A new
report by The Heritage Foundation analyzes the international response to the Ebola epidemic during 2013 and 2014. The findings are not good news for the World Health Organization (WHO), whose track record has been less than stellar over time.
The report's editors -- James Jay Carafano, Charlotte Florance, and Daniel Kaniewski -- arrived at the following conclusion:
"Politicization within the organization and inefficient lines of authority severely limited WHO's ability to respond swiftly and effectively to the EVD outbreak in West Africa. Serious reforms must be implemented to ensure the agency does not continue to fumble in potentially catastrophic public health emergencies. WHO must remain focused on its core competencies: building the capacity of national health systems in developing countries and monitoring and coordinating the international response to epidemic disease."
While Director-General Dr. Margaret Chan admitted that her organization "was too slow to see what was unfolding before us," the WHO has not moved in the direction of making the reforms needed to prevent future poor responses, instead -- as the Heritage report notes -- "it has demonstrated a troubling lack of initiative and decisiveness."
The causes of these problems are two-fold. Carafano and colleagues identify both "structural and bureaucratic inefficiencies" as well as the WHO's tendency to "focus on non-core initiatives, such as tobacco use and childhood obesity, that distract it from its correct focus: building the capacity of national health systems in developing countries and monitoring and coordinating the international response to epidemic disease."
Ebola's spread in Guinea can likely be blamed directly on the WHO, says the Heritage report: "WHO's failure to acknowledge the seriousness of the outbreak, particularly once EVD [Ebola virus disease] reached highly concentrated urban areas, is deeply concerning."
Luigi Mariano, the Deputy Director of MSF (Medecins Sans Frontieres) Switzerland, is quoted as observing that "in all the meetings I attended, even in Conakry, I never saw a representative of the WHO ... The coordination role that WHO should be playing, we just didn't see it. I didn't see it the first three weeks and we didn't see it afterwards." Despite the outbreak beginning in late 2013, the WHO did not declare an international health emergency for West Africa until August 2014, whereas MSF was already warning of the outbreak several months earlier. The MSF's Director of Operations was concerned that the WHO "played a critical role in that failure in the first two to three months ... They were in the same mode of denial as the governments were." Joanne Liu -- the MSF president -- is on-record as saying that the WHO failed to meet its "mandate to help member states cope with health emergencies."
Based on this failure to respond appropriately, the Heritage report states that "the situation in West Africa could have been far smaller, less severe, and simpler to contain if WHO had acted sooner."
A specific failing by the WHO "was a lack of coordination between the Africa Regional Bureau and the headquarters in Geneva, a problem many have blamed on the local and international leadership." The WHO's response to bring in experienced staff to work in local offices was termed a "half measure" and "too little, too late." This delay was termed "a crucial factor in allowing the epidemic to reach unprecedented levels" by Dr. Peter Piot, a former WHO official and co-discoverer of Ebola. Carafana et al. note the "WHO's inability to get in front of the disease and provide the leadership necessary in this public health crisis highlights serious concerns over the agency, its structure, resource allocation, and priorities."
The age-old problems of the WHO include politically driven appointments, bureaucracy, and a lack of disease monitoring, which the Heritage report indicates "are not new problems. Similar criticism was directed at WHO during the H1N1 (swine flu) outbreak in 2009." In response, Margaret Chan blamed a lack of money at the WHO for its problems. Her reply to valid criticisms over the substandard Ebola response overlooks the WHO's already wasteful spending on "noncritical issues, such as childhood obesity."
From its analysis, the Heritage Foundation team identified the following recommendations for urgently needed WHO reform:
- Narrow the organization's priorities to focus on a limited number of core responsibilities: building national health capacity, monitoring and tracking disease outbreaks, developing national and regional outbreak response plans, coordinating and managing rapid deployment commitments, and encouraging development, especially by promoting the protection of intellectual property, vaccinations for neglected diseases, and new antibiotics and treatments as resistance rises;
- Emphasize and encourage multilateral and bilateral health funding and building public health expertise and capacity in developing nations; and
- Strengthen lines of authority and responsibility in WHO to avoid repetition of the politicization and inefficiencies that slowed WHO's Ebola response and exacerbated the situation.
While one hopes the member states supporting the WHO will demand greater efficiencies, efforts at reform will be severely challenged by the entrenched WHO bureaucracy, poor leadership, and a general lack of political will among western nations to lead the charge for serious reform. This failure to act with resolve by all parties will lead to future international health crises that are worse than need be.
