A Global Health Reserve Corps to Combat Ebola

A Global Health Reserve Corps to Combat Ebola
Michele Barry MD, FACP and Lawrence Gostin JD
The World Health Organization (WHO) recently said the West Africa Ebola outbreak
would not be contained for 6-9 months, predicting 20,000 deaths. As the weekly
surge of new cases continues to unfold, it has become clear this a gross
underestimate of the true dimension of the health crisis.
Why is the outbreak so out of control? The answer is simple; Ebola struck postconflict states with fragile, understaffed health systems. Complicating that is a global
response that is uncoordinated, fragmented, and utterly incommensurate with the
scale of the health needs. The WHO estimates a 4 million shortage of healthcare
workers globally; Africa has 25% of the global burden of disease, but only 3% of the
world’s health workers and 1% of its economic resources. Médecins Sans Frontières
(MSF), a non-governmental organization working in over 60 countries, currently
accounts for two thirds of the treatment and care in the affected regions with Ebola.
Although showing much valor and stamina, MSF cannot be expected to control an
epidemic of this size. The other organization tasked with taking on a global health
crisis, WHO, is working on a drastically reduced budget, less than the annual budget
of just one large hospital in the United States. Due to these cutbacks, experienced
WHO personnel have left and its once existing and functional pandemic and
epidemic unit has disbanded.
How does the world help solve this massive health crisis, and prevent future crises?
We propose the formation of a Global Health Workforce Reserve akin to the US
Military Reserves, where well-trained physicians and nurses with experience in lowresource settings sign up for a period of time and be ready for a centrally
coordinated deployment when epidemics and catastrophic events occur. A Corps
such as this could be scaled up quickly and centrally managed at the WHO or the
United Nations. Periodically short-term boot-camp training for disaster relief and
outbreak training could be held. Given the incredible interest in global health
training programs in the past ten years, as documented by the Consortium of
Universities for Global Health, we think there would be no dearth of volunteers.
The President of MSF has called for emergency response teams from the countries
around the world to help them battle Ebola. The generous outpouring of healthcare
workers after the Haiti earthquake and Indonesian tsunami demonstrate that such
volunteers who are well-intended can often be disorganized and ineffective. In
contrast, a Global Health Reserve Corps like peace-keeping units at the UN could
rapidly scale up trained teams in an organized way to strengthen and help lead
humanitarian assistance efforts.
The answer to the current Ebola crisis and containment is not scarce untested
drugs or vaccines, mass quarantines, or even airdrops of personal protective gear. If
1
the real reasons this outbreak has turned into a tragedy are fragile health systems
and human resource shortages, the solution is to fix these fundamental structural
deficiencies. In the long term, it will be necessary to help poor countries build their
own health systems, with a well-trained domestic workforce able to prevent
epidemics and provide humane care and treatment. That will take time and
substantial resources, comparable to the President’s Emergency Fund for AIDS
Relief (PEPFAR). But we can begin right now with a Global Health Workforce
Reserve, which would cost a tiny fraction of current international health assistance.
With the realization that epidemics like Ebola threaten regional and global
economic stability, the World Bank led by Dr. Jim Kim, a former physician involved
in human rights and the caring of underserved populations could lead the way with
seed funding for such a Corps.
The West African Ebola epidemic is a wake-up call that could spark an idea not only
offering a humanitarian lifeline to poor countries, but also preventing future
uncontrolled spread of epidemic diseases.
Michele Barry is Senior Associate Dean for Global Health and Director of the Center
for Global Health Innovation at Stanford University
Lawrence Gostin is University Professor and Director, O’Neill Institute for National
and Global Health, Georgetown University
2