Empowering the Global Health System

In March 2014, the largest Ebola epidemic in history broke out in West Africa. It rapidly spread over the region, killing over 10,000 individuals since being declared an international public health concern in August. While projections suggest that the epidemic will end during 2015, there is still a desperate need for a vaccine. Results from a pre-clinical study of an Ebola vaccine out of the University of Texas Medical Branch in Galveston are showing promising results after all three infected monkeys, which received the vaccine, recovered within 28 days with just a single dose. More recently, the World Health Organization (WHO) declared Liberia Ebola-free after 42 days of no new cases. Still, the WHO warns against complacency.

While the latest developments are encouraging, public distrust of vaccines, along with misinformation about Ebola and inadequate healthcare infrastructure, have led to the need for a different approach for moving forward post-Ebola and addressing future outbreaks. Ebola has certainly served as a wake-up call for the potential global disaster of a similar outbreak in the future, but it is easy to see that the world needs a better global response system for outbreaks. The WHO, which has a Global Outbreak Alert and Response Network, is currently under both an internal and external review for its Ebola response. The organization is also working to implement reforms in light of the failures of this response; however, whether this will be enough for a future outbreak remains unseen. Some have suggested that the answer may lie, not only in the innovative technological and biomedical advances developing in light of this disaster, but in building trust in our global health systems. Others have suggested that this epidemic exposed a divide between the objectives of global health officials and the reality of infectious disease control, which needs addressing in order to better react to similar situations in the future. While Ebola is unique in its lethality, when a contagious virus meets health care systems undermined by internal conflict and chronic poverty, it is a short jump from rural villages to crowded cities.

Unlike previous Ebola outbreaks, which were contained quickly, the scale of the latest Ebola epidemic demonstrated deep, fundamental flaws with the health systems of affected states. Institutional weakness of the affected countries led to overwhelmed (rudimentary) health systems and, when paired with clearly ill-equipped and slow to respond multilateral institutions, a problem with our international response system is displayed. Critics worldwide have placed the blame on the WHO, using it as a global scapegoat. In its defense, the agency may have been set up to fail from the start, its lackluster performance more a reflection of the unreasonable expectations placed on it[1], especially when considered in light of the modest resources at its discretion. If the global health system expects the WHO to cope with similar global public health emergencies then it must empower it to respond to transnational health threats. Better still, the world may potentially be improved by addressing the underlying deficiencies in the multilateral framework infrastructure. Incorporating health into post-conflict reconstruction could be the key to preventing another rapid spread of Ebola or a future outbreak of the same degree (or, god forbid, one of greater magnitude.) Similarly, the development of, and the continued support of, a global health fund or contingency fund for the WHO would empower the global health system to react earlier and more efficiently to emergencies.

[1] Years of budget cuts and subsequent staff cuts weakened the WHO’s ability to respond in the magnitude required by the Ebola epidemic. While the WHO is responsible for responding to global health issues, decreasing financial contributions have arguably created unrealistic expectations given the world’s health needs.

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