March 23, 2016 — Global public health experts are overlooking the most critical lessons of the Ebola outbreak that could help prevent the next epidemic, according to the International Rescue Committee. In a report titled, “The Ebola Lessons Reader: What’s being said, what’s missing and why it matters,” the IRC has synthesized actionable insight and analyzed critical gaps that were missed in the plethora of reports generated in the aftermath of the Ebola epidemic.
The unprecedented and deadly scale of Ebola, which began two years ago today, inspired actors across the global health community to examine the weaknesses of the global response and what must change. In an effort to consolidate their actionable insight, the IRC reviewed 74 recommendations from donors, United Nations agencies, think-tanks, academics and governmental public health agencies. This review identified two key gaps: an imbalanced scrutiny of actors who will play major roles in averting the next epidemic and limited attention to the political dimensions of epidemics.
“Ebola evolved into a regional catastrophe precisely because the most important and sensitive issues — particularly those related to the politics of poor, post-conflict countries and the politics on the United Nations, NGOs, and the international aid world — have been wished away in the past by those of us who work on public health,” said Emmanuel d’Harcourt, Senior Health Director of the International Rescue Committee. “If we want ‘never again’ to be a reality rather than just another good intention, we need to call out the most sensitive and important issues.”
The analysis found that the World Health Organization received the most focus collectively, in terms of critiques and recommendations. Other major actors, like other UN agencies, militaries and donors, received significantly less attention and scrutiny. The vulnerabilities of affected governments received ample attention, but were largely focused on resources and weak health systems versus the overall political context.
The IRC’s analysis focused on three key gaps:
- The reports focus on the World Health Organization’s role and performance but fail to address basic questions about the WHO’s mandate. Most of the reports assume, in both their diagnosis and their prescriptions, that WHO is and should be an operational agency, rather than a norm-setting, coordinating agency. In reality, there are legitimate questions about whether, even with significant reforms, WHO can be operational at a large scale.
- The reports give little attention or scrutiny to other actors who provided the bulk of the response. While the reports collectively give sufficient attention to the WHO, it gives little attention and scrutiny to other actors, including other UN agencies, a variety of NGOs, militaries, donors and governmental public health agencies. These organisations collectively played a large role in the response on the ground and their contributions and failures will play key roles in the next epidemic.
- Overall, the reports pay inadequate attention to the political economy of the countries affected and of the international response. Epidemics are political, and Ebola was no exception. Yet the political context of this epidemic is glossed over in most of the reports, with the exception of the one. Similarly, several of the reports recommend health system strengthening, treating the issue as a technical one, and ignoring the political economy for health system weakness: the failures to pay health workers and the failure of external actors to tackle the political aspects of health systems reform.
“Many of the recommendations from the Ebola reports make sense. But the most critical issues seem to have been swept under the carpet, minimized or ignored altogether,” d’Harcourt said. “Ebola has laid bare the tragic rift that exists between theory and reality when it comes to epidemic response in the poorest places on earth. If we don’t acknowledge and deal with these realities, they will continue to compromise recovery efforts in West Africa, as well as our ability to stop the next epidemic.”