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Post-covid reforms: can we avoid fighting the last war?

BMJ 2021; 373 doi: (Published 19 May 2021) Cite this as: BMJ 2021;373:n1184

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  1. Anna Bezruki, research officer1,
  2. Suerie Moon, co-director1 2
  1. 1Graduate Institute of International and Development Studies, Geneva, Switzerland
  2. 2Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
  1. Correspondence to: S Moon

Anna Bezruki and Suerie Moon explain why post-pandemic reforms are unlikely to leave the world fully prepared for the next emergency and argue for a focus on strong monitoring systems and flexible arrangements

Covid-19 has exposed glaring gaps in the global system for preventing, detecting, and responding to potential pandemics. Attention to, and political momentum for, reform is building with a series of high level international reviews,123 and calls for a pandemic treaty by more than 25 heads of state and the director general of the World Health Organization.

The last major effort to reform pandemic preparedness followed the 2014-16 west African Ebola crisis. Looking at what was and was not implemented after Ebola provides insight not only into how that reform process has affected the global covid-19 response but also into future potential challenges.

After the Ebola crisis there was strong overall agreement on what needed to change. Attention centred on strengthening national preparedness in developing countries and buttressing the international safety net (eg, funding, technical assistance, humanitarian aid) for when an outbreak overwhelmed a country’s national capacities.4 Some of these reforms have proved critical in the response to covid-19. However, there were also gaps (inadequate action on identified problems) and blind spots (issues not identified) in that reform process (table 1).

View this table:
Table 1

Summary of post-Ebola reforms, gaps, and blind spots

The same is likely be true after covid-19: some crucial reforms will be made, but not every problem will be addressed and issues specific to covid-19 are likely to be prioritised. What does this tendency to “fight the last war” mean for the post-covid reform process now getting under way? We discuss below the difference post-Ebola reforms made for covid-19, the remaining gaps and blind spots, and implications for the future.

Reforms implemented after Ebola

Several critical reforms …

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