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WHO hopes Ebola incidence will decline after peaking in December

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6255 (Published 15 October 2014) Cite this as: BMJ 2014;349:g6255

Dilemmas faced by the World Health Organization in connection with the Ebola Emergency response

On January 25th a Special Session of the World Health Organization’s (WHO) Executive Board will be convened to discuss the Ebola emergency and the WHO response to the epidemic that has affected several countries in West Africa It is the third time in the history of WHO that the Executive Board organizes a Special Session. This is motivated by the multiple difficulties faced by the international response to the problem, resulting in ineffective and untimely action in countries lacking the adequate health infrastructure and sufficient health workforce.

This debate is happening too late within WHO’s Governance structure. Neither the Executive Board held in January 2014 nor the World Health Assembly held in May 2014 gave adequate attention to the matter. The fight against Ebola has been full of mistakes and has lacked coordination. The affected countries’ health systems (Guinea, Liberia and Sierra Leone), WHO, the UN System and the International Community at large have been stumbling along. More than ever it is important to conduct an exercise of self-criticism and to call a spade a spade. It is important to identify the critical bottle necks that have impeded a more determined, effective and prompt action.

Decisions of major importance for the global health governance will be derived from the debate on the dilemmas faced, on the different options available and on the lessons learned about the successes and failures. It is a pity not to have and Independent Real Time Evaluation that would permit an objective and factual stock-taking of the problems to overcome. Notwithstanding, whatever is agreed will have to be ratified in May 2015 by the World Health Assembly and will influence in a decisive manner in the way crises like this will be faced in the future.

The matter is particularly sensitive since there is a risk of making mistakes either by omission or by inappropriate decision making. At the same time there is a unique opportunity for rectifying directions and improving the response capacity, provided Member States and the WHO Secretariat articulate a visionary consensus on the changes that have to take place for leading and managing these affairs in the future. So far this has not been the case.

Las week the WHO Secretariat issued two reports on the situation of the epidemic and on WHO response to it. They will be the main documents informing the deliberations of the Special Session on the Ebola Emergency. The first one “Current context and challenges; stopping the epidemic; and preparedness in non-affected countries and regions” (Document EBSS/3/2) and the second one “Ensuring WHO’s capacities to prepare for and respond to future large-scale and sustained outbreaks and emergencies” (Document EBSS/3/3). It is important to read in detail the reflections and proposals made by the Secretariat in these documents, even though both of them are rather general in nature, not supported by formal evaluations, sometimes superficial in the analysis and vague or ambivalent in the proposals .Overall reflect a late WHO’s awakening to the need of putting its act together to fulfil some of its constitutional mandates related to public health emergencies and humanitarian crises.

In the weeks before the release of these two documents many worrisome ideas and opinions on the issues at stake floated in different media:
1) the idea of creating a new international agency for facing health emergency situations ,relegating WHO to a role of producing technical norms and standards without any armed branches for orchestrating operational responses at country, regional or global level;
2) creating an international health emergency response fund outside WHO; and
3) creating an international corps of emergency health workers managed outside WHO and not linked neither to the structures established by the International Health Regulations approved in 2005 nor to the Health Cluster that is part of the International Humanitarian Response.

Evidently these absurd ideas have been triggered by the frustration resulting from the lack of an effective and timely response. However they point in the wrong direction fostering proposals that would only weaken the global health architecture and its current coordination mechanisms. If this paths is followed there would be an even further atomization/balkanization of the already failed global health governance. It is time to halt this trend and make the necessary steps for rationalizing the huge dispersion of channels and mechanisms associated to the global health partnerships created during the last 20 years at a high cost for the effective coordination of international public health.

It will be important to follow closely the deliberations of the Special Session of the Executive Board on the 25th of January. . What is at stake is the rationalization of the global health governance and the support of those proposals that will avoid an unnecessary dispersion of mechanisms for having an effective humanitarian health response and an atomization of the fight against disease outbreaks.

Competing interests: No competing interests

21 January 2015
Daniel Lopez-Acuna
Public Health Expert
Independent Consultant. Retired WHO Official
Camino de Cabuenes 806 Casa 25. Gijon 33203 Spain