Combatting Ebola and Infectious Disease Long-Term

While we are seeing glimpses of hope in the ongoing battle against Ebola, it's already apparent that we need new global capacity to confront and defeat infectious diseases including -- and beyond -- Ebola. It may seem premature to address our capacity to deal with these challenges long-term when the immediate needs in West Africa are so great, but the long-term action may be needed sooner than we think and the short-term solutions could well be the first bricks in the that foundation.

The Ebola crisis has taught us several fundamental lessons that define the global capacity we need. The first is that, even in the face of a crisis as dire as Ebola, it is not easy to assemble needed funds on relatively short notice. The United Nations has estimated that it will cost $1.5 billion to defeat the Ebola epidemic and has created the Ebola Response Multi-Partner Trust Fund as the vehicle for receiving these resources.

A permanent infectious epidemic fund needs to be created that would expedite future relief for Ebola and other infectious diseases. Commitments should be made in advance, perhaps with the caveat that individual countries approve allocation of their own contributions, but with funds assembled and ready to be spent.

The second lesson is that infectious disease is especially dangerous -- and likely to spin out of control -- in areas where the health care and public health infrastructure are weakest, with consequences extending well beyond affected areas. We must make a concerted global effort to bring every nation up to a minimum standard of health systems. This can involve design, logistical, technical, and consulting support -- everything from educational initiatives to constructing health care facilities and public health systems. We've already learned how to create great health systems, and making them available at some basic level is increasingly crucial to the entire world.

The World Health Organization's core roles include providing leadership on matters critical to health; shaping the research agenda; setting norms and standards and promoting and monitoring their implementation; and providing technical support and motivating change. But bringing the health care infrastructure of every nation up to a minimum standard of care or having the authority to mobilize global responses clearly goes beyond the WHO's existing mandate.

Still a new commitment is required to ensure adequate health care and public health infrastructures around the world. The New York Times stunningly highlighted the need, reporting from Monrovia: "Though Redemption (Hospital) often did not have running water, it was one of the biggest medical centers in Liberia."

Third, we must enhance local capacities to respond to sudden needs. As the Washington Post has stated, "The virus is more nimble than the human response to it." U.S. Ambassador to the United Nations Samantha Power commented after a recent trip to West Africa, "We tend to plot out static long-term plans to respond to the outbreak and then stick to them, rather than developing fluid structures that can move with the virus."

Anthony Banbury, head of the U.N. Mission for Ebola Emergency Response (UNMEER), described the U.N.'s needs in combating Ebola in a November 13 speech to the General Assembly: "Ebola is a fearsome enemy, and we will not win by chasing it. We must get ahead of it, and there are two implications to that: first, we need - as UNMEER and the responders - much greater geographic dispersion of our interventions; secondly, we need much greater mobility and a rapid response capability."

Fourth, the ability to provide direct medical care and public health containment and prevention should be a global responsibility. That role has fallen especially heavily on Doctors Without Borders/Médecins Sans Frontières and the International Medical Corps, among a small number of nonprofits who are performing heroically and deserve enormous recognition for assuming that mantle. But even a group of remarkable organizations like these cannot carry so universal a burden.

In our globalized world, it is time to develop permanent capacity, whether through existing international organizations or a newly created one, to prevent and address major outbreaks of infectious disease. That capacity must have qualities of rapid response, specialized training, assembled technical resources, and boots on the ground where need is greatest. It must have the strength to address more than one crisis at a time. And it could provide the basis for responding to other types of humanitarian disasters and build the infrastructure for prevention and care of a broader list of health concerns.

Ebola alone has overwhelmed the world community but other infectious diseases will someday emerge on a large scale. Yet even with the inevitable shortcomings of our response Ebola has energized an international reaction that may have set in motion a new commitment to preparing for and tackling infectious disease. The U.N.'s peacekeeping forces, which are deployed around the world in response to crises, could be a useful model.

Defeating major outbreaks of infectious disease must be a shared global commitment. That commitment should be ready to be implemented whenever and wherever a challenging outbreak takes place.