Strategies to prevent future Ebola epidemics

The continuing Ebola outbreak is unprecedented in its magnitude. The fragile health infrastructure of the three countries in which transmission spiralled out of control (Guinea, Sierra Leone, and Liberia) made them particularly susceptible to the outbreak. Present international discourse is focused on making health systems more resilient to Ebola and other epidemics. To accomplish this, any initiative must address poverty, strengthen the health workforce with technical and fi nancial support, and develop basic facility and communication infrastructure. Before the Ebola outbreak, financing of health care was largely supported by donors. In the absence of a strong economy, no financial reserves are available for health care in normal circumstances, or during emergencies, as shown by the shortage of protective equipment for health-care workers during the Ebola outbreak. One underlying obstacle to economic progress is the absence of basic infrastructure. Inadequate transportation systems cut rural Liberia off from the capital, Monrovia, and other urban areas, preventing the distribution of crops and thus discouraging investment in agriculture. In April, 2014, and again in July, 2014, when the Ebola crisis was escalating in Liberia, health workers went on strike for increased pay. Additionally, many workers received no relevant training or equipment, which led to many Ebola deaths among them. The supply of health workers in these countries is at risk—eg, the University of Liberia Medical School is closed because of insuffi cient funding. Many facilities do not have basic medical and communication equipment, which severely affects patient care. Basic infection control is difficult without rubber gloves or running water and makes facilities vectors of disease rather than places of healing. During the initial phase of the Ebola outbreak, public health workers did not have the simple and inexpensive instruments needed to communicate vital information quickly. Present proposals for epidemic control, such as a new worldwide response team, or an emergency fund, are unlikely to help if these weaknesses are not addressed. Protection from worldwide pandemics starts locally, with investments in poverty reduction, health workforce development, and basic health and communication infrastructure. The Ministries of Health, Education, Public Works, Finance and Planning, and Agriculture, and the corporations responsible for utilities, such as electricity and internet, must all cooperate. We are calling for some of the post-Ebola funding to be used for long-term investment in the economy, in infrastructure, and in people, without which west Africa and the rest of the world will remain susceptible to Ebola and other epidemics.