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The current outbreak of Ebola virus disease (EVD) in West Africa is spiraling out of control, but it never had to happen. What can the international community do now to bring the epidemic under control, and how can we prevent the next one?

The counties most affected by Ebola (Guinea, Liberia, and Sierra Leone), rank among the lowest in global development, lacking essential public health infrastructure. If the affected countries had adequate public health systems, they probably would have contained Ebola within rural settings, avoiding the first outbreak in major urban areas.

More than 130 health workers have died from Ebola during the current outbreak, depleting already scarce human resources. Hospitals lack personal protective equipment and safe isolation facilities, becoming amplification points for transmission. The absence of basic public health infrastructure means that countries have instead often resorted to military-led cordons sanitaires, without ensuring access to basic necessities, such as food, clean water, and health care.

This article proposes an International Health Systems Fund, encompassing both emergency response capabilities and enduring health-system development. The WHO’s Ebola response roadmap estimates than an initial US$490 million in global resources over 6 months would be needed to curb the outbreak, although the total costs are likely to be considerably higher. What is needed is a standing crisis fund to ensure surge capacity in the event of a WHO declared Public Health Emergency of International Concern.

To prevent future epidemics, and to provide health services for the entire population, we also urgently need a sustainable International Health Systems Fund to build long-term capacity. This fund, however, would require multibillion-dollar investment. Although large, the international community has mobilized before on this scale through PEPFAR and the Global Fund.

The West African Ebola epidemic should spark a badly needed global course correction that would favor strong health infrastructure. It would encourage high-income countries to meet their International Health Regulations obligations to mobilize financial resources and provide technical land logistical support to develop, strengthen, and maintain public health capacity, especially in lower-income countries. Although the scale of investment would be substantial, it is a wise and affordable investment in containing global health hazards, and moving towards a right-to-health based universal health coverage.

Publication Citation

Lawrence O. Gostin, Ebola: Towards an International Health Systems Fund, The Lancet, published Online First (September 4, 2014),