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At the core of the present Ebola crisis in West Africa is a lack of global health leadership. WHO should be the global health leader, following its constitutional charge, yet it is significantly under-resourced, having a direct effect on its rapid response capacity. The Organization's response to this crisis has been constantly behind, from low funding appeals to its delay in declaring this outbreak to be a Public Health Emergency of International Concern under the binding International Health Regulations (2005) (IHR). The IHR themselves have proven insufficient, as countries have failed to cooperate in building the public health capacities that the IHR requires, reflecting the absence of incentives, sanctions, or a clear allocation of responsibility.

The United States and United Nations have sought to fill this leadership vacuum. The United States is deploying military assets to utilize their logistics, engineering, and similar capacities. Yet a single state cannot fill the significant governance gaps, mobilizing and coordinating global efforts. The United Nations has now assumed this leadership role. The UN Security Council's resolution has raised the political profile in a way that WHO could not even as the resolution left unclear the exact duties required of states. The UN Secretary-General initiated the UN Mission for Ebola Emergency Response.

Going forward, the United Nations must maintain its leadership, from the Security-General identifying states that fail to contribute fairly to the global response -- or that strip other health and development funding to do so -- to the Security Council being prepared to pass another resolution, this one with unambiguous binding authority and clear allocation of responsibility. Looking further ahead, the Security Council should interpret its mandate for maintaining international peace and security broadly, encompassing human security. States should give WHO the funding and other support the Organization requires, as WHO undertakes reforms necessary for it to be a global health leader. The UN Secretary-General and WHO Director-General should establish an independent commission to comprehensively review the response and recommend what is needed to prevent future global health emergencies. National and institutional leaders must respond to Ebola by enacting the far-reaching reforms required for genuine global health leadership, exercising the political will and leadership whose absence enabled the current Ebola outbreak to turn into a global crisis.

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384 Lancet 1323-1325 (2014)