Global Reports on Ebola’s Lessons Overlook Politics and Misplace Scrutiny
International Rescue Committee
22 Mar 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.

Report Analysis
We have selected reflections from key actors involved in the Ebola response. Our selection includes representa¬tives from academia, think-tanks, NGOs, donors and the United Nations. We identified specific top-line recom¬mendations assigned to actors and consolidated similar observations. Pages 4-9 include our review.
:: Bill Gates. The Next Epidemic – Lessons from Ebola. New England Journal of Medicine 2015. April 9, 2015.
:: World Health Organization. Ebola Interim Assessment Panel “Stocking Report.” July 2015.
Tony Blair Africa Governance Initiative. State of Emergency: How Government Fought Ebola. July 10, 2015.
:: Overseas Development Institute. Humanitarian Policy Group Working Paper. The Ebola Response in West Africa: Exposing the politics and culture of international aid. July 10, 2015.
:: The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola. Will Ebola change the game? Ten essential reforms before the next pandemic. The Lancet. November 22, 2015.
:: Council on Foreign Relations. Lessons Learned After the Ebola Crisis – Darryl G. Behrman Lecture on Africa Policy with Thomas Frieden. November 24, 2015.
:: Médecins Sans Frontières. Epidemics as Neglected Emergencies. November 25, 2015.

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 organizations 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.”

Report: The Ebola Lessons Reader – What’s being said, what’s missing and why it matters
International Rescue Committee
March 2016 :: 16 pages