By Rosalind McCollum and Miriam Taegtmeyer
The Ebola epidemic in West Africa resulted in calls for universal health coverage and revision of global health governance for emergency response. This political economy analysis identifies structural reasons why Sierra Leone and the international health community failed to respond in a timely and effective manner to the Cholera and Ebola epidemics or to translate learning from the Cholera epidemic to the Ebola response. The analysis considers how structural factors interact with stakeholder institutions’ interests and power dynamics before it identifies potential solutions. We urge national and global decision makers to take concrete action to tackle underlying inequity within the global health system and address the root causes of populations’ vulnerability to future infectious disease outbreaks.