Intended for healthcare professionals


Post-Ebola reforms: ample analysis, inadequate action

BMJ 2017; 356 doi: (Published 23 January 2017) Cite this as: BMJ 2017;356:j280
  1. Suerie Moon, director of research1,
  2. Jennifer Leigh, research fellow2,
  3. Liana Woskie, assistant director3,
  4. Francesco Checchi, professor of epidemiology and international health4,
  5. Victor Dzau, president5,
  6. Mosoka Fallah, founding director6,
  7. Gabrielle Fitzgerald, founder and CEO7,
  8. Laurie Garrett, senior fellow8,
  9. Lawrence Gostin, faculty director9,
  10. David L Heymann, head,
  11. Rebecca Katz, codirector11,
  12. Ilona Kickbusch, director1,
  13. J Stephen Morrison, director12,
  14. Peter Piot, director4,
  15. Peter Sands, senior fellow13,
  16. Devi Sridhar, professor of global public health14,
  17. Ashish K Jha, director15
  1. 1Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
  2. 2Harvard T H Chan School of Public Health, Boston, MA, USA
  3. 3Harvard Initiative on Global Health Quality, Cambridge, MA, USA
  4. 4London School of Hygiene and Tropical Medicine, London, UK
  5. 5National Academy of Medicine, Washington, DC, USA
  6. 6National Public Health Institute of Liberia, Monrovia, Liberia
  7. 7Panorama, Seattle, WA, USA
  8. 8Council on Foreign Relations, New York City, NY, USA
  9. 9O’Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA
  10. 10Centre on Global Health Security, Chatham House, London, UK
  11. 11Center for Global Health Science and Security, Washington, DC, USA
  12. 12Global Health Policy Center, Center for Strategic and International Studies, Washington, DC, USA
  13. 13Mossavar Rahmani Center for Business, Cambridge, MA, USA
  14. 14Edinburgh University, Edinburgh, UK
  15. 15Harvard Global Health Institute at Harvard University, Cambridge, MA, USA
  1. Correspondence to: S Moon suerie.moon{at}

Reports on the response to Ebola broadly agree on what needs to be done to deal with disease outbreaks. But Suerie Moon and colleagues find that the world is not yet prepared for future outbreaks

In August 2014, the World Health Organization (WHO) declared the Ebola outbreak in west Africa a public health emergency of international concern, and the world scrambled to respond. Better preparedness and a faster, more coordinated response could have prevented most of the 11 000 deaths directly attributed to Ebola and also the broader economic, social, and health crises that ensued. In the aftermath of this collective failure, numerous reports were published reviewing what went wrong and how infectious disease outbreaks should be better managed.

An enormous amount of analysis has been done: as at December 2016, more than 40 targeted examinations1 had been published, which largely agree on the priority actions.2 The global community has also launched several initiatives that begin to fill the identified gaps. Yet, despite the great interest in ensuring progress, a clear picture of what has actually been achieved is elusive. Given the importance of improving our ability to battle current (Zika, yellow fever, etc) and future outbreaks of infectious disease, we examined seven major reports and identified areas of consensus on action. We then assessed what progress has been made and what can be done to address the gaps.

The seven reports were selected on the following criteria: scope (tackling problems beyond a single organisation, country, or sector); diverse authorship (defined by country of origin, organisational affiliation, area of expertise, and gender); and public availability (excluding internal reviews) (table 1).34567891011 We grouped recommendations under key themes (table 2) and identified the greatest areas of progress and stasis. …

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