Making global health governance work: recommendations for how to respond to Ebola

The Ebola pandemic is a crisis of global proportion and of global concern. It is locally concentrated and requires responses on a local scale with a global scope. Its projected trajectory is the subject of volatile predictions, confused communication, imperilled responses and, increasingly, panic. It is at once a health crisis, with severe economic repercussions, and a threat to peace and security, espe­cially in the region and even beyond. The response to the Ebola pandemic should be twofold. The immediate crisis must be brought under control. We propose a set of short-term actions that are based on a much stronger commitment and co­ordination by the international community. Above all, these are geared towards establishing an acknow­ledged and legitimate global health leadership structure: based in the United Nations system and supported by key global players such as the United States and the European Union. In order to overcome the current Ebola outbreak with a view towards drawing conclusions to prevent another such crisis, international actors need to reflect on the structural aspects undergirding this crisis. Three elements of such a response need to be recognised. First, the Ebola pandemic is a global crisis; in addition to the individual impacts of infection, a global pandemic can easily lead to a panic in which health, social, economic and political costs are impossible to quantify. Second, it is a health crisis not only for those infected with and affected by the Ebola virus, but also for the most affected region - in health, economic and security terms (as people seek health care apart from Ebola treatment). Third, Ebola poses a health, economic and security crisis for the West Africa region and beyond: its spread threatens the fragile gains made in the post-conflict societies of Guinea, Liberia and Sierra Leone. The broader West Africa region and the Sahel are characterised by fragile social cohesion, as people struggle to sustain livelihoods curtailed by quarantines, fear and falling trade while authorities work to maintain and manage socio-political tensions. The current Ebola crisis illustrates the shortcomings of the way international cooperation is organised. In rising to the challenge of a committed, coordinated response, the following points must be acknowledged. Ebola's eruption into densely populated urban areas reinforces the vital necessity of functioning local, national and global health systems. Zoonoses are likely to multiply; learning to predict and prepare for them is vital. It makes it clear that weak and fragile local systems, especially in a post-conflict setting, pose not only a local hazard but a global threat. Current crisis response mechanisms of the international community are neither effective nor adequate. To a large extent, the situation is caused by chronic underfunding of the core functions of leading international institutions. There are urgent opportunities that the international community should take advantage of to improve the workings of the (global) health sector, e.g. compre­hensively supporting health systems' development