Ebola's legacy: UK deficits and their global lessons

Abstract

A devastating report on the UK's lessons from Ebola was published this week by the House of Commons Science and Technology Committee. Much of the blame for the world's lacklustre response to Ebola has been laid at the door of WHO. But the committee also found surprising weaknesses in the UK's application of science to global health emergencies. It makes important recommendations for corrective action. Although targeted towards the UK, the committee's findings will also likely apply to other high-income countries involved in the response to Ebola. The investigation by the Science and Technology Committee is welcome and deserves serious reflection. What does it conclude? The report begins by commending the UK Government on its “leading contribution to the fight against Ebola”. But it quickly goes on to say that these actions were “undermined by systemic delay…at every stage of our response”. These delays almost certainly cost lives. The committee quotes research showing that a faster response could have prevented as many as 12 500 cases of Ebola if interventions had been delivered just 1 month earlier. Delays took place in convening a Scientific Advisory Group for Emergencies (SAGE) and in delivering Public Health England's (PHE's) disease surveillance data to those charged with acting to defeat the Ebola outbreak. SAGE was chaired by Sally Davies, Chief Medical Officer (CMO) for England, and the Government's Chief Scientific Adviser, Mark Walport. Witnesses to the committee criticised not only the slowness of SAGE's assembly, but also its composition and coordination with existing scientific committees. Walport admitted that SAGE could have moved faster. The CMO, the committee noted, was “very defensive” on this question. The committee concluded that the government failed to use the range of high-quality scientific advice available to it. Put simply, the committee found that the UK was not “research ready” to address Ebola. The result was a “less than optimal” response, including serious missed opportunities to save lives. Systems for sharing advice, expertise, and data were “inadequate”. The government failed to explain why it went against advice from WHO and PHE. The result of these collective failures is that the UK is “vulnerable” to future health emergencies. Worse, the MPs judged that, despite the bravado of witnesses, lessons still have not been learned. The lack of cross-government coordination and accountability was alarming. The UK has one of the most advanced systems for public health (and global health) in the world. But the Ebola virus outbreak revealed astonishing fragility in those systems. The committee recommends that the CMO “urgently establishes new processes and protocols to ensure that knowledge and data are communicated effectively throughout an outbreak and that research is embedded into an emergency response from the outset”. Moreover, it recommends that the government devises an Emerging Infectious Diseases Strategy, including “priority threats” that the UK needs to address and the mechanisms needed to expand vaccine manufacturing capabilities. In sum, “The Government must work to strengthen surveillance capacity and capability globally”. It is clear that science and technology are some of the most potent weapons we have to combat outbreaks. But the UK and other nations are not agreed on how to mobilise and maximise these resources during emergencies. The report comes at a time when there has already been intense debate about global health security. The UK Government should focus especially on the recommendation by David Heymann, published in The Lancet last year, that to deliver global health security, governments should be active advocates for individual health security achieved through universal health coverage. Lawrence Gostin and Eric Friedman have also analysed the Ebola outbreak and the “profound harms posed by fragile national health systems”. They proposed a new global health framework that has national health systems at its foundation and an empowered WHO at its apex. They outline priority reforms to achieve this, including enforcement of the International Health Regulations (IHR)—the international rules for health security that aim to prevent, protect against, control, and provide a public health response to the global spread of disease. Gostin warns that the window is closing for fundamental reform of the IHR and calls for strengthening of a legal framework to enforce them. The timing of the report could not be better. In March, France will host a conference on global health security in Lyon. That meeting will provide the opportunity to re-calibrate the world's preparedness for future health emergencies. We should look ahead to the Lyon meeting to learn the lessons from Ebola and to apply those lessons to preparedness for future outbreaks.