Although the sharp drop in the number of new Ebola infections has, worryingly, appeared to level off, the international community has made significant progress toward raising funds toward the response, developing and now undertaking widespread testing of vaccines, and implementing measures meant to control the worldwide spread of the disease. All of this leaves the global public health community with a number of questions about what pandemic threats might emerge in the future and, so far as the most important international agreement on pandemics goes, what international regulatory preparedness is in place?

The experience with the 2013-14 Ebola outbreak has taught at least two lessons about the International Health Regulations as they now operate. First, they do not effectively commit the international community to the core capacities the IHR contemplate to manage international public health emergencies. The Ebola experience has shown that outbreaks in low-resource settings can have cataclysmic multiplier effects. The IHR’s Annex 1 Core Capacities call for health systems infrastructure and medical personnel almost impossible to imagine without international assistance for the most afflicted countries: Guinea, Liberia, and Sierra Leone. Second, the IHR may have been dated even at their passage as to the role and influence of non-governmental organizations in global public health responses to public health emergencies of international concern. The great hero of the Ebola response will almost certainly be remembered as Medicins Sans Frontieres (MSF) which led the first-line response, mobilized the international community, including WHO, with evidence as to the seriousness of the emergency, and did so through a decentralized structure that emphasizes responses at once humanitarian and public health-promoting in nature like civilian casualties and refugees of war.

The takeaway for the IHR is that, if it remains a mirror of its backing organization – state-centered and slowly moving – it will at the very least need to commit real resources to the Annex 1 core capacities. Even better, its next revision may acknowledge and internalize the non-governmental networks making real gains by tackling disease at some of its resource and conflict roots.