A Retrospective and Prospective Analysis of the West African Ebola Virus Disease Epidemic: Robust National Health Systems at the Foundation and an Empowered WHO at the Apex

The West African Ebola epidemic is a pivotal moment for the global health system. Just as the depth of the crisis ultimately spurred an unprecedented response, the failures of leadership demand innovative reforms. This analysis offers a template for these reforms, responding to the profound harms posed by fragile national health systems, delays in the international response, deficient resource mobilization, ill-defined responsibilities, and insufficient coordination. The scope of the reforms must address the failures evident in the Ebola response, as well as entrenched weaknesses that enabled the epidemic to reach its heights, transforming the existing inchoate, organically developed global health architecture into a purposeful, organized system. At the apex of the global health system should be an empowered, highly capable World Health Organization (WHO), using its powerful normative tools including its treaty-making ability, with technical excellence including anthropologic, legal, and other competencies, and operational capacity. Member states should fund WHO primarily through assessed contributions and at the level required to fully meet its global responsibilities, and enable WHO to re-assert control over the regions, including through Executive Board selection of Regional Directors. In an invigorated global health system, civil society will be able to effectively engage in WHO policymaking. The World Health Assembly would enhance the International Health Regulations, including to improve monitoring of capacities, clarify responsibilities, and increase transparency of the Emergency Committees, while an independent working group would advise the Director-General on declaration public health emergencies of international concern. National health systems must be strengthened, including with sufficient numbers of well-trained, equitable distributed, sufficient numbers of health workers, particularly at the community-level building trust and engaging communities, working in safe conditions. Global resources need to support national systems, including a global health workforce and new financing, with an International Health Systems Fund to strengthen health systems and emergency contingency fund and Pandemic Emergency Facility to prepare for and respond to health emergencies