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When health emergencies like the Ebola epidemic strike, there's one group the world looks to for help: the UN's World Health Organization. But never has this disturbing truth been clearer: The organization isn't funded or empowered to actually respond in a crisis.
This year the Ebola virus outfoxed the organization so badly that the WHO boss, Dr. Margaret Chan, convened an independent panel of experts to review what went wrong and chart a pathway to reform. Today, the panel released its final report, which reads like a dire assessment of a broken organization in need of immediate repair.
"The panel considers that WHO does not currently possess the capacity or organizational culture to deliver a full emergency public health response," the panelists write.
"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."
The experts, led by former Oxfam head Dame Barbara Stocking, provided 21 recommendations for immediate action. Considering that the world hasn't yet seen the last of Ebola and that there are other disease crises on the horizon, acting on the panel's insights is a very important step. They include:
1) Fixing the International Health Regulations
These are a set of laws that govern how member states react to disease outbreaks. Established in 2005 in the wake of SARS crisis, they were designed to make reporting outbreaks more transparent and build countries' capacities for disease surveillance.
Countries were supposed to improve their own disease surveillance and reporting systems, and richer countries are under a legal obligation to help poorer ones do so. The rules also mandate that countries avoid punishing each other for disease outbreaks within their borders through economic sanctions and travel bans.
But many countries never built up their disease surveillance systems and also quickly enacted travel bans during the Ebola epidemic. "The panel considers this situation, in which the global community does not take seriously its obligations under the international health regulations (2005) — a legally binding document — to be untenable," the panelists write.
So the experts asked for special attention to figuring out how to build up countries' ability to carry out the regulations, including creating incentives for declaring and sharing data on disease outbreaks.
2) Increasing countries' mandatory payments to the WHO
The WHO hasn't seen a budget increase since the 1990s. Largely because of these funding cuts and freezes, the panel determined that the WHO doesn't have the capacity or organizational culture to respond to health crises. It suggested fixing this immediately:
Funding for emergency response and for technical support to the International Health Regulations (2005) is lacking. Currently, less than 25% of WHO’s Programme budget comes from assessed contributions [what countries must pay in for membership] (and the remainder from voluntary funds). There are no core funds for emergency response. The longstanding policy of zero nominal growth policy for assessed contributions has dangerously eroded the purchasing power of WHO’s resources, further diminishing the Organization’s emergency capacity.
To address the problem, the panel recommends a 5 percent increase in mandatory payments from countries to the WHO.
3) Embed the WHO within the wider health and humanitarian system
The Ebola crisis made it clear that the WHO is not properly coordinating its efforts with other humanitarian agencies, even within the UN:
The Panel considers 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 nongovernmental organizations understood only either the health emergency or the humanitarian system. In part this was due to lack of understanding across the two systems, caused by different approaches to risk assessment.
So the panel suggests that the WHO figure out how to coordinate its own emergency responses with the rest of the UN and the broader humanitarian system, and also that WHO staff and partners better understand the humanitarian system and its key players.
