London School of Hygiene & Tropical Medicine

An independent group of 19 experts from around the globe, convened by the Harvard Global Health Institute (HGHI) and the London School of Hygiene & Tropical Medicine, has issued a hard-hitting analysis of the global response to the 2014-15 Ebola outbreak in West Africa, published in The Lancet.

The report offers 10 major reform proposals to prevent future such catastrophes, with emphasis on: preventing major disease outbreaks; responding to outbreaks; the production and sharing of research data, knowledge, and technologies; and ways to improve the governance of the global health system, with a focus on the World Health Organization (WHO).

The members of the Harvard Global Health Institute-London School of Hygiene & Tropical Medicine Independent Panel on the Global Response to Ebola concluded that while the 2014-15 Ebola outbreak "engendered acts of outstanding courage and solidarity," it also caused "immense human suffering, fear and chaos, largely unchecked by high level political leadership or reliable and rapid institutional responses."

Panel members come from academic institutions, think tanks and civil society, with expertise in Ebola, disease outbreaks, public and global health, international law, development and humanitarian assistance, and national and global governance.

The Panel is chaired by Professor Peter Piot, Director of the London School of Hygiene & Tropical Medicine and co-discoverer of the Ebola virus. Professor Piot said: "We need to strengthen core capacities in all countries to detect, report and respond rapidly to small outbreaks, in order to prevent them from becoming large-scale emergencies. Major reform of national and global systems to respond to epidemics are not only feasible, but also essential so that we do not witness such depths of suffering, death and social and economic havoc in future epidemics. The AIDS pandemic put global health on the world's agenda. The Ebola crisis in West Africa should now be an equal game changer for how the world prevents and responds to epidemics."

In addition to more than 11,000 deaths from Ebola, the epidemic "brought national health systems to a halt, rolled back hard-won social and economic gains in a region recovering from civil wars, sparked worldwide panic, and cost several billion dollars in short-term control efforts and economic losses."

Panel co-chair Dr Ashish Jha of Harvard T.H. Chan School of Public Health and Harvard Medical School, said: "The most egregious failure was by WHO in the delay in sounding the alarm. People at WHO were aware that there was an Ebola outbreak that was getting out of control by spring…and yet, it took until August to declare a public health emergency.  The cost of the delay was enormous. There is a high risk that we will fail to learn our lessons. We've had big outbreaks before and even careful reviews after, but often the world gets distracted.  We owe it to the more than 11,000 people who died in West Africa to see that that doesn't happen this time."

Video: recording of the event on 23 November 2015 when the findings were presented at the Royal Society, London

The report's 10 recommendations provide a roadmap to strengthen the global system for outbreak prevention and response:

1. Develop a global strategy to invest in, monitor and sustain national core capacities
2. Strengthen incentives for early reporting of outbreaks and science-based justifications for trade and travel restrictions
3. Create a unified WHO Centre with clear responsibility, adequate capacity, and strong lines of accountability for outbreak response
4. Broaden responsibility for emergency declarations to a transparent, politically-protected Standing Emergency Committee
5. Institutionalise accountability through an independent commission for disease outbreak prevention and response
6. Develop a framework of rules to enable, govern and ensure access to the benefits of research
7. Establish a global fund to finance, accelerate and prioritise R&D
8. Sustain high-level political attention through a Global Health Committee of the Security Council
9. A new deal for a more focused, appropriately-financed WHO
10. Good governance of WHO through decisive, timebound reform and assertive leadership

The Harvard and London School of Hygiene & Tropical Medicine teams felt strongly that an independent analysis from academic and civil society voices should inform the public debate, in addition to other planned official reviews of the global response.

Panel member Professor David Heymann, from Chatham House and the London School of Hygiene & Tropical Medicine, said: "National governments and NGOs on the ground should provide the first response when outbreaks arise, supported by WHO if required. Under the International Health Regulations, WHO is the second line of defence when an outbreak strikes more than one country and international support is needed. Capacity within WHO should be strengthened to do this by merging existing response and humanitarian teams to create a well-resourced WHO Centre with strong lines of accountability and the ability to muster the world's best expertise to tackle disease threats, both to help countries prepare between crises, and to rapidly mobilise when outbreaks occur."

Liberian Panel member Dr Mosoka Fallah, of Action Contre La Faim International, said: "The human misery and deaths from the Ebola epidemic in West Africa demand a team of independent thinkers to serve as a mirror of reflection on how and why the global response to the greatest Ebola calamity in human history was late, feeble and uncoordinated. The threats of infectious disease anywhere is the threat of infectious disease everywhere. The world has become one big village."

The Panel's Study Director Dr Suerie Moon, of the Harvard T.H. Chan School of Public Health and Harvard Kennedy School, said: "We gathered world-class experts and asked, how can we bolster the dangerously fragile global system for outbreak response? Now, the billion-dollar question is whether political leaders will demand the difficult but necessary reforms needed before the next pandemic. In other words, will Ebola change the game?"

Publication

• Suerie Moon, Devi Sridhar, Muhammad A Pate, Ashish K Jha, Chelsea Clinton, Sophie Delaunay, Valnora Edwin, Mosoka Fallah, David P Fidler, Laurie Garrett, Eric Goosby, Lawrence O Gostin, David L Heymann, Kelley Lee, Gabriel M Leung, J Stephen Morrison, Jorge Saavedra, Marcel Tanner, Jennifer A Leigh, Benjamin Hawkins, Liana R Woskie, Peter Piot. Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola. The Lancet. DOI: 10.1016/S0140-6736(15)00946-0

Members of the Panel

• Professor Peter Piot, London School of Hygiene & Tropical Medicine (Chair)
• Dr Ashish Jha, Harvard Global Health Institute/Harvard School of Public Health (Co-chair)
• Dr Muhammad Pate, Duke University (Co-chair)
• Dr Devi Sridhar, Edinburgh Medical School (Co-chair)
• Dr Suerie Moon, Harvard Global Health Institute/Harvard School of Public Health/Harvard Kennedy School (Study Director)
• Dr Chelsea Clinton, Bill, Hillary & Chelsea Clinton Foundation
• Ms Sophie Delaunay, Médecins Sans Frontières
• Ms Valnora Edwin, Campaign for Good Governance
• Dr Mosoka Fallah, Action Contre La Faim International (ACF)
• Mr David Fidler, Indiana University Maurer School of Law
• Dr Eric Goosby, University of California, San Francisco
• Ms Laurie Garrett, Council on Foreign Relations
• Dr Larry Gostin, Georgetown University
• Dr David Heymann, Chatham House
• Dr Kelley Lee, Simon Fraser University
• Dr Gabriel Leung, The University of Hong Kong
• Dr Steve Morrison, Center for Strategic and International Studies
• Dr Jorge Saavedra, AIDS Healthcare Foundation
• Dr Marcel Tanner, Swiss Tropical & Public Health Institute