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Ebola crisis: the world must do better

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The reputation of the global system for preventing and responding to infectious disease outbreaks has taken a battering in the wake of the west African Ebola epidemic.

Yet a prestigious Independent Panel believes it is possible to rebuild confidence and prevent future disasters, releasing a roadmap of 10 interrelated recommendations for national governments, the World Health Organisation, non-government organisations and researchers.

The Independent Panel on the Global Response to Ebola, launched jointly by the Harvard Global Health Institute and the London School of Hygiene and Tropical Medicine, spent months reviewing the worldwide response to the outbreak that began in 2013.

“The west African Ebola epidemic … was a human tragedy that exposed a global community altogether unprepared to help some of the world’s poorest countries control a lethal outbreak of infectious disease,” the Panel wrote in The Lancet.

“The outbreak continues … It has infected more than 28,000 people and claimed more than 11,000 lives, brought national health systems to a halt, rolled back hard-won social and economic gains in a region recovering from civil wars, sparked worldwide panic, and cost several billion dollars in short-term control efforts and economic losses.”

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The Panel said its goal was to convince high-level political leaders worldwide to make necessary and enduring changes to better prepare for future outbreaks while memories of the human costs of inaction remained vivid and fresh.

It identified four key phases of inaction:

  • December 2013 to March 2014, when Guinea’s lack of capacity to detect the virus allowed it to spread to neighbouring Liberia and Sierra Leone;
  • April to July 2014, when intergovernmental and non-government organisations started to respond, health workers struggled to diagnose patients and provide effective care, national authorities played down the scope of the outbreak, and WHO and the US CDC sent expert teams but withdrew them prematurely;
  • August to October 2014, when global attention and responses grew, but so did panic and misinformation, leading to unnecessary and harmful trade and travel bans; and
  • October 2014 to September 2015, when cases began to decline, and large-scale global assistance started to arrive, albeit with weak coordination and a lack of accountability for the use of funds.

“This Panel’s overarching conclusion is that the long-delayed and problematic international response to the outbreak resulted in needless suffering and death, social and economic havoc, and a loss of confidence in national and global institutions,” the Panel said.

“Failures of leadership, solidarity and systems came to light in each of the four phases. Recognition of many of these has since spurred proposals for change. We focus on the areas that the Panel identified as needing priority attention and action.”

The Panel made 10 recommendations:

  • develop a global strategy to invest in, monitor, and sustain national core capacities;
  • strengthen incentives for early reporting of outbreaks and science-based justifications for trade and travel restrictions;
  • create a unified WHO Centre for Emergency Preparedness and Response with clear responsibility, adequate capacity, and strong lines of accountability;
  • broaden responsibility for emergency declarations to a transparent, politically protected Standing Emergency Committee;
  • institutionalise accountability by creating an independent Accountability Commission for Disease Outbreak Prevention and Response;
  • develop a framework of rules to enable, govern and ensure access to the benefits of research;
  • establish a global facility to finance, accelerate, and prioritise research and development;
  • sustain high-level political attention through a Global Health Committee of the Security Council;
  • a new deal for a more focused, appropriately financed WHO; and
  • good governance of WHO through decisive, time-bound reform, and assertive leadership.

“The human catastrophe of the Ebola epidemic that began in 2013 shocked the world’s conscience and created an unprecedented crisis,” the Panel concluded.

“The reputation of WHO has suffered a particularly fierce blow. Ebola brought to the forefront a central question: is major reform of international institutions feasible to restore confidence and prevent future catastrophes? Or should leaders conclude the system is beyond repair and take ad hoc measures when the next major outbreak strikes?

“After difficult and lengthy deliberation, our Panel concluded major reforms are warranted and feasible.”

Maria Hawthorne