’s hospital using an ETF member survey	Health care provider	Cost analysis	Overall, Ebola preparedness annualized expenditures totaled $181,350.
Smit, 2017, USA^46	To assess resource allocation and costs associated with US hospitals preparing for the possible spread of the 2014–2015 EVD epidemic in the US	Health care provider	Cross-sectional study using surveys sent to stratified national probability sample of US hospitals. Surveys assessed EVD preparation supply costs and overtime staff hours.	Supply and overtime labor costs totaled $80,461. The cost of preparedness of acute-care hospitals in the US was estimated at $361,108,968.
Suijkerbuijk, 2017, Netherlands^47	To present the total costs associated with EVD preparedness and response in healthcare in the Netherlands	Health care provider	Activity based costing methods using interviews with key professionals in EVD preparedness and response in the organizations involved. A time-recording system was used to estimate the cost of staff time spent in preparedness and response activities.	Estimated total cost averaged €12.6 million (€ 6.7 million to 22.5million).
Tariq, 2020, West Africa^48	To estimate the economic costs of preventive measures of the epidemic to an extractive firm, ArcelorMittal (AM), using data in the epidemic region from March 2014 to December 2015	An extractive company (ArcelorMittal)	Qualitative methods were used to investigate the events and channels of impact on the firm while retrospective cost analysis was used to estimate the cost of preventive methods.	“Total costs incurred for adopting preventive measures were USD 10.58–11.11 million. The overall direct costs of preventive measures adopted within the fence, meaning within the physical boundary of the firm’s sites, shared 30–31% of the total costs incurred. The share of external donations supporting humanitarian response was 11–12% of the total costs, followed by 7–12% of relational costs”
Yacisin, 2015, USA^49	To describe preparedness activities that include planning and practice in effectively monitoring the health of workers involved in Ebola patient care	Local health department	Cost analysis	In New York City, the public health response to one Ebola case cost $4,300,000 in Department of Health and Mental Hygiene funds. This cost included the direct costs of the local public health response and also the indirect costs of increasing citywide preparedness after identifying the one case.

Table 6. Funding.

First Author, Year, Country/Region	Objective	Perspective	Method	Results
Boddie, 2015, USA^50	To discuss resources dedicated by the federal government for developing medical countermeasures to be used if Ebola is used as a bioweapon against USA	Federal government	Discussion	As of December 1, 2014, $25.6 million of the $750 million in funding had been expended by DoD for Ebola countermeasures research and development.
Fitchett, 2016, USA^51	To document data on research funding for emerging infections (EBOLA)	Funding organizations	Systematic review using data directly from funding organizations.	Funding for Ebola and Marburg virus research totaled $1.035 billion.
Shimizu, 2022, Africa^52	To analyze the extent to which equitable development assistance for health (DAH) has been provided in accordance with disease burden in EVD-affected countries.	International development agencies	Estimates of disability-adjusted life years (DALYs) in the Global Burden of Disease (GBD) Study 2017 and DAH Database 1990–2019 in 2005–2017 were analyzed by disease category: vaccine-preventable diseases (VPDs), HIV/AIDS, malaria, tuberculosis, and EVD.	In West Africa, DAH/DALYs increased in EVD while fluctuating in HIV/AIDS and malaria between 2013–2016.

Figure 1. Number of Ebola virus disease cases per country between 1976 and 2023.

Figure 2. Number of Ebola virus disease deaths per country between 1976 and 2023.

Bartsch SM, Gorham K, Lee BY. The cost of an ebola case. Pathog Glob Health. 2015;109(1):4–9. http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L603981462.

 PubMed Web of Science ®Google Scholar

Bowles J, Hjort J, Melvin T, et al. Ebola, jobs and economic activity in Liberia. J Epidemiol Community Health. 2016;70(3):271–277. http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L614446481. doi:10.1136/jech-2015-205959.

 PubMed Web of Science ®Google Scholar

Da Costa S. The impact of the ebola crisis on mortality and welfare in Liberia. Health Econ. 2020;29(12):1517–1532. doi:10.1002/hec.4150.

 PubMed Web of Science ®Google Scholar

Elmahdawy M, Elsisi GH, Carapinha J, et al. Ebola virus epidemic in west africa: global health economic challenges, lessons learned, and policy recommendations. Value Health Reg Issues. 2017;13:67–70. http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L618232240. doi:10.1016/j.vhri.2017.08.003.

