The World Health Organisation should be stripped of its role in declaring disease outbreaks to be an international emergency following the catastrophic failure to warn the world of the dangers of Ebola in west Africa last year, according to an independent panel of experts.
The recommendation is made in a report, published in the Lancet medical journal, by 20 experts convened by the Harvard Global Health Institute and the London School of Hygiene and Tropical Medicine, who analysed the response to the Ebola epidemic.
A series of Guardian articles on the United Nations in September showed up the failings of the WHO in pandemic situations. More than 11,000 people died in the Ebola epidemic, which has still not quite ended. Liberia, which appeared to be clear of the virus, has just found new cases.
The report calls for far greater accountability and transparency within global health institutions, including a proposal that the WHO should be required to respond to freedom of information requests.
There is strong criticism of the WHO, but the focus is on shoring up its strengths while farming out crucial decisions to those outside its politics, such as when to declare that an epidemic is an international emergency.
“The most egregious failure was by WHO in the delay in sounding the alarm,” said Prof Ashish Jha, the director of the Harvard Global Health Institute. “People at WHO were aware that there was an Ebola outbreak that was getting out of control by spring … and yet it took until August to declare a public health emergency. The cost of the delay was enormous.”
The WHO should instead have a standing emergency committee to declare that an epidemic poses an international risk, which must be transparent and protected from political pressures, the report says. It should have strong technical capacity, a protected budget and clear lines of accountability within the WHO. It would be governed by a separate board to ensure its independence.
The UN security council should also have a standing committee on global health to ensure high-level political attention to disease outbreaks that recognise no geographical borders, the report says.
The panel calls for the capacity of small countries, such as those in west Africa, to detect and then respond to disease outbreaks to be strengthened, and for them to get financial support, in line with a World Bank proposal, if the decision is likely to have a major cost when business and tourism are badly affected.
Prof Peter Piot, the director of the London School of Hygiene and Tropical Medicine, who chaired the panel, said: “We need to strengthen core capacities in all countries to detect, report and respond rapidly to small outbreaks, in order to prevent them from becoming large-scale emergencies.
“Major reform of national and global systems to respond to epidemics are not only feasible, but also essential, so that we do not witness such depths of suffering, death and social and economic havoc in future epidemics. The Aids pandemic put global health on the world’s agenda. The Ebola crisis in west Africa should now be an equal game-changer for how the world prevents and responds to epidemics.”
The WHO must have a fund to support research and development and rules to ensure all countries get the benefits, the report says. The panel also calls for a better financial settlement for the WHO and good governance “through decisive, timebound reform and assertive leadership”, a nod towards the elections for the next director general when Margaret Chan steps down in 2017.
The proposals are likely to be closely studied by a high-level UN group appointed by Ban Ki-moon in April, which is discussing the future of global health governance and the WHO. It is expected to report at the end of the year.
Jeremy Farrar, the director of the Wellcome Trust, said: “Today’s report includes some sobering lessons and sets out critical recommendations for increasing our resilience to future epidemics. Particularly welcome are the calls for greater investment from governments to build a core capacity to detect, report and respond rapidly to outbreaks, as is the idea of creating a dedicated centre for outbreak response within the WHO.
“It’s vital that the lessons learned are translated into concrete action if we are to avert another crisis on the scale of Ebola.”(Sarah Boseley)
Link: http://www.theguardian.com/world/2015/nov/22/experts-criticise-world-health-organisation-who-delay-ebola-outbreak
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