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Experts advocate increased preparation, funding to reform global outbreak response
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A panel of health experts released an analysis highlighting several weaknesses in the global response to the 2014-2015 Ebola outbreak. Recently published in The Lancet, the critique offers a list of 10 recommendations to WHO and global political leaders for better preparation for the next major outbreak.
“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,” Peter Piot, MD, PhD, professor and director of the London School of Hygiene & Tropical Medicine, said in a press release. “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.”
Peter Piot
The Harvard Global Health Institute and the London School of Hygiene & Tropical Medicine spearheaded the panel which, according to a press release, included 19 experts from academic institutions, think tanks and civil society. Along with identifying driving weaknesses in response efforts, the group convened to persuade political leaders to “better prepare for future outbreaks while memories of the human costs of inaction remain vivid and fresh,” they wrote.
International Ebola response flawed
To determine systemic weaknesses, panel members analyzed the Ebola outbreak in relation to the epidemic’s progression.
During the initial phase of Ebola’s spread (December 2013 to March 2014), health infrastructure in Guinea was unable to detect the virus for several months. According to the panel, this reflected “inadequate investments” in the country’s infrastructure in spite of formal support agreements from better-funded national governments. As the virus began to spread through major cities in Guinea, Liberia and Sierra Leone (April 2014 to June 2014), teams from Médecins Sans Frontières’ calls for aid did not receive adequate attention from WHO and international partners, the experts wrote. This oversight, which the researchers wrote represented “Failures in both technical judgment and political leadership,” was attributed to Guinean authorities downplaying the outbreak to reduce panic and economic instability, and to WHO’s weak technical capacity within the infected countries.
Response failures continued as the Ebola outbreak reached its peak (August 2014 to October 2014). Despite increasing media attention, public interest, relief funding from the World Bank and WHO’s designation of Ebola as an outbreak emergency of international concern, travel restrictions and clashes between local authorities and certain populations driven by fear and hysteria hampered large- and small-scale efforts to limit the disease, the experts wrote. Meanwhile, the U.N. complicated international coordination by creating response plans superseding those already in place, and international field staff often were forced to substantially modify relief strategies to maintain their effectiveness. Although the outbreak eventually began to wane by October, the panel said that weak coordination, accountability and resource transparency continued to limit relief during the final stages of the epidemic.
These failures do not discount the more admirable aspects of the world’s response effort, the experts wrote. They praised the courage of local and international health workers caring for those infected; the support of several nongovernmental organizations that vocally advocated for more support during the outbreak’s early stages; the acceleration of clinical trials and treatment production amid the expanding outbreak; and the significant relief funding from “traditional” donors, private foundations and less affected nations.
“These positive steps notwithstanding, 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 experts wrote.
Steps toward preventing future outbreaks
In 2005, 196 governments agreed to implement the International Health Regulations, which required participating countries to meet a minimum level of detection, reporting and rapid response infrastructure. However, health systems in many resource-poor regions continue to be ill-prepared for a major outbreak, and no strategies have yet been developed to improve them, according to the researchers.
“The International Health Regulations did not include binding obligations for donors to provide support to poorer countries to meet these obligations, nor to fund WHO to fulfill its mandate to provide technical assistance,” the experts wrote. “If countries remain unable to detect outbreaks in a timely way, the rest of the chain of International Health Regulation-stipulated notifications and responses will fail once again.”
To address these and other concerns, the panel offered a list of 10 suggestions for WHO and other global policymakers. These were divided into the following major categories:
- Outbreak prevention, which includes the development of a global investment plan, economic incentives for early outbreak reporting and confrontation of governments implementing trade and travel restrictions without scientific justification;
- Outbreak response, which includes the creation of a strong, dedicated center for outbreak response at WHO, a transparent Standing Emergency Committee responsible for declaring public health emergencies and an independent U.N. Accountability Commission;
- Research and knowledge dissemination, which includes the development of an infrastructure to accelerate, share and finance research operating at all times; and
- Global response governance, which includes the creation of a Global Health Committee as part of the U.N. Security Council, a restructuring of WHO resuming focus on the organization’s core functions and a refinancing of WHO’s budget aimed toward supporting these core functions.
“Taken together, the panel’s 10 recommendations provide a vision for a more robust, resilient global system able to manage infectious disease outbreaks,” the experts wrote. “Success requires one other essential ingredient: high-level political leadership determined to translate this roadmap into enduring systemic reform so that the immense human suffering of the Ebola outbreak will not be repeated.” – by Dave Muoio
Disclosures: Moon reports receipt of a grant from the Rockefeller Foundation supporting the conduct of the study, and serves of the Board of Directors of Médecins Sans Frontières. Piot is a board member of Biocartis, and reports grants from the Bill and Melinda Gates Foundation, UNAIDS, the U.K. Department for International Development and the European Commission’s Innovative Medicines Initiative. Please see the full study for a list of all other authors’ relevant financial disclosures.
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