IN THE SUMMER OF 2014, Shunsuke Mabuchi MPP 2007 received an urgent call from his supervisor at the World Bank. The worst outbreak of Ebola in 40 years was cutting a deadly swath across West Africa, and the World Bank, well-known for financing long-term development projects, was mobilizing emergency funding for the first time in its history.
The virus was traveling fast, migrating from isolated, rural areas to dense capital cities, and would eventually spread to Europe and the United States. By August, it had claimed close to 1000 lives, mostly in Liberia, Sierra Leone, and Guinea, and estimates projected over 700,000 deaths if left unchecked.
Across the world, Mabuchi was a week into paternity leave with his first child when he was appointed to lead the emergency response. “I was told, ‘Take whatever measures you want,’” he says. “‘But do it in 30 days.’”
The normal timeline for World Bank funding approval was one-and-a-half years. To deliver money to the countries that were hardest hit in 30 days meant drastically reorganizing funding protocols. Mabuchi quickly assembled a team that “cut whatever we could cut, postponed whatever [compliance measure] we could postpone, and visualized every process and every delay in each of the three countries” on a daily basis, he recalls.
“Shunsuke was beloved as a teaching fellow. [He] is brilliant and passionate about public service, but what sets him apart is his incredible wit and sense of delight.”
Some of the operational complexities, such as ensuring effective infection prevention and contact tracing procedures, coordinating efforts between multiple governments, aid agencies, and NGOs, and overcoming people’s distrust of public health facilities, Mabuchi had previously managed as team lead of various World Bank health projects, including the eradication of polio in Nigeria.
But there were two complex challenges unique to the Ebola outbreak: first, after accelerating approval for an initial $123 million, he had to deliver funds quickly and securely to frontline workers, who were facing extremely high risks with inadequate pay.
“Ebola response workers were dying in droves,” says Steve Gaojia, who was chief operating officer of Sierra Leone’s National Ebola Response Center. “Nobody wanted to risk his or her life without some kind of hazard pay and insurance for their families.”
The lack of “a sufficient risk premium” caused many strikes; protesters piled dead bodies—a dangerous source of contagion—on the streets, says Mabuchi, who developed and delivered a risk hazard allowance, along with other funds, within a month, an impossibly fast time frame.
“But [then] there were no linked bank accounts, no record of who was working where, or even if a worker actually existed.” Early on, there was a feverish grab of emergency response money, and senior management teams in the Ministry of Health in Sierra Leone were removed to curb corruption.
Working in tandem with the police, anti-corruption workers, and a local IT company, Mabuchi’s team registered and paid workers one by one, creating a database for streamlining payments as they went along. They leveraged village resources to make secure payments, accompanying workers to local mobile phone kiosks, where payment could be verified by a SIM card, and cash transferred to the health workers.
The second challenge was containing social transmission. In West Africa, funeral rites are very important, says Mabuchi. It’s customary for families to wash and dress the bodies, and for mourners to touch the deceased—a custom that sped transmission of the virus, which peaks as death approaches.
“You had to understand the cultural context and local reality,” he says. “You couldn’t do the [standard] approach where you disinfect the body, pack it in a bag, and burn it ... [that led] people to resist, and even hide the dead,” which further escalated infection.
The tide turned when community, tribal, and religious leaders, health authorities, and anthropologists were brought together to create a solution deemed acceptable to the community yet safe. Ceremonies were held so the living could say goodbye and pay respects to the dead in a dignified manner, guided in prayer by spiritual leaders, at a safe distance.
At the end of two and a half years, Ebola took over 11,000 lives, a fraction of the early projections. Sierra Leone was declared Ebola-free in 18 months, in no small part due to Mabuchi’s diligence, says Gaojia, who recalls working with him, sleeves rolled up in the emergency response center, breaking complex problems down into manageable parts.
“Shun has a way of looking at a complex issue, simplifying it, and making implementable [solutions],” Gaojia says.
Mabuchi credits his ability to cut through complexity to a diverse academic and career path that appears at first glance meandering.
He was born in Philadelphia, and after the age of one, grew up in Tokyo, where he was raised in a family of academics (both his parents are biochemists, his grandfather was a linguist, and his aunt a professor of European art history) who pursued “what fascinated them.” As a young man, he sought to do the same.
At the University of Tokyo, he was drawn to cultural anthropology after watching a video of a tribal ritual in Papua, New Guinea. Captivated by the beauty of the ritual, Mabuchi decided, “This is what I want to do: learn about different cultures by being there, potentially living there; I wanted to understand why [different] beliefs and social systems developed.”
He backpacked around the world during school holidays, to Morocco, Egypt, Cambodia, Thailand, Nepal, Mexico, Belize, and Guatemala, where he set up an informal field study by asking Indigenous communities if he could stay with them and learn about their cultures.
Ethnographers face a double bind: they must embed themselves within a society without impacting it. For Mabuchi, befriending communities, breaking bread with people, partaking in their customs, seeing their daily struggles—deeply rooted discrimination, malnutrition, the lack of opportunities and basic medical care—instilled a deep drive to “work with a community [...] to help improve lives.”
After college, he worked for the Japanese International Cooperation Agency (JICA), an aid organization that provides grants, loans, and technical cooperation to developing countries, on various projects, including in education, rural development, and investment promotion. To enhance his impact, he enrolled at Harvard Kennedy School. vlog broadened his vision of what he could do and where.
But first he had to overcome a major obstacle: the English language. “Initially, I could not understand or follow the discussions in classes at all,” he says. He decided to “spend more time than anyone else preparing in advance,” reading all the case materials and composing thoughtful comments, which were well received but at times broke the flow of discussion. Gradually, as his English improved, he was able to build on peers’ comments, and join in spontaneous conversations.
As a teaching fellow for Professor Linda Bilmes’ budgeting class, he won the Dean’s Award for excellence in student teaching, becoming the first Japanese student in the School’s history to do so.
“[Shunsuke] was beloved as a teaching fellow,” says Bilmes, the Daniel Patrick Moynihan Senior Lecturer in Public Policy. “[He] is brilliant and passionate about public service, but what sets him apart is his incredible wit and sense of delight.” He can transform the driest of accounting topics into something funny and engaging, she says. The School still uses teaching materials he created for cost accounting “because no one has been able to come up with a better way to visualize the transformation of a line-item budget into cost drivers, cost pools, and activities leading to an activity-based budget.” That probably doesn’t sound very amusing, she notes, but when Shunsuke teaches, it is so fun.
Because he had to teach in a foreign language he was still mastering, he focused on “understanding complex subjects in a simple, visual way.” That skill has served him well in tackling the hard problems of public health, a field he was inspired to enter after hearing Bill Gates’ commencement speech urging Harvard graduates to take on the challenge of reducing global inequities.
The Bill & Melinda Gates Foundation had begun to focus on global health issues, trying to eliminate diseases like polio and malaria, which cause needless deaths every year in developing countries. Mabuchi would find his way to the foundation after a stint as a management consultant at McKinsey, then over seven years at the World Bank, during which he managed several national health portfolios (in Nigeria, Tanzania, Somalia, and Liberia) and simultaneously completed a doctorate in public health from Johns Hopkins.
As he led global healthcare delivery programs, including COVID-19 vaccine delivery, at the Gates Foundation, it became increasingly clear that “the public health problem in Africa is not a medical problem, but a managerial [one]. There were cheap, highly effective interventions that were not reaching people” because of political bureaucracy and operational delays.
The things he learned in the private sector—how to improve the profitability of a grocery store, or the productivity of an iron ore mining site; how to revive an ailing helicopter manufacturing company; how to turn a public transportation company into a private one—proved applicable to public health. The sum of his seemingly disparate experiences, it turned out, could make a huge impact.
When COVID-19 hit, he served on the Independent Panel for Pandemic Preparedness and Response led by Ellen Johnson Sirleaf MPA 1971, former president of Liberia, and Helen Clark, former prime minister of New Zealand—an experience that reinforced for him the importance of integrating pandemic response with a community’s overall health system.
Creating “an integrated system that can respond to all kinds of problems, including [current and emerging] diseases” is a task he is now leading as head of health systems at the Global Fund, one of the world’s largest global health investors. Founded in 2002, the fund aims to eliminate AIDS, tuberculosis, and malaria in lower- and middle-income countries. Twenty years ago, the three infectious diseases were the deadliest in the world; today, those deaths have been roughly halved in countries where the Global Fund invests.
But progress has slowed, and as global attention post-COVID-19 shifts to climate change and geopolitical conflicts, more will have to be done with fewer resources. Over the next three years, Mabuchi will oversee the investment of $2 billion per year to develop, strengthen, and monitor health systems and pandemic preparedness in over 100 countries.
“It’s a mission-critical role” that must see how all the pieces of a complex health ecosystem (such as disease education and prevention, supply chain warehousing and distribution, laboratory testing and tracking, data information systems, primary care operations, health workers, community leaders, and patients) interact, while prioritizing areas of greatest need and highest impact, says Michael Byrne, the Global Fund’s head of technical advice and partnerships.
The fight against the three diseases is at a critical juncture: if they are ended, the Global Fund will have fulfilled its mission. But without sustainable health systems in place, they will be near impossible to end. Mabuchi’s results may well determine the future of the fund.
In the Gisaro ritual of the Kaluli tribe, the ceremony that first drew Mabuchi to explore cultures worlds apart from his own, a group of men dressed in bright plumage are invited to sing a song of mourning for the host community’s departed. As they sing and dance, the audience is moved to tears, first of sorrow, then rage; their suffering is released by burning the flesh of the dancers. It is a performance of reciprocity between host and guest, each compensating, in turn, for the grief of the other.
“How many scars a singer has is a sign of his greatness,” Mabuchi says. “It’s a beautiful kind of vision.” A vision, in the end, not so far removed from a young backpacker’s dream to ease the struggles of his hosts, and create a more equitable future.
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Banner and inline images courtesy of Shunsuke Mabuchi.