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Since the 2014 Ebola outbreak many public- and private-sector leaders have seen a need for improved management of global public health emergencies. The effects of the Ebola epidemic go well beyond the three hardest-hit countries and beyond the health sector. Education, child protection, commerce, transportation, and human rights have all suffered. The consequences and lethality of Ebola have increased interest in coordinated global response to infectious threats, many of which could disrupt global health and commerce far more than the recent outbreak.

In order to explore the potential for improving international management and response to outbreaks the National Academy of Medicine agreed to manage an international, independent, evidence-based, authoritative, multistakeholder expert commission. As part of this effort, the Institute of Medicine convened four workshops in summer of 2015 to inform the commission report. The presentations and discussions from the Governance for Global Health Workshop are summarized in this report.

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Section	Section Description	Page Number
Acronyms and Abbreviations	p. xvii
1	Introduction	p. 1
    The Global Health Risk Framework Initiative	p. 2
    Meeting Objectives	p. 3
    Organization of the Report	p. 4
2	Need for Global Health Risk Governance	p. 5
    Defining Governance for Global Health	p. 6
    Diversification of Global Health	p. 12
    Strengthening Existing Systems	p. 14
3	Lessons from Past Outbreaks	p. 17
    SARS and the 2005 Revision of the IHR	p. 18
    The IHR and the 2009 H1N1 Influenza Pandemic	p. 23
    West Africa Ebola Outbreak, 2014-2015	p. 25
    Organization and Coordination of Global Health Actors	p. 35
4	Challenges for Fragile States	p. 43
    Elements of Governance for Public Goods	p. 44
    Sustaining Health Systems in the Face of Evolving Threats	p. 47
    Contributors to Declining Health Systems	p. 48
5	Challenges in Design of Governance for Global Health	p. 51
    World Health Organization	p. 52
    Roles and Responsibilities of Global Health Actors	p. 61
6	Elements of a Governance Framework	p. 65
    Overview of Global Health Security	p. 66
    WHO Regional Office Roles	p. 73
    Role of National-Level Governance	p. 76
    Role of Local Humanitarian Organizations	p. 78
    Role of Public-Private Partnerships	p. 79
7	Comparing Hypothetical Models of Governance for Global Health	p. 83
Model 1	    A Reformed WHO	p. 84
Model 2	    WHO Plus	p. 86
Model 3	    An Executive Agency	p. 88
Model 4	    A Separate Agency	p. 92
    Considerations Across Hypothetical Models	p. 97
8	Closing Comments	p. 105
    Convergence on Elements of a Successful Model	p. 105
    Decision Making in Health Emergencies	p. 107
    Measurement and Accountability	p. 107
Appendixes	
A	References	p. 109
B	Glossary	p. 111
C	Statement of Task	p. 123
D	Workshop Agenda	p. 127
E	Workshop Speaker Biographies	p. 139
F	Forum on Microbial Threats Member Biographies	p. 155