The World Health Organization must undergo fundamental changes if it is to fulfill its function of protecting global health, according to an independent panel of experts that reviewed the agency’s bungled response to the deadly Ebola outbreak.
“The panel considers that WHO does not currently possess the capacity or organizational culture to deliver a full emergency public health response,” it says in a scathing report released Tuesday.
The panel, headed by Barbara Stocking, a former head of the aid group Oxfam GB, urged the WHO to create a division to oversee preparations for the next major outbreak and coordinate the response.
But it did not endorse more radical solutions, such as creating a separate agency or putting another United Nations body in charge of health emergencies. Such agencies would in any case need to coordinate with the WHO, complicating the response, the review concluded.
The panel said it would be “far more effective and efficient” to revamp the WHO. “This transformation must be carried out urgently,” it said.
The WHO welcomed the panel’s findings. In a statement Tuesday, it said it was already moving forward on some of the recommendations, including the development of a global workforce that can be deployed in a health emergency and the establishment of a contingency fund to ensure that resources are available for the initial response. Others will be discussed at a meeting in August.
The WHO ordered the review in March after coming under intense criticism from aid groups such as Doctors Without Borders, which argued that the largest Ebola epidemic on record could have been averted had the agency more quickly sounded the alarm and mobilized outside help.
The WHO first reported the outbreak in March 2014 but did not declare a public health emergency of international concern until August. By then, the virus had spread to four West African countries, and casualties were beginning to arrive in the United States and Europe.
More than 11,000 people are now believed to have died of Ebola, most of them in Guinea, Liberia and Sierra Leone. Although the epidemic has slowed, new cases continue to be reported in these countries.
Dr. Margaret Chan, director general of the WHO, acknowledged in May that the world was ill-prepared to respond to an outbreak of the scale and complexity of Ebola. “WHO was overwhelmed, as were all other responders,” she said.
The panel did not single out individuals for blame but criticized the U.N. organization’s bureaucratic culture.
“WHO does not have a culture of rapid decision-making and tends to adopt a reactive, rather than a proactive, approach to emergencies,” the report said.
In the early stages of the outbreak, messages were sent by WHO staff members at headquarters and in the field about the seriousness of the crisis.
“Either these did not reach senior leaders, or senior leaders did not recognize their significance,” the report said. “There seemed to be a hope that the crisis would be managed by good diplomacy rather than by scaling up emergency response.”
As a result, aid groups in the affected countries were left to respond to a crisis for which they were not well equipped.
Stocking acknowledged at a news briefing Tuesday that an emergency declaration by the WHO carries serious political, economic and trade implications for the affected countries, which might resist such a move. The panel recommended the introduction of an intermediate-level alert that could mobilize the international community at an earlier stage in a crisis.
The report also highlights failings of member states, which it says did not fulfill their responsibilities under the WHO’s international health regulations. The agency’s nearly 200 members are supposed to conduct surveillance and collect data to detect public health threats at an early stage, but largely failed to do so in this outbreak.
Countries that have not developed the capacity to fulfill these functions need support from the WHO and other member states to do so, the report says.
In addition, nearly a quarter of the member states instituted travel bans and other measures that were not called for by the WHO. This not only impeded the delivery of medical supplies and personnel but also created a disincentive for countries to quickly report Ebola cases, as they were often penalized as a result, the report says.
Stocking said both incentives and penalties might be needed to encourage countries to fulfill their obligations.
“Where member state behavior threatens the response to the crisis by, for example, making it impossible for health workers to reach affected countries, there should be a procedure to take this matter to the United Nations Security Council,” the report says.
The panel welcomed the creation of a $100-million fund for health emergencies and urged member states to contribute. But it said it was disappointed that they had not agreed to increase core funding for the WHO.
Although critical of the WHO’s organizational failings, the panel praised its efforts to develop a vaccine, treatment and diagnostic tools for neglected diseases such as Ebola.
Dr. Joanne Liu, the international president of Doctors Without Borders, welcomed the recommendations but said member states would need to step up and see that they were translated into action.
“This is not the first time we come with a good plan and a good design for reforming the WHO. This happened after the swine flu [pandemic in 2009] and all the good plans stayed on paper,” she told the Los Angels Times.
Meanwhile, there is still an Ebola epidemic to contain. "I think that it’s good to want to prepare for the next hypothetical epidemic," she said, "but we need to finish the job" at hand.
The panel recommended that an independent board be established to oversee the development of a new Center for Emergency Preparedness and Response and hold it accountable.
“The world simply cannot afford another period of inaction until the next health crisis,” the report said.
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