Intended for healthcare professionals


Global epidemics: how well can we cope?

BMJ 2018; 362 doi: (Published 09 August 2018) Cite this as: BMJ 2018;362:k3254
  1. Jennifer Leigh, DrPH candidate1,
  2. Gabrielle Fitzgerald, chief executive officer2,
  3. Elvis Garcia, DrPH candidate1,
  4. Suerie Moon, director of research3
  1. 1Harvard T H Chan School of Public Health, Boston, MA, USA
  2. 2Panorama Global, Seattle, Washington, USA
  3. 3Global Health Centre, Graduate Institute of Geneva, Switzerland
  1. Correspondence to: J Leigh jleigh{at}

Although numerous initiatives have been launched to improve global capacity to respond to major outbreaks of disease, worrying gaps remain, report Jennifer Leigh and colleagues

The recent spread of Ebola to an urban centre in the Democratic Republic of Congo (DRC) highlights the importance of capacity to manage disease outbreaks.1 This outbreak was just one of many; already this year there have been outbreaks of Middle East respiratory syndrome (MERS), dengue, Lassa fever, yellow fever, Nipah, and cholera.2 Most of these were contained within the originating country, and so the global reforms implemented after the west Africa Ebola outbreak have not yet been seriously tested.

In January 2017, we analysed seven reports into the response to the Ebola outbreak,34567891011 identified areas of consensus, assessed progress made, and highlighted gaps, concluding that the world remained unprepared for major outbreaks.12 Here, we assess progress made since then in each of the gaps identified.

Capacity of national health systems

National capacity to manage outbreaks, including workforce development and training, was reiterated as a priority after the west Africa Ebola outbreak. As an important first step, by the end of May 2018, 77 countries had completed joint external evaluation, an assessment of country capacity to prevent, detect, and respond to public health risks.13 The World Health Organization’s Health Emergencies Programme has supported 39 countries to improve their preparedness, prioritising fragile states.14 The Global Health Security Agenda, with 61 participating countries, has also been an important driver for building national preparedness, including a $1bn US government investment.15 In addition to several regional initiatives, the World Bank committed to support at least 25 countries to develop and implement pandemic preparedness plans.16

Surveillance initiatives are working to increase capacity to detect and report outbreaks and promote …

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