International Order & Conflict

Lessons from Ebola: Preparing for the Next Infectious Disease Crisis

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By Sharon Jackson: 

The emergence of novel infectious diseases during the last 50 years has challenged both developed and developing countries. Regardless of the level of development and resource endowment, the optimal emergency preparedness and public health response to an infectious disease crisis needs at least the following three components: policies that maximize the utility of available resources within the context of local political, social, and cultural norms; a plan to rapidly and efficiently distribute materiel and human expertise; and a well-considered implementation framework that accounts for foreseeable challenges that may arise.  Ideally, each of these components should be mutually supportive and integrated into a unified national policy framework.  Economic development planning can provide countries that are building health and emergency preparedness capacity an overarching framework to achieve a unified national policy.

One of the lessons learned from the Ebola crisis during 2014-2015 was the importance of understanding how culture may play a role in the spread of infectious disease.  When the number of Ebola cases detected in cities began to rise precipitously, the community was traumatized by the presence of a disease that was little understood and the disruption of traditional practices for the care of ill family members. The clinical activities required to reduce disease transmission were initially ignored and resulted in the ineffective use of limited response resources; great efforts were spent to identify and isolate patients who were removed from care by frightened family members and more people were exposed and infected by the disease as they tried to care for patients at home.  Once the public health policy response was modified to educate the community about the disease and to change those cultural practices that facilitated the spread of disease while retaining the essential purpose of respecting the relationship between the patients and their families, the spread of Ebola was brought under control and the outbreak ended.  The way forward for improving emergency preparedness and public health response necessarily includes expertise in culture and social structures so that available resources are effectively and efficiently used.

Another critical component for a robust emergency preparedness and public health response to an infectious disease crisis is the efficient distribution of resources and personnel to support disease control.  Both densely populated urban areas and remote communities require timely interventions.  A case in point was 2005-2006 when the highly pathogenic avian influenza began to spread from migratory birds to domestic poultry and humans in Europe and Africa. During this period, supplying disease surveillance capability for both birds and humans, transport of supplies and personal protective equipment for the safe destruction and disposal of the contaminated poultry carcasses, and the timely distribution of reimbursement to farmers for the loss of their birds were essential to reduce the harmful impact of avian influenza on human health.

While the specific circumstances of an infectious disease crisis will vary depending on the particular infectious disease and its ecology, the existence of a thoughtful response implementation framework to identify and mobilize appropriate response resources and regular drills to maintain readiness and proficiency is a third essential element of an effective response.  An effective framework facilitates coordination and communication so that government authorities know the resources that will be made available and which organizations must be integrated into the response operation.  Because different contingencies will have been exercised prior to the emergency, the process of adaptive planning and execution for a specific crisis can occur with all participating support elements understanding their missions and how they fit into overall response.

Developed countries have an advantage inasmuch as they have already built response capacity for a range of health emergencies that require controlling disease vectors and eliminating many communicable diseases.  Developed countries also have the economic resources to sustain these efforts over time.  Many developing countries still continue to struggle to achieve sufficient emergency preparedness and public health response capacities to address infectious disease threats, even though the essential elements are well understood. Because many developing countries are building infrastructure de novo, they will be able to plan systems that fit their unique requirements and address emergent health crises effectively and efficiently.

Sharon Jackson has extensive experience in public health, international relations, regional studies, and economics and applies this expertise to complex global health challenges. 

Photo credit: U.S Government Work via flickr
An aerial porter from the Kentucky Air National Guard’s 123rd Contingency Response Group places a pallet of in-bound humanitarian aid in the cargo yard of Joint Task Force-Port Opening Senegal at Léopold Sédar Senghor International Airport in Dakar, Senegal, Nov. 2, 2014. The cargo, which includes medical supplies and troop-support equipment, will be airlifted to Liberia aboard C-130s in support of Operation United Assistance, the U.S. Agency for International Development-led, whole-of-government effort to contain the Ebola virus outbreak in West Africa. 


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