London School of Hygiene & Tropical Medicine

The west African Ebola epidemic has rekindled interest in global health security, but it has also highlighted a troubling lack of political commitment to public health, and it is far from clear whether the crisis will be enough to rejuvenate global health security, say leading global health experts writing in The Lancet.

Through a series of essays, the review, which is published as part of a special issue on global health security, explores different perspectives on the wider lessons that can be drawn from the outbreak, including how it has demonstrated the importance of securing individuals' access to health care as part of the pursuit of global health security.

The essays, each by different global health practitioners from organisations around the world, discuss whether the Ebola crisis is likely to increase political commitment to advancing health security and provide insight into the relevance to global health security of several issues, from counterfeit medicines and antimicrobial resistance, to armed conflict, natural disasters and migration.

Lead author of the review, David Heymann, Professor of Infectious Disease Epidemiology at the London School of Hygiene & Tropical Medicine and Head of the Centre on Global Health Security at Chatham House, said: "The Ebola epidemic has clearly illustrated the importance of protecting societies from infectious disease threats that spread across national borders. Throughout history, the approach to threats like this has been to focus on rapid detection of outbreaks and rapid response - this has been the commonly understood conceptualisation of health security for centuries. But the crisis has also highlighted a second, equally important but less-appreciated aspect of global health security - ensuring personal access to health services and products around the world. This needs to be better recognised as part of the scope of global health security."

One essay in the review argues that, despite having been formerly catalytic in raising the prominence of global health in world affairs, global health security has suffered years of political neglect by countries, downgrading within the World Health Organization (WHO), and legal non-compliance in the decade preceding the west African Ebola outbreak. It also highlights how the Ebola crisis has exposed WHO's shortcomings and damaged its credibility.

Another essay discusses how the Ebola epidemic is only the most recent event to have exposed how ill-suited the medical research and development system is to tackle the world's health priorities, arguing that improving access to diagnostics, drugs, and vaccines cannot be left to market forces. Three-quarters of new medicines reaching the market provide no added therapeutic value, and the authors argue that too often promising leads which could address public health priorities are not pursued, and a system that prioritises development according to unmet health needs, rather than profit prospects, could play a key role in improving global health security.

Moreover, as the authors of another essay point out, with a quarter of medicines in low-income countries believed to be substandard or counterfeit, the global trade in fake medicines drastically undermines the capabilities of governments to curb both infectious and non-communicable diseases (NCDs), while eroding public confidence in governments and international institutions.

Just as noteworthy are the challenges that stem from the rising prevalence and soaring costs of NCDs, which increasingly undermine the ability of governments to implement universal health coverage. One essay argues that non-governmental organisations should lead efforts to improve the population's health by holding major corporations to account, in the same way that climate change activists have driven improved greenhouse gas emissions and climate change strategies for more than 3000 major corporations worldwide.

While the international response to the Ebola outbreak has shown how much concerted global action can achieve, say the authors, only an increased commitment to improving individual access to affordable, safe and effective health services, products, and technologies-the goal of universal health coverage-can make health security a reality for all.

Relevant links:

• See The Lancet's interactive infographic that accompanies the special issue.
• Publication: David L Heymann, Thomas R Frieden, Ravi P Rannan-Eliya et al. Global health security: the wider lessons from the west African Ebola virus disease epidemic, Lancet. DOI: 10.1016/S0140-6736(15)60858-3 (Paper is split into 10 essays.)