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Ebola experience leaves world no less vulnerable

November 22, 2015 This article courtesy of Nature News.

Report concludes that not enough has changed nearly two years after the start of the catastrophic West Africa epidemic.

The world is no better prepared for the next global health emergency than it was when the current Ebola epidemic began nearly two years ago, an expert panel warns.

The problems that led to the deaths of more than 11,000 people in history's worst Ebola outbreak have not been solved, a group of 20 physicians, global health experts, lawyers and development and humanitarian experts convened by Harvard University and the London School of Hygiene and Tropical Medicine (LSHTM) warn in a paper published on 22 November by The Lancet. Meanwhile, the outbreak stubbornly hangs on: on 20 November, hopes that it might be declared over by year's end were dashed by reports of new infections in Liberia, which has twice been declared Ebola-free.

“We're closer, but we're not yet ready for another outbreak of this magnitude,” says epidemiologist David Heymann at the London School of Hygiene and Tropical Medicine, a member of the commission that produced the report.

The report comes from one of four major post-Ebola review panels that are expected to call for overhauling the way the international health community prevents and responds to outbreaks; others have been convened by the World Health Organization (WHO), the United Nations and the US National Academy of Medicine. The current report lays out ten recommendations for better preventing, detecting and responding to outbreaks; for speeding research on diseases that cause them; and for reforming the global systems that manage them.

Like previous analyses, the latest report singles out the WHO for failing to alert the world to the severity of the outbreak early enough, and recommends several reforms to the agency's structure, including changing the way it declares and responds to health emergencies and narrowing the scope of the WHO’s activities, which far outstrip its budget.

But the committee behind the report says that the blame is not the WHO's alone. It calls for steps to bolster international research and development on emerging diseases between and during outbreaks, including negotiating agreements ahead of time on how to share data and samples and conduct ethically sound clinical trials during outbreaks. And it recommends that those agreements ensure that affected communities gain access to the benefits of research. Ethical disputes, disorganization and bureaucratic barriers delayed research on experimental interventions during the current outbreak until it was largely too late to prove that they worked.

The report also calls for a dedicated research fund aimed at interventions for neglected diseases that afflict the poor, which generally hold little potential for profit.

While there is consensus that the WHO is not up to the task of managing global outbreak response, long-time observers of the agency doubt that most of the reforms to the organization that are spelled out in The Lancet report will be adopted, due to resistance from the 194 member states that govern it. Health-security specialist Adam Kamradt-Scott at the University of Sydney in Australia says that the report's ideas for WHO reform represent “noble ideals”, but are unlikely to be passed, and wishes that the report had laid out more realistic recommendations.

“It is genuinely disappointing that there are so few practical suggestions that take account of the very real political constraints that the WHO currently confronts,” Kamradt-Scott says. “I honestly doubt that many of these recommendations will be acted upon.”

But physician Ashish Jha, co-chair of the Harvard/LSHTM panel, is hopeful that the scale of this epidemic will serve as a wake-up call.

“We have a horrific human casualty that should spur us on,” Jha says. “We have to engage in a sustained effort for as long as it takes to make sure the world is better prepared for the next pandemic.”


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