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