IT IS a safe bet that Margaret Chan, head of the World Health Organization, won’t be relaxing much over the holidays. In January, she faces representatives of 34 governments who sit on the . And they are hopping mad about Ebola.
A clutch of from high-level panels have agreed that dithering by this United Nations agency in 2014 was partly what turned an outbreak in Guinea into the worst-ever epidemic of the virus. At last count, it had stricken 28,600 people, killed 11,300 and cost billions – and at one point almost became too big to rein in.
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Almost. The epidemic was on course for apocalyptic case numbers in mid-2014; epidemiologists feared the virus would become a constant presence in the region, and even beyond. But the WHO, the world – and the people in affected countries, who changed their behaviour to stop contagion – rallied in time. It now seems .
But it was a close-run thing. To stop that happening again, Chan will next month present her board with a plan, unprecedented in UN history, to completely redesign the WHO into something we urgently need: an epidemic preparedness and response agency for the world.
It is astonishing that we don’t really have one yet. The WHO has mainly dispensed health advice and organised long-term campaigns such as vaccination programmes. Its small outbreak-response unit is a recent creation outside its mainstream concerns, which require different skills and structures. Under the new plan, a quarter of the agency’s resources could be reorganised along lines more similar to disaster-response organisations such as the World Food Programme.
It’s a good plan. But it won’t solve the underlying problem: national governments, including those Chan is due to face.
Here’s the rub. Emerging infectious diseases threaten the world, so we must address them on a global scale, with global interests in mind. Yet political power rests with sovereign states, whose individual interests are often very different from those of the planet as a whole – they hate admitting they have diseases, for starters. And member states run the WHO.
“Emerging infectious diseases threaten the world, so we must address them on a global scale”
That collision between national power and global governance is the quintessential problem of our time for climate, refugees or finance as well as disease. Fixing it means that governments must occasionally cede sovereignty in the common interest.
What are the chances of that? They might be better if we learn the lessons of West Africa. The Ebola outbreak started in December 2013, but wasn’t diagnosed until the following March, when it had already spread to several big towns. The WHO’s small (GOARN) immediately went in.
But it couldn’t do enough. Member states reeling from financial crises had cut the WHO’s budget by 20 per cent in 2011, and halved emergency and epidemic funding in 2012. GOARN lost many seasoned specialists. Countries may criticise the WHO’s response to Ebola, but they cut its ability to respond. National budget worries trump global ones.
On top of that, governments in Guinea and Sierra Leone, afraid of scaring foreign investors, initially played down Ebola. Experts who were there say it was hard to argue because foreign-aid organisations disagreed on how bad the outbreak was. Guinea let GOARN report only confirmed cases – and with labs and public cooperation limited, only about half the suspected cases were confirmed.
Worse, this meant that only people who had contact with confirmed cases could be traced and isolated – and there were too few resources even to do that, especially when the virus hit cities. So it spun out of control.
Why didn’t the WHO simply demand the powers and resources it needed? The WHO’s country and regional offices control much of what staff from its Geneva HQ can do on the ground. Those offices are appointed by local governments, and do their bidding. A WHO expert who called for a more aggressive early response was on a plane back to Geneva sooner than expected.
Chan could have weighed in under existing rules, but didn’t – possibly because the WHO was already stretched fighting MERS, bird flu in China, and disease emergencies in the Middle East and Africa.
By June 2014, aid groups declared the epidemic out of control and said the WHO was failing to coordinate the international response. GOARN staff complained up the hierarchy – only to be told, inexplicably, that there was no problem. In August, though, the WHO declared a global emergency, Chan put a new team in charge, and the response shifted into high gear.
The WHO did finally do a lot to coordinate an ultimately effective response. But why the dangerous delay? After talking to many of the people involved, all I can conclude is that those who led the initial response were perhaps unduly cautious about sounding alarms and upsetting member states.
All organisations have people with different predilections – that isn’t a problem unless rigid hierarchies and skeleton staffs mean there is little recourse if one person happens to make a bad call. But the real problem is that deference to governments, while almost disastrous in this case, can . The member states really do hold all the cards. What else can any but the bravest leader do but defer?
That is the real question: what else can the WHO do? Its rebirth as an International Rescue for health is essential, and governments must pay for that to happen. But they must also agree on a mechanism for giving the WHO the clear lead in emergencies, with the resources – and accountability – to protect global health whether governments like it or not. We need a real worldwide health agency now, before the next Ebola strikes. And that could happen any time.
(Image: Andrzej Krauze)
This article appeared in print under the headline “All together now”
