The next epidemic--lessons from Ebola.

more effectively than Ebola. There is a significant chance that an epidemic of a substantially more infectious disease will occur sometime in the next 20 years; after all, we saw major epidemics during the 20th century, including the Spanish influenza epidemic of 1918–1919 and the ongoing pandemic of human immunodeficiency virus. In fact, of all the things that could kill more than 10 million people around the world, the most likely is an epidemic stemming from either natural causes or bioterrorism. Ebola is far from the most infectious known disease. Other disease agents (measles and influenza, for example) are far more infectious because they can be spread through the air, rather than requiring direct contact. People may not even be aware that they are infected or infectious. Since a person carrying one of these pathogens can infect many strangers in a marketplace or on an airplane, the number of cases can escalate very quickly. As the Ebola epidemic fades from the world’s attention, we risk missing the opportunity to learn from it. Even if the system we have today had worked perfectly for Ebola, it would fail to contain a more infectious disease. It’s instructive to compare our preparations for epidemics with our preparations for another sort of global threat — war. The North Atlantic Treaty Organization (NATO) has a mobile unit that is ready to deploy quickly. Although the system is not perfect, NATO countries participate in joint exercises in which they work out logistics such as how fuel and food will be provided, what language they will speak, and what radio frequencies will be used. Few, if any, such measures are in place for response to an epidemic. The world does not fund any organization to manage the broad set of coordinated activities required in an epidemic. The last serious simulation of an epidemic in the United States, the Dark Winter exercise, took place in 2001. And few countries have met their commitments under the International Health Regulations, which were adopted by the United Nations after the 2002–2003 outbreak of the severe acute respiratory syndrome (SARS) and were intended to improve the world’s ability to prevent and contain outbreaks.1 The Next Epidemic — Lessons from Ebola