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On August 8, 2014, the World Health Organization (WHO) Director-General Margaret Chan declared the West Africa Ebola crises a “public health emergency of international concern,” triggering powers under the 2005 International Health Regulations (IHR).

The most affected West African states have attempted classic public health measures with varied success, including quarantine and isolation, social distancing, risk communication, and travel restrictions. These have involved a trade off between population health and human rights; sometimes to the disadvantage of both. At the same time, the countries’ health systems and human resources are fragile, impeding an effective response.

Beyond the public health and humanitarian implications, this crisis has raised controversial ethical issues concerning the withholding or providing early access to investigational therapies, the preference given to foreign aid workers, and the disproportionate impact of Ebola on domestic health care workers.

The WHO director-general’s declaration of a public health emergency of international concern underscores the urgency of a coordinated international response and the imperative of raising the health systems capacity of low-income states. However, the current outbreak demonstrates how global governance has suffered from a lack of binding international commitment to sustainable capacity building and technical assistance in low-income states.

Publication Citation

312 JAMA 1095-1096 (2014)