Table 1 Characteristics of the response to the 2014–2016 Ebola outbreak and actionable lessons learned for local and global response preparedness and capabilities^a

Slow detection of Ebola

Local: Strengthen disease surveillance systems for a quick detection of an infectious disease outbreak.

Focus surveillance efforts on specific diseases.

Define the type of incentives and capabilities needed to facilitate rapid and transparent reporting of surveillance data.

Global: Support initial stages of training for surveillance, detection, and response and building surveillance capabilities in low- and middle-income countries.

Lack of a coherent, predictable, organized global response

Local: Build capabilities for diagnostics, situational awareness data (cases, severity, treatment setting), and data analysis and reporting.

Prepare a cadre of “basic responders”, i.e., community-level health workers, with essential basic training to assist early detection and response efforts in communities, including education and awareness.

Global: Define the minimum data needed to track disease incidence, spread, and the effects of intervention.

Support initial training of “basic responders”.

Support emergency response training and simulation exercises for preparedness at local and global level.

Define who will coordinate response efforts and make decisions if global response was necessary.

Define the type of IT resources are needed to coordinate a response (e.g., electronic connectivity, telecommunications).

Limited national public health systems and, closely related, potential inability of the international community to respond to multiple outbreak foci, beyond West Africa

Local: Strengthen public health systems of low and middle- income countries, including health personnel, primary and critical healthcare facilities, and laboratories.

Establish procedures and personnel to staff and operate Emergency Operation Centers.

Global: Support training of public health workers, development of infrastructure and capabilities, and assessment of public health interventions.

Train and maintain rapid response teams, including health workers, epidemiologists, managers, ready for quick deployment in case of a threats of international concern, including natural disasters.

Secure infrastructure for the quick deployment of Emergency Operation Centers in case of a threats of international concern.

Coordinate intercountry and interagency efforts to achieve maximal coverage.

Define and secure funding for response workers’ insurance, compensations, and potential evacuation costs.

Inability to concurrently support multiple public health programs in West Africa, including malaria, HIV, childhood vaccination, and maternity services.

Local: Strengthen health systems including health personnel, primary and critical healthcare facilities.

Global: Define emergency migratory policies and strategies that need to be strengthened/modified/adapted to respond to biological threats.

Insufficient preventive and treatment technologies available

Global: Strengthen research on emerging infectious diseases and public health threats, above and beyond market forces, including preventive technologies, diagnostics, and protective equipment for health workers.

Establish guidelines, preparedness and training for diseases with insufficient treatment, including quarantine and isolation, contract tracing, safe burials, community awareness.

Define infrastructure and specific resources requirements needed to implement alternative to treatments (e.g., Ebola Treatment Units).

Larger outbreaks need international, external funding

Global: Ensure a reliable intercountry and interagency response.

Define and secure sustainable sources of funding.