The most recent Ebola epidemic that began in late 2013 alerted the entire world to the gaps in infectious disease emergency preparedness and response. The regional outbreak that progressed to a significant public health emergency of international concern (PHEIC) in a matter of months killed 11,310 and infected more than 28,616. While this outbreak bears some unique distinctions to past outbreaks, many characteristics remain the same and contributed to tragic loss of human life and unnecessary expenditure of capital: insufficient knowledge of the disease, its reservoirs, and its transmission; delayed prevention efforts and treatment; poor control of the disease in hospital settings; and inadequate community and international responses. Recognizing the opportunity to learn from the countless lessons of this epidemic, the National Academies of Sciences, Engineering, and Medicine convened a workshop in March 2015 to discuss the challenges to successful outbreak responses at the scientific, clinical, and global health levels. Workshop participants explored the epidemic from multiple perspectives, identified important questions about Ebola that remained unanswered, and sought to apply this understanding to the broad challenges posed by Ebola and other emerging pathogens, to prevent the international community from being taken by surprise once again in the face of these threats. This publication summarizes the presentations and discussions from the workshop.

Beyond the terrible toll in human lives and suffering, the Ebola epidemic currently afflicting West Africa is already having a measurable economic impact. This report provides a systematic analysis of the channels of economic impact and the likely magnitude of that impact for Guinea, Liberia, and Sierra Leone, as well as West Africa as a whole.

From 2013 to 2015, over 11,000 people across West Africa lost their lives to the deadliest outbreak of the Ebola virus in history. Crucially, this epidemic marked the first time the virus was able to spread beyond rural areas to major cities, overturning conventional assumptions about its epidemiology. With backgrounds ranging from development to disease control, the contributors to this volume - some of them based in countries affected by the Ebola epidemic - consider the underlying factors that shaped this unprecedented outbreak. While championing the heroic efforts of local communities and aid workers in halting the spread of the disease, the contributors also reveal deep structural problems in both the countries and humanitarian agencies involved, which hampered the efforts to contain the epidemic. Alarmingly, they show that little has been learned from these events, with health provision remaining underfunded and poorly equipped to deal with future outbreaks. Such issues, they argue, reflect the wider challenges we face in tackling epidemic disease in an increasingly interconnected world.

“Paul Farmer brings his considerable intellect, empathy, and expertise to bear in this powerful and deeply researched account of the Ebola outbreak that struck West Africa in 2014. It is hard to imagine a more timely or important book.” —Bill and Melinda Gates "[The] history is as powerfully conveyed as it is tragic . . . Illuminating . . . Invaluable." —Steven Johnson, The New York Times Book Review In 2014, Sierra Leone, Liberia, and Guinea suffered the worst epidemic of Ebola in history. The brutal virus spread rapidly through a clinical desert where basic health-care facilities were few and far between. Causing severe loss of life and economic disruption, the Ebola crisis was a major tragedy of modern medicine. But why did it happen, and what can we learn from it? Paul Farmer, the internationally renowned doctor and anthropologist, experienced the Ebola outbreak firsthand—Partners in Health, the organization he founded, was among the international responders. In Fevers, Feuds, and Diamonds, he offers the first substantive account of this frightening, fast-moving episode and its implications. In vibrant prose, Farmer tells the harrowing stories of Ebola victims while showing why the medical response was slow and insufficient. Rebutting misleading claims about the origins of Ebola and why it spread so rapidly, he traces West Africa’s chronic health failures back to centuries of exploitation and injustice. Under formal colonial rule, disease containment was a priority but care was not – and the region’s health care woes worsened, with devastating consequences that Farmer traces up to the present. This thorough and hopeful narrative is a definitive work of reportage, history, and advocacy, and a crucial intervention in public-health discussions around the world.

The 2014-2015 Ebola epidemic in West Africa was an unprecedented medical and political emergency that cast an unflattering light on multiple corners of government and international response. Fear, not rational planning, appeared to drive many decisions made at population and leadership levels, which in turn brought about a response that was as uneven as it was unprecedented: entire populations were decimated or destroyed, vaccine trials were fast-tracked, health staff died, untested medications were used (or not used) in controversial ways, humanitarian workers returned home to enforced isolation, and military was employed to sometimes disturbing ends. The epidemic revealed serious fault lines at all levels of theory and practice of global public health: national governments were shown to be helpless and unprepared for calamity at this scale; the World Health Organization was roundly condemned for its ineffectiveness; the US quietly created its own African CDC a year after the epidemic began. Amid such chaos, Médecins sans Frontières was forced to act with unprecdented autonomy -- and amid great criticism -- in responding to the disease, taking unprecedented steps in deploying services and advocating for international aid. The Politics of Fear provides a primary documentary resource for recounting and learning from the Ebola epidemic. Comprising eleven topic-based chapters and four eyewitness vignettes from both MSF- and non-MSF-affiliated contributors (all of whom have been given access to MSF Ebola archives from Guinea, Sierra Leone, and Liberia for research), it aims to provide a politically agnostic account of the defining health event of the 21st century so far, one that will hopefully inform current opinions and future responses.

From 2013 to 2015, over 11,000 people across West Africa lost their lives to the deadliest outbreak of the Ebola virus in history. Crucially, this epidemic marked the first time the virus was able to spread beyond rural areas to major cities, overturning conventional assumptions about its epidemiology. With backgrounds ranging from development to disease control, the contributors to this volume - some of them based in countries affected by the Ebola epidemic - consider the underlying factors that shaped this unprecedented outbreak. While championing the heroic efforts of local communities and aid workers in halting the spread of the disease, the contributors also reveal deep structural problems in both the countries and humanitarian agencies involved, which hampered the efforts to contain the epidemic. Alarmingly, they show that little has been learned from these events, with health provision remaining underfunded and poorly equipped to deal with future outbreaks. Such issues, they argue, reflect the wider challenges we face in tackling epidemic disease in an increasingly interconnected world.

In 2014, a 28-year old British doctor found himself co-running the Ebola isolation unit in Sierra Leone’s main hospital after the doctor in charge had been killed by the virus. Completely overwhelmed and wrapped in stifling protective suits, he and his team took it in turns to provide care to patients while removing dead bodies from the ward. Against all odds he battled to keep the hospital open, as the queue of sick and dying patients grew every day. Only a few miles down the road the Irish Ambassador and Head of Irish Aid worked relentlessly to rapidly scale up the international response. At a time when entire districts had been quarantined, she travelled around the country, and met with UN agencies, the President and senior ministers so as to be better placed in alerting the world to the catastrophe unfolding in front of her. In this blow-by-blow account, Walsh and Johnson expose the often shocking shortcomings of the humanitarian response to the outbreak, both locally and internationally, and call our attention to the immense courage of those who put their lives on the line every day to contain the disease. Theirs is the definitive account of the fight against an epidemic that shook the world.