The World Health Organization, sharply criticized for its missteps responding to Ebola in West Africa, announced a $100 million contingency fund to better respond to crises in the future. It is the latest reform undertaken by the U.N. agency in the wake of an Ebola epidemic that killed more than 11,000 people in Guinea, Sierra Leone and Liberia.
“I do not ever again want to see this organization faced with a situation it is not prepared, staffed, funded or administratively set up to manage,” said Dr. Margaret Chan, World Health Organization (WHO) director general. “The Ebola outbreak shook this organization to its core.”
Her remarks come during this week’s 68th World Health Assembly, the annual global health meeting hosted by the WHO. She admitted that the agency “was overwhelmed” by the outbreak, during her opening remarks. The establishment of a new fund provides the financial backing to respond to emergencies immediately.
The Ebola outbreak exposed the WHO’s weak structure and limited capacity to mount a speedy response. It did not declare the outbreak a public health emergency until August 2014, months after aid groups were operating above capacity and calling for emergency assistance. Chan and the rest of the agency’s leadership admitted they made mistakes and are showing willingness to learn from their mistakes.
Dr Margaret Chan, Director-General of W.H.O., makes her opening statement at the plenary session of the Sixty-seventh World Health Assembly. (Credit: W.H.O.)
“The Ebola outbreak has pushed the process of WHO reform into high gear, giving top priority to changes in WHO emergency operations,” said Chan. “As director-general of WHO, I am committed to building an organization with the culture, systems and resources to lead the response to outbreaks and other health emergencies. The organization you want. The organization the world needs.”
The need for reform was the leading topic at the World Health Assembly from the very start. German Chancellor Angela Merkel called on major changes during her event-opening speech. She urged greater efficiency between the Geneva-based headquarters and country-level staff.
“I am convinced if we act faster and have clear command structure in place, we will be better equipped to combat a crisis like Ebola,” said Merkel.
But that may be overstating the capacity and influence of the WHO. As Julia Belluz of Vox showed yesterday, the meteoric rise in global health spending from 1990 to today means that the agency is far less powerful than it used to be. For most of the 1990s, the WHO budget was greater than that of the United States and other donors. Today, it spends less than the U.S., the vaccine organization GAVI, and the Global Fund for AIDS, tuberculosis and malaria. The Gates Foundation spends about as much as the body meant to lead and coordinate global health.
Development assistance for health 1990 to 2013. (Credit: IHME)
The changed global health landscape and a lack of timely reform contributed to the poor Ebola response by the WHO.
“The WHO probably couldn’t actually do much more than it did,” said Grant Hill-Cawthorne, an infectious diseases expert at the University of Sydney, to the Australian Broadcasting Corporation. “Being on the ground and trying to get the treatment centers set up and burials being done safely – the WHO just isn’t resourced for that. And we have seen, in the last couple of years, the budget for this kind of response slashed by a third.”
By establishing a dedicated fund and embarking on needed reforms, Chan is hopeful that the WHO can in fact do more the next time around. And she is optimistic that the changes will work.
“The threats to health have multiplied, but so has our capacity to respond. For some reason, health brings out the very best in human creativity and determination,” she said. “This was a defining moment for the work of WHO and an historic political moment for world leaders to give WHO new relevance and empower it to lead in global health.”
