The Lancet
Sep 13, 2014 Volume 384 Number 9947 p929 – 1070 e38
http://www.thelancet.com/journals/lancet/issue/current

Editorial
The silver bullet of resilience
The Lancet
The irony of September being US National Preparedness month was not lost as Médecins sans Frontières (MSF) made an uncharacteristic global call for rapid deployment of civil and military medical assets with expertise in biohazard containment to west Africa. With 42% of all reported Ebola infections occurring in the past month, and more than 2000 reported deaths, local health systems and international organisations were not prepared for the scale and speed of the current outbreak. MSF called for countries such as the UK and USA to deploy disaster response teams with medical and logistical experts for water and sanitation, building of mobile laboratories, isolation centres, hospitals, crematoriums, and the establishment of dedicated air bridges to move personnel and equipment between countries. On Sept 7, the US government announced that their military would be mobilised to set up isolation units and equipment, and provide security for public health workers.

Delayed international action has been largely blamed on the chronic underfunding and inability of WHO to mount an adequate initial response to manage the outbreak. This institutional failure begs first and foremost an urgent rethink of how the world responds to outbreaks, and with whom. The second equally important task is building resilience into health systems.

The notion of resilience is defined as the capacity to adapt and thrive in the face of challenge. For health organisations, this could mean creating more redundancy and organisational slack to respond efficiently to crises

For companies, it might mean rethinking the development pipeline of their products, delinked from profit, to contribute to a better prepared world. For countries and their partners, it means investing in weak health systems, building back the trust of communities, and examining the complex interactions between people and the environment. However, to earn the luxury of a much needed resilience debate for west Africa, countries and international organisations must heed the call to immediately deploy medical assets to contain the Ebola outbreak and offset further deaths.