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After Ebola outbreak, expert panel urges ‘unified entity’ within UN health agency for emergency response

Ebola caregivers in Guinea.
UNMEER/Simon Ruf
Ebola caregivers in Guinea.

After Ebola outbreak, expert panel urges ‘unified entity’ within UN health agency for emergency response

Independent experts tasked to assess the World Health Organization’s (WHO) response to the Ebola outbreak in West Africa today said “at present, WHO does not have the operational capacity or culture to deliver a full emergency public health response” and urged investments by its member States to make it fit for purpose.

“Now is the historic political moment for world leaders to give WHO new relevance and empower it to lead in global health,” said the panel’s first report, commissioned by WHO’s Director-General Dr. Margaret Chan and shared today with member States in advance of next week’s World Health Assembly, the world’s highest-level health setting body.

“A strengthened, well-funded WHO can support all countries as they prepare to meet the challenges of increasing global interdependence and shared vulnerability,” the report said. “In response, the [WHO] Secretariat needs to take serious steps to earn this leadership role in relation to outbreaks and emergency response and to regain the trust of the international community.”

The panel will present its final report after visiting and consulting with the affected countries, currently set for June 2015.

WHO spokesman Tarik Jašarevic told the UN News Centre that the agency appreciated the work done by the panel to have the report ready ahead of the World Health Assembly so that member States could assess the committee’s findings and make recommendations based on those findings.

“We can then take forward the recommendations endorsed by our member States,” Mr. Jašarevic said.

The Ebola Virus Disease (EVD) outbreak is the largest and most complex Ebola outbreak on record, and to date has affected more than 26,000 people including over 11,000 deaths, mostly in Guinea, Liberia and Sierra Leone.

Retracing the timeline of the epidemic, the report said that “although WHO drew attention to the ‘unprecedented outbreak’ at a press conference in April 2014, this was not followed by international mobilization and a consistent communication strategy.”

“The countries most affected, other WHO Member States, the WHO Secretariat, and the wider global community were all “behind the curve” of the rapid spread of the Ebola virus,” it said.

“Further, in this emergency, before August 2014 WHO did not appropriately seek support from other United Nations agencies and humanitarian actors in the United Nations Inter-Agency Standing Committee system,” it said. “ At an earlier stage these resources could have been made available and known systems put in place; these might have averted the crisis that led to the need to establish the United Nations Mission for Ebola Emergency Response (UNMEER).”

And “given WHO’s extensive experience with outbreaks, health promotion and social mobilization,” the panel noted, “it is surprising that it took until August or September 2014 to recognize that Ebola transmission would be brought under control only when surveillance, community mobilization and the delivery of appropriate health care to affected communities were all put in place simultaneously.”

The panel, chaired by Barbara Stocking, President of Murray Edwards College, University of Cambridge of the United Kingdom and former chief executive of Oxfam GB, concluded that “there is a strong, if not complete, consensus that WHO does not have a robust emergency operations capacity or culture.”

The report says that each global health crisis has shown the tragic consequences, including those in the social and economic spheres, of the failure of countries to invest in global public goods for health. Those failures are then mirrored as weaknesses in WHO, as the agency suffers from a lack of political and financial commitment by its Member States despite the global health risks they face.

“The Ebola outbreak might have looked very different had the same political will and significant resources that were spent in responding to it been made available to member States and the WHO Secretariat over the past five years in order to support three key areas of action: ensuring global health preparedness at country level in implementing the International Health Regulations (2005); supporting countries to establish or strengthen primary health care systems; and developing diagnostics, vaccines, and medicines for neglected tropical diseases.”

Turning to the number of options that have been suggested by different organizations and individuals regarding the way forward for WHO, the report listed three: a new agency should be established for health emergencies; the emergency part of the health response should be led by another United Nations agency; or investments should be made so that the operational capacity of WHO for emergency response is fully in place.

The panel said it recommends that the third option “be pursued with vigour.”

“As WHO already has the mandate to deliver on operational response, it would be a far more effective and efficient use of resources to make WHO fit for purpose,” the report concluded. “This will require the resources and political will of the Member States.”

In addition to Ms. Stocking, the other members of the panel are: Professor Jean-Jacques Muyembe-Tamfun, Director-General of the National Institute for Biomedical Research, Democratic Republic of the Congo; Dr Faisal Shuaib, Head of the National Ebola Emergency Operations Center, Nigeria; Dr Carmencita Alberto-Banatin, independent consultant and advisor on health emergencies and disasters, Philippines; Professor Julio Frenk, Dean of the Faculty, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; and Professor Ilona Kickbusch, Director of the Global Health Programme at the Graduate Institute of International and Development Studies, Geneva, Switzerland.