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Global Ebola Response: Late, Feeble and Uncoordinated

A team of independent international experts has reviewed the World Health Organization’s handling of the 2014 Ebola outbreak and found it severely lacking.

The Independent Panel on the Global Response to Ebola, convened by Harvard University and the London School of Hygiene and Tropical Medicine, issued its report today in The Lancet.

“We issued what may well be the strongest rebuke to the World Health Organization on its handling of the 2014 Ebola outbreak of any group to date,” says Duke Global Health Institute visiting scholar and former Nigerian Minister of State for Health, Dr. Muhammad Pate, who co-chaired the panel. “There was a frightening lack of local public health systems and infrastructure and a breathtaking absence of leadership on the part of the world body when it came to an effective response to the Ebola crisis. Our panel suggests critically needed reforms.”

The members of the Harvard Global Health Institute-London School of Hygiene & Tropical Medicine Independent Panel on the Global Response to Ebola concluded that while the 2014-15 Ebola outbreak “engendered acts of outstanding courage and solidarity,” it also caused “immense human suffering, fear and chaos, largely unchecked by high level political leadership or reliable and rapid institutional responses.”

In addition to over 11,000 deaths from Ebola, the epidemic “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.”

The report offers 10 major reform proposals to prevent future such catastrophes, with emphasis on: preventing major disease outbreaks; responding to outbreaks; the production and sharing of research data, knowledge, and technologies; and ways to improve the governance of the global health system, with a focus on the World Health Organization (WHO).

“We need to strengthen core capacities in all countries to detect, report and respond rapidly to small outbreaks, in order to prevent them from becoming large-scale emergencies,” said panel chair Professor Peter Piot, Director of the London School of Hygiene & Tropical Medicine and co-discoverer of the Ebola virus. “Major reform of national and global systems to respond to epidemics are not only feasible, but also essential so that we do not witness such depths of suffering, death and social and economic havoc in future epidemics.”

“The most egregious failure was by WHO in the delay in sounding the alarm,” said Ashish K. Jha, Director of the Harvard Global Health Institute, K.T. Li Professor of International Health at the Harvard T.H. Chan School of Public Health (Harvard Chan) and a professor of medicine at Harvard Medical School. “People at WHO were aware that there was an Ebola outbreak that was getting out of control by spring…and yet, it took until August to declare a public health emergency. The cost of the delay was enormous,” said Jha.

The report’s 10 recommendations provide a roadmap to strengthen the global system for outbreak prevention and response:

  1. Develop a global strategy to invest in, monitor and sustain national core capacities
  2. Strengthen incentives for early reporting of outbreaks and science-based justifications for trade and travel restrictions
  3. Create a unified WHO Center with clear responsibility, adequate capacity, and strong lines of accountability for outbreak response
  4. Broaden responsibility for emergency declarations to a transparent, politically-protected Standing Emergency Committee
  5. Institutionalise accountability through an independent commission for disease outbreak prevention and response
  6. Develop a framework of rules to enable, govern and ensure access to the benefits of research
  7. Establish a global fund to finance, accelerate and prioritise R&D
  8. Sustain high-level political attention through a Global Health Committee of the Security Council
  9. A new deal for a more focused, appropriately-financed WHO
  10. Good governance of WHO through decisive, timebound reform and assertive leadership

The Harvard and London School of Hygiene & Tropical Medicine teams felt strongly that an independent analysis from academic and civil society voices should inform the public debate, in addition to other planned official reviews of the global response.

According to Liberian Panel member Mosoka Fallah, Ph.D., MPH, of Action Contre La Faim International (ACF). “The human misery and deaths from the Ebola epidemic in West Africa demand a team of independent thinkers to serve as a mirror of reflection on how and why the global response to the greatest Ebola calamity in human history was late, feeble and uncoordinated. The threats of infectious disease anywhere is the threat of infectious disease everywhere,” Fallah said. “The world has become one big village.”

“We gathered world-class experts and asked, how can we bolster the dangerously fragile global system for outbreak response?” said the Panel’s Study Director, Suerie Moon, MPA, PhD of the Harvard T.H. Chan School of Public Health and Harvard Kennedy School. “Now, the billion-dollar question is whether political leaders will demand the difficult but necessary reforms needed before the next pandemic. In other words, will Ebola change the game?”

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