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The Ebola epidemic that surged in 2014 and continues into 2015 is the largest in history, primarily affecting three countries in West Africa — Guinea, Liberia, and Sierra Leone. A small number of cases were reported in Mali, Nigeria, Senegal, and Democratic Republic of the Congo, but these countries intervened early and effectively to limit disease transmission. The authors propose a two-phase approach as a proof of concept to help identify potential hot zones and explore concrete actions to mitigate the impact of Ebola in these potentially vulnerable countries.

To determine what factors might indicate vulnerability to a future Ebola outbreak, the authors assess a number of widely available statistical indicators in four broad domains: political, economic, sociocultural, and health. For the exemplar countries used in the perspective, the authors establish criteria and, in progressively aggregating fashion, classify each indicator, domain, and country as high, medium, or low risk. Upon selecting three countries — Côte d'Ivoire, Ethiopia, and Pakistan — to examine further as potential Ebola hot zones, the authors describe both weaknesses and mitigating factors relevant to an Ebola outbreak. Finally, the perspective outlines a tabletop exercise for Ethiopia to highlight how a scenario might unfold and the questions, decisions, and challenges to be addressed along the way.

The approach in this perspective is not inherently specific to Ebola — it can be applied or adapted to address other types of natural, accidental, or intentional health emergencies.