By the time the extent of the first Ebola virus disease (EVD) outbreak in West Africa was recognised, and a coordinated response initiated in August 2014, there had been over 3000 cases and 1500 deaths in three countries. Although the outbreak began in Guinea in December 2013, it was not recognised as EVD until March 2014. In June, Médecins Sans Frontières declared it “out of control”, but there was little international response until August when the WHO acknowledged a “public health emergency of international concern” after two infected aid workers were evacuated from West Africa to the USA. In September, the United Nations Mission for Ebola Emergency Response (UNMEER) was established – the first for a health emergency.

At last a coordinated plan was implemented to control the outbreak, already by far the largest ever (the previous largest, since EVD was first recognised in Central Africa in 1976, involved ~400 cases). Isolation facilities and diagnostic laboratories were established and more international personnel arrived to supplement the grossly inadequate health infrastructure in the three affected countries. By April 2015, there had been more than 20,000 cases and 10,000 deaths, but the outbreak had apparently ended in Liberia and slowed in Sierra Leone. Cases were still occurring, albeit at a relatively low level, in Guinea. Meanwhile, western countries have hastily established emergency procedures for identification, management and prevention of EVD cases and there has been little transmission from, and a relatively low mortality among, the small number of cases managed in non-African countries.