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. Table of Contents Front Matter 1 Introduction 2 The Outbreak 3 Global Preparedness and Response Efforts 4 Current and Future Research Opportunities Appendix A: References Appendix B: Ebola: A View from the National Institute of Allergy and Infectious Diseases Appendix C: Ebola Virus Disease Preparedness in Germany: Expertise Focused in Specialized Laboratories, Competence, and Treatment Centers Appendix D: Statement of Task Appendix E: Workshop Agenda Appendix F: Speaker Biographies

Emerging infectious disease threats that may not have available treatments or vaccines can directly affect the security of the world's health since these diseases also know no boundaries and will easily cross borders. Sustaining public and private investment in the development of medical countermeasures (MCMs) before an emerging infectious disease becomes a public health emergency in the United States has been extremely challenging. Interest and momentum peak during a crisis and wane between events, and there is little interest in disease threats outside the United States until they impact people stateside. On March 26 and 27, 2015, the Institute of Medicine convened a workshop in Washington, DC to discuss how to achieve rapid and nimble MCM capability for new and emerging threats. Public- and private-sector stakeholders examined recent efforts to prepare for and respond to outbreaks of Ebola Virus Disease, pandemic influenza, and coronaviruses from policy, budget, and operational standpoints. Participants discussed the need for rapid access to MCM to ensure national security and considered strategies and business models that could enhance stakeholder interest and investment in sustainable response capabilities. This report summarizes the presentations and discussions from this workshop. Table of Contents Front Matter 1 Introduction 2 A Wake-Up Call: The 2014 Ebola Outbreak Response 3 Preparedness as an Issue of National Security 4 Rapid Development of Ebola Vaccines 5 Influenza Risk Assessment and Pandemic Preparedness 6 Developing MCMs for Coronaviruses 7 Sustainable Business Models to Ensure Rapid and Nimble Responses 8 Supporting MCM Development Across Threats and Funding Cycles A References B Acronyms and Abbreviations C Statement of Task D Agenda E Biosketches of Invited Speakers and Facilitators