In the wake of numerous criticisms over their initial response to the Ebola Outbreak in West Africa, the World Health Organization’s Director-General commissioned A panel of independent experts to assess WHO's response in the Ebola outbreak in March, with the goal of presenting their first progress report at the 68th World Health Assembly being held this month.
Today, that committee released a 12-page interim report that found serious problems in the WHO’s early response to the Ebola crisis, and stated there was a “strong, if not complete, consensus that WHO does not have a robust emergency operations capacity or culture.”
A few excerpts, but follow the link to read the entire report.
The Panel considers this a defining moment for the work of WHO. Together, the WHO leadership and the Member States need to take determined action to address the challenges at hand. “Business as usual” or “more of the same” is not an option. Although there may be responsibility on the part of individuals for the way in which the response to the Ebola outbreak has been handled, it is necessary to identify and correct the structural causes of any shortcomings. In doing so, it must be recognized that there is an increasingly complex nexus of health, humanitarian and security crises that requires the United Nations system to find new approaches that go beyond institutional silos.
There were serious gaps in the early months of the outbreak in terms of engaging with the local communities. Traditional cultural practices, including funeral and burial customs, contributed to virus transmission, yet culturally sensitive messages and community engagement were not prioritized. Essentially, bleak public messaging emphasized that no treatment was available and reduced communities’ willingness to engage; medical anthropologists should have been better utilized to develop this messaging. It must also be realized that the fact that communities were already in a post conflict situation manifested itself in high levels of distrust in authority. Owing to an extent to a lack of involvement on the part of the broader humanitarian systems, the nongovernmental organization resources, such as community development workers and volunteers, many from the countries and communities themselves, were not mobilized in the early stages. Given WHO’s extensive experience with outbreaks, health promotion and social mobilization, it is surprising that it took until August or September 2014 to recognize that Ebola transmission would be brought under control only when surveillance, community mobilization and the delivery of appropriate health care to affected communities were all put in place simultaneously.
It is still unclear to the Panel why early warnings, approximately from May through to July 2014, did not result in an effective and adequate response. Although WHO drew attention to the “unprecedented outbreak” at a press conference in April 2014, this was not followed by international mobilization and a consistent communication strategy. The countries most affected, other WHO Member States, the WHO Secretariat, and the wider global community were all “behind the curve” of the rapid spread of the Ebola virus. Many of the nongovernmental organizations that were on the ground in the affected countries, running development or humanitarian programmes, were faced with having to respond to a situation for which they were not well prepared; they lacked normative guidance and no adequate coordination mechanisms existed. The Panel is continuing to explore reasons for this delay, including political, cultural, organizational and