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WHO warns over complacency as targets on Ebola are met

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g7424 (Published 02 December 2014) Cite this as: BMJ 2014;349:g7424

What are member states expecting to decide during the WHO Executive Board Special Session on the Ebola Emerency on January 25th?

A group of Member States, led by South Africa and the United States of America, have circulated a draft resolution with the idea of approving it during the Special Session of the WHO Executive Board on the Ebola emergency on January 25th. Other countries that so far have adhered to this draft resolution are Chile, China, Cuba, France, Guinea, Liberia, Norway, Senegal, Sierra Leone, the United Kingdom, Zambia and Zimbabwe. It is a long resolution seeking to promote a consensus on the necessary reforms that are considered as vital for WHO’s adequate and effective functioning in emergency situations and extended outbreaks. A plea is made for having WHO consult on these matters with Member States, relevant non-State Actors and the UN System in preparation for the 68th World Health Assembly.

This draft resolution rightly proposes reaching zero cases of Ebola Virus Disease, but also rebuilding the devastated health systems of the affected countries. It also seeks to reaffirm the role that WHO ought to play in the response to outbreaks, to natural disasters and to humanitarian crises triggered by conflict. It is mindful, in particular, of the WHO role as the leader of the health cluster in humanitarian health response. This is timely because during the last years both the current administration of the Secretariat and some Member States have been short sighted and ambivalent in this connection, reaching the point of suggesting the relinquishing of operational responsibilities in emergency response and favoring a vision of WHO as a merely normative agency.

WHO is not Medecins Sans Frontieres (MSF). Each organization has its role and hopefully a greater coordination, complementarity and convergence between them can be developed. However, the worst mistake that could be made would be to conceive WHO as an entity that only produces norms and standards but does not get the feet dirty in the trenches or in the direct operational action in support to Countries.

Clear reference is made in the draft resolution to the need of having WHO working on a better coordinated response, with greater linkages with the rest of the humanitarian system and other entities or organizations. However it gets lost at times in formal aspects, such as the proposal of creating a post of Deputy Director for Ebola, instead of proposing a rationalization and reassignment of functions among current senior management. It does not define sufficient concrete actions that should be put in place nor discusses the reallocation of resources that will be warranted for effecting a change of direction.
It is general in its proposals on health work force when this is one of the fundamental bottlenecks impeding the delivery of quality health care that can make a difference. It is right in proposing that WHO should strengthen its capacity to coordinate the deployment of foreign medical teams and field hospitals in crises situations. Unfortunately the necessary strength, determination and convening capacity to make this happen has not been present so far.

The draft resolution is right in pointing at the problem that 70 per cent of the WHO Member States do not fulfill the requirement of core capacities for complying with the mandates of the 2005 International Health Regulations .It also requests the Director General of the World Health Organization, to prepare an analysis on options to make more decisive progress on this area and submit a report to the 68th World Health Assembly in May 2015.

The draft resolution is, in many ways, an implicit admonition to the current administration of the WHO Secretariat. It states that the administrative and managerial processes have delayed action. It also calls for the creation of a Global Health Emergency Work Force including a global “on call” rapid response team ready to be activated in cases of outbreaks, disasters and other emergencies. The initiative is important but the devil is in the detail. If it is not well thought out it will not be very effective. It will only crystallize if there is a clear Member State’s will and commitment of making available their civil and military health assets and placing them at the disposal of a global mechanism coordinated by WHO. In addition, as highlighted in the draft resolution, other initiatives advanced by the World Bank and the Global Health Security Agenda promoted by the government of the U.S. should be aligned with the framework of the International Health Regulations, not opening parallel paths that may weaken the multilateral efforts led by WHO.

Finally, the draft resolution makes a call for adequately resourcing WHO to fulfill the mandate of Article 58 of its Constitution, creating a special fund to meet health emergencies and unforeseen contingencies. This would be very positive if Member States really commit to finance it. It asks the Director General of WHO to establish an ad hoc advisory group, within the framework of the Executive Board, to provide administrative and logistical support in case of future outbreaks or emergencies. It also requests her to commission a panel of outside independent experts to conduct an analysis to be presented to the 68th World Health Assembly covering the following:
1) how WHO organized its emergency response and the functioning of the Global Outbreak Alert and Response Network (GOARN) before the UNMEERR was created;
2) how WHO has functioned within UNMEER and how effective has been the arrangement;
3) an analysis of the role chosen and performed by WHO during the Ebola epidemic; and
4) a review of WHO’s internal coordination.

All of this shows that Member States are not satisfied with the way of doing business so far. It is therefore important that they pronounce themselves on the above mentioned subjects. They should be critical with respect to the errors identified, they should demand rapid reforms and provide guidance, but they should also support unequivocally the strengthening of WHO and its multilateral solutions and not favor solutions outside WHO.

Competing interests: No competing interests

21 January 2015
Daniel Lopez-Acuna
Public Health Expert
Independent Consultant, Retired WHO Offical
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