After missteps on Ebola, WHO must re-establish itself as 'guardian of global public health': review panel

“The Panel firmly believes that this is a defining moment not only for WHO and the global health emergency response but also for the governance of the entire global health system,” said the Report of the Ebola Interim Assessment Panel released today. “The challenges raised in this report are critical to the delivery of the proposed Sustainable Development Goals, especially Goal 3: Ensure healthy lives and promote well-being for all age.”

At WHO Executive Board's special session on Ebola in January 2015, Member States adopted a resolution calling for an assessment by a panel of independent experts on all aspects of WHO's response in the Ebola outbreak, which affected more than 27,500 people, including over 11,000 deaths, mostly in West Africa. In response to the resolution, WHO Director-General Dr. Margaret Chan established a panel to undertake this work.

WHO welcomed the report and outlined its initial efforts towards implementation of recommendations that examined: the International Health Regulations; WHO's health emergency response capacity; and WHO's role and cooperation with the wider health and humanitarian systems.

On the first category the they looked into, the experts concluded that “the Ebola crisis not only exposed organizational failings in the functioning of WHO, but it also demonstrated shortcomings in the International Health Regulations (2005).”

“If the world is to successfully manage the health threats, especially infectious diseases that can affect us all, then the Regulations need to be strengthened,” the panel said. “Had the recommendations for revision made in 2011 by the Review Committee in relation to Pandemic (H1N1) 2009 been implemented, the global community would have been in a far better position to face the Ebola crisis.”

“The world simply cannot afford another period of inaction until the next health crisis,” it said.

On WHO's emergency response capacity, “having reviewed all the options, the Panel has concluded that WHO should be the lead health emergency response agency,” but “his requires that a number of organizational and financial issues be addressed urgently,” the report said.

Currently, less than 25% of WHO's Programme budget comes from assessed contributions (and the remainder from voluntary funds) and “there are no core funds for emergency response,” it said.

“At the 2016 Executive Board and World Health Assembly meetings, Member States should reconsider moving from the policy of zero nominal growth to increase assessed contributions by 5 per cent,” the panel recommended.

And “in order to ensure delivery of effective preparedness and response capacity, Member States and partners should contribute immediately to the contingency fund in support of outbreak response, with a target capitalization of $100 million fully funded by voluntary contributions,” it said.

On WHO's role and cooperation with the wider health and humanitarian systems, the panel concluded that during the Ebola crisis, the engagement of the wider humanitarian system came very late in the response.

“The Panel was surprised that many donors, governments, the United Nations and international non-governmental organizations understood only either the health emergency or the humanitarian system,” it said.

The experts noted that it was clear that by September 2014 it was essential that highly visible action be taken to generate political and financial support from the global community, but “while the UN Mission for Emergency Ebola Response (UNMEER) catalysed this high-level political and financial support, it was less successful in coordinating the effort in affected countries.”

The panel concluded that the UN “Office for the Coordination of Humanitarian Affairs (OCHA) and other United Nations agencies should have been engaged more strongly and earlier in the crisis.”

It also recommended that the Secretary-General should consider – when a crisis escalates to a point where it poses a high-level global health threat requiring greater political and financial engagement – the appointment of a Special Representative or a Special Envoy with a political/strategic role to provide greater political and financial engagement, but “would not recommend the establishment of a full United Nations mission.”

In a statement issued in response to the Panel's conclusions, WHO said that next month, Dr. Chan will convene a Review Committee of the International Health Regulations, where Member States can discuss the recommendations of the panel, including the idea of establishing an intermediate level of alert to sound an alarm earlier than a full Public Health Emergency of International Concern.

As for WHO's health emergency response capacity, the agency said that it is already moving forward on some of the panel's recommendations including the development of the global health emergency workforce and the contingency fund to ensure the necessary resources are available to mount an initial response.

Going forward, WHO says the current Ebola outbreak is still ongoing and improved methods of working are incorporated into the response as they are developed. “But it will take many more months of continued hard work to end the outbreak and to prevent it from spreading to other countries.”

Photo: UNICEF/NYHQ2015-0135/Naftalin