 PubMedGoogle Scholar

Huber C, Finelli L, Stevens W. The economic and social burden of the 2014 ebola outbreak in west africa. J Infect Dis. 2018;218(suppl_5):S698–S704. https://academic.oup.com/jid/article-abstract/218/suppl_5/S698/5129071. doi:10.1093/infdis/jiy213.

 PubMed Web of Science ®Google Scholar

Kirigia JM, P A, Masiye F, et al. Indirect costs associated with deaths from the ebola virus disease in west africa. Infect Dis Poverty. 2015;4(1):45. http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L606662254. doi:10.1186/s40249-015-0079-4.

 PubMedGoogle Scholar

Kirigia JM, Muthuri RNDK, Muthuri NG. The monetary value of human lives lost through ebola virus disease in the democratic republic of Congo in 2019. BMC Public Health. 2019;19(1):1218. doi:10.1186/s12889-019-7542-2.

 PubMed Web of Science ®Google Scholar

Kum FV, Olayiwola S, Aloysius NM. The impact of ebola virus disease on government expenditure in Sierra Leone. In: Socio-cultural dimensions of emerging infectious diseases in Africa. Springer Nature Switzerland AG; 2019. p. 75–90. https://www.worldbank.org/en/topic/macroeconomics/publication/2014-2015-west-africa-ebola-crisis-impact-update

 Google Scholar

Morrison IDL, Anderson BI, Brower AI, et al. Macroeconomic impact of ebola outbreaks in Sub-Saharan africa and potential mitigation of GDP loss with prophylactic ebola vaccination programs. PLOS ONE. 2023;18(4):e0283721. doi:10.1371/journal.pone.0283721.t001.

 PubMed Web of Science ®Google Scholar

Olugasa BO, Oshinowo OY, Odigie EA. Preventive and social cost implications of ebola virus disease (EVD) outbreak on selected organizations in Lagos state, Nigeria. Pan Afr Med J. 2015;22(Supp 1):20–20. http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L616010262. doi:10.11604/pamj.supp.2015.22.1.6673.

 PubMedGoogle Scholar

Onyekuru NA, Ihemezie EJ, Ezea CP, et al. Impacts of ebola disease outbreak in west africa: implications for government and public health preparedness and lessons from COVID-19-NC-ND license. Sci Afr. 2023;19:e01513. (http://creativecommons.org/licenses/by-nc-nd/4.0/). doi:10.1016/j.sciaf.2022.e01513.

 PubMedGoogle Scholar

Zacharowski K, Brodt HR, Wolf T. Medical treatment of an ebola-infected doctor - Ethics over costs? Lancet. 2015;385(9969):685–685. doi:10.1016/S0140-6736(15)60279-3.

 PubMed Web of Science ®Google Scholar

Zeng W, Samaha H, Yao M, et al. The cost of public health interventions to respond to the 10th ebola outbreak in the democratic republic of the Congo. BMJ Glob Health. 2023; 8(10):e012660. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10583089/. doi:10.1136/bmjgh-2023-012660.

 PubMed Web of Science ®Google Scholar

Huo X, Shi G, Li X, et al. Knowledge and attitudes about ebola vaccine among the general population in Sierra Leone. Vaccine. 2016;34(15):1767–1772. doi:10.1016/j.vaccine.2016.02.046.

 PubMed Web of Science ®Google Scholar

Kpanake L, Sorum PC, Mullet É. Willingness to get vaccinated against ebola: a mapping of guinean people positions. Hum Vaccin Immunother. 2018;14(10):2391–2396. doi:10.1080/21645515.2018.1480236.

 PubMed Web of Science ®Google Scholar

Mudatsir M, Anwar S, Karunia Fajar J, et al. Willingness-to-pay for a hypothetical ebola vaccine in Indonesia: a cross-sectional study in Aceh. F1000Res. 2019;8:1441. doi:10.12688/f1000research.20144.1.

 PubMedGoogle Scholar

Painter JE, von Fricken ME, Viana de O, et al. Willingness to pay for an ebola vaccine during the 2014–2016 ebola outbreak in west africa: results from a U.S. National sample. Hum Vaccin Immunother. 2018;14(7):1665–1671. doi:10.1080/21645515.2018.1423928.

 PubMed Web of Science ®Google Scholar

Ughasoro MD, Esangbedo DO, Tagbo BN, et al. Acceptability and willingness-to-pay for a hypothetical ebola virus vaccine in Nigeria. PLoS Negl Trop Dis. 2015;9(6):e0003838. http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L605059981. doi:10.1371/journal.pntd.0003838.

 PubMed Web of Science ®Google Scholar

Obeng-Kusi M, Habila MA, Roe DJ, et al. Economic evaluation using dynamic transition modeling of ebola virus vaccination in lower-and-Middle-income countries. J Med Econ. 2021;24(sup1):1–13. doi:10.1080/13696998.2021.2002092.

 PubMed Web of Science ®Google Scholar

Kellerborg K, Brouwer W, Van Baal P. Costs and benefits of early response in the ebola virus disease outbreak in Sierra Leone. Cost Eff Resour Alloc. 18(1):13. doi:10.1186/s12962-020-00207-x.

 PubMed Web of Science ®Google Scholar

Abraham N, Jain A, Harrison D, et al. 70 A cost analysis of a county hospital emergency department’s ebola virus disease preparedness. Ann Emerg Med. 2015;66(4):S25. doi:10.1016/j.annemergmed.2015.07.102.

 PubMedGoogle Scholar

Herstein JJ, Biddinger PD, Kraft CS, et al. Initial costs of ebola treatment centers in the United States. Emerg Infect Dis. 2016;22(2):350–352. doi:10.3201/eid2202.151431.

 PubMed Web of Science ®Google Scholar

Herstein JJ, Le AB, McNulty LA, et al. Update on ebola treatment center costs and sustainability, United States, 2019. Emerg Infect Dis. 2020;26(5):1007–1009. doi:10.3201/eid2605.191245.

 PubMed Web of Science ®Google Scholar

Mccullough JM, Fowle N, Sylvester T, et al. Cost analysis of 3 concurrent public health response events: financial impact of measles outbreak, super bowl surveillance, and ebola surveillance in maricopa county. J Public Health Manag Pract. 2019;25(4):357–365. doi:10.1097/PHH.0000000000000818.

 PubMed Web of Science ®Google Scholar

Morgan DJ, Braun B, Milstone AM, et al. Lessons learned from hospital ebola preparation. Infect Control Hosp Epidemiol. 2015;36(6):627–631. doi:10.1017/ice.2015.61.

 PubMed Web of Science ®Google Scholar

Ripper J, Nagurka R, Patel M, et al. 98 The cost of safety: implementation, maintenance, and patient care expenses of an emergency department ebola extended treatment area. Annals of Emergency Medicine. 2015;66(4):S34–S35. doi:10.1016/j.annemergmed.2015.07.130.

 Google Scholar

Simonsen KA, Phipps AR, Hall M, et al. Costs associated with ebola preparedness at a freestanding pediatric assessment center. Infect Control Hosp Epidemiol. 2017;38(11):1367–1369. doi:10.1017/ice.2017.193.

 PubMed Web of Science ®Google Scholar

Smit MA, Rasinski KA, Braun BI, et al. Ebola preparedness resources for acute-care hospitals in the United States: a cross-sectional study of costs, benefits, and challenges. Infect Control Hosp Epidemiol. 2017;38(4):405–410. doi:10.1017/ice.2017.6.

 PubMed Web of Science ®Google Scholar

Suijkerbuijk AWM, Swaan CM, Mangen MJJ, et al. Ebola in The Netherlands, 2014–2015: costs of preparedness and response. Eur J Health Econ. 2018;19(7):935–943. doi:10.1007/s10198-017-0940-4.

 PubMed Web of Science ®Google Scholar

Tariq H, Emes DT, Boo YY, et al. Economic impact of ebola virus disease outbreak on an extractive firm: a case study. UCL Open Environ. 2020;2:e007. doi:10.14324/111.444/ucloe.000007.

 PubMedGoogle Scholar

Yacisin K, Balter S, Fine A, et al. Ebola virus disease in a humanitarian aid worker—New York city, october 2014. Mortality Weekly Report. 2015;64:321–323.

 PubMed Web of Science ®Google Scholar

Boddie C. Federal funding in support of ebola medical countermeasures R&D. Health Secur. 2015;13(1):3–8. doi:10.1089/hs.2015.0001.

 PubMed Web of Science ®Google Scholar

Fitchett JRA, Lichtman A, Soyode DT, et al. Ebola research funding: a systematic analysis, 1997-2015. J Glob Health. 2016;6(2):020703. doi:10.7189/jogh.06.020703.

 PubMed Web of Science ®Google Scholar

Shimizu K, Checchi F, Warsame A. Disparities in health financing allocation among infectious diseases in ebola virus disease (EVD)-affected countries, 2005–2017. Healthcare (Switzerland). 2022;10(2):179. doi:10.3390/healthcare10020179.

 PubMedGoogle Scholar