The next global pandemic is a matter of when, not if. Preparing for this inevitability requires that policy­makers understand not just the science of limiting dis­ease transmission or engineering a drug, but also the practical challenges of expanding a response strategy to a regional or global level. Achieving success at such scales is largely an issue of operational, strategic, and policy choices—areas of pandemic preparedness that remain underexplored.

The response to the 2014–2015 Ebola outbreak in West Africa illuminates these challenges and highlights steps toward better preparedness. Ebola was a known disease whose basic transmission pathways and con­trol strategies were understood. Yet traditional Ebola control strategies were premised on small, non-urban outbreaks, and they rapidly proved inadequate as the disease reached urban environments, forcing policy­makers to develop new strategies and operational plat­forms for containing the outbreak, which generated unique policy challenges and political pressures. Lack­ing a blueprint for controlling Ebola at scale, response leaders scrambled to catch up as the disease began threatening the wider West African region.

This report explores the lessons of the Ebola outbreak through the lens of the US and UN policymakers who were forced to construct an unprecedented response in real time. It tells the story of their choices around four major policy challenges:

1. Operationalizing the US government response

2. Balancing the politics and the science of travel restrictions

3. Defining the role of a reluctant military

4. Coordinating complex international partnerships

The report draws on interviews with 19 high-level US and UN policymakers, a desk review of after-action reports, and the author’s own experiences while lead­ing the response efforts of the US Agency for Interna­tional Development (USAID).