Intended for healthcare professionals


Call for independent monitoring of disease outbreak preparedness

BMJ 2018; 361 doi: (Published 24 May 2018) Cite this as: BMJ 2018;361:k2269
  1. Olga Jonas, senior fellow1,
  2. Rebecca Katz, co-director2,
  3. Shana Yansen, programme manager1,
  4. Katrina Geddes, research fellow1,
  5. Ashish Jha, K T Li professor of international health1 3
  1. 1Harvard Global Health Institute, Cambridge, MA, USA
  2. 2Center for Global Health Science and Security, Washington, DC, USA
  3. 3Department of Health Policy and Management, Harvard T H Chan School of Public Health, Cambridge, MA, USA
  1. Correspondence to: A Jha ajha{at}

It’s time for a system of accountability to break the cycle of panic and neglect, say Olga Jonas and colleagues

Four years ago, a delayed and initially inadequate response to control an outbreak of Ebola virus in west Africa resulted in a devastating regional epidemic. In addition to its heavy toll of death and illness, the epidemic damaged the already fragile healthcare systems, sharply reduced economic activities, and disrupted the lives of several million people.1 The costs were borne largely by some of the world’s poorest communities. And, to contain the outbreak, external partners spent $3.6bn (£2.7bn; €3bn).

The Ebola crisis is just one example of the consequences of poor preparedness for disease outbreaks. AIDS is another, as it became a pandemic (worldwide epidemic) by the time a robust response was organised. The Ebola crisis prompted numerous expert analyses of what went wrong and why. A synthesis of the findings, published in The BMJ, found a remarkable convergence both on the failures and on what must be done to reduce the costs of disease outbreaks.2 Clearly, we need to be prepared to thwart the spread of pathogens (including drug resistant pathogens) promptly.

Persistence of poor preparedness is no surprise. How governments and international organisations deal with the risks of infrequent, predictably recurring, and high impact outbreaks has long followed a set pattern. An initial panic during the outbreak is followed by neglect once the outbreak is over. Although the recent Ebola and Zika outbreaks spurred actions to improve preparedness, neglect has set back in. Preventing the next epidemic or pandemic is no longer on the agendas of national and global leaders, though they are well aware that protecting health and economies from the effects of contagion are major national and global public goods and are less expensive …

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