London School of Hygiene & Tropical Medicine

In a year's time, member states of the World Health Organization (WHO) will elect a new director general. In light of heavy criticism of the organisation's handling of the Ebola outbreak, the election process will be under intense scrutiny. The key questions on epidemic preparedness that prospective candidates will have to consider are outlined in a BMJ editorial co-authored by Professor Peter Piot, Director of the London School of Hygiene & Tropical Medicine.

The analysis is based on each of the authors' involvement in three of the major reports reviewing the global response to Ebola, including the Harvard-London School of Hygiene & Tropical Medicine independent panel (chaired by Prof Piot), the WHO interim assessment panel, and the National Academy of Medicine panel.

They say their aim is to clarify the candidates' position on what policies and procedures need to be in place before the next health crisis occurs and how they see the leadership challenges ahead of them. For example, they question WHO's role in any future health emergency and outbreak response and how this should be financed, following deep budget cuts to its outbreak response capacity.

Following concerns that the director general did not act quickly enough to declare a public health emergency in response to the Ebola outbreak in West Africa, they also ask if there is a need to change this procedure for future emergencies.

The analysis includes questions about health security concerns, WHO's operational role in any future health emergency response, and whether WHO should engage in research to better prepare for outbreaks.

The authors argue that an effective global system for preventing and responding to outbreaks "needs well-coordinated and appropriately resourced organisations to fulfil clearly defined roles and responsibilities and to hold each other accountable for doing so."

They ask candidates to reflect on how the WHO could achieve this, and how WHO should engage with private sector foundations and communities, especially during a public health emergency. The authors say that the relationship between the WHO director general and the UN secretary general should be strengthened, and ask how better links could be made as well as the establishment of new health security mechanisms.

Finally, they point to accountability mechanisms, asking candidates to reflect on how accountability be strengthened in relation to health and emergency and outbreak response, including the creation of a freedom of information policy and an inspector general at the WHO.

They say their questions "show the different facets of leadership that are required to ensure that WHO has a key role in the coming years and decades and that an Ebola-like crisis never happens again… Business as usual cannot continue; transformative leadership is called for."

Speaking last year when the Harvard-London School of Hygiene & Tropical Medicine Panel on the Global Response to Ebola was launched, Prof Piot said: "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."

Publication:

• Devi Sridhar, Ilona Kickbusch, Suerie Moon, Victor Dzau, president4 , David Heymann, Ashish K Jha, Jorge Saavendra, Barbara Stocking, Liana Woskie, Peter Piot, Facing forward after Ebola: questions for the next director general of the World Health Organization, BMJ. DOI: 10.1136/bmj.i2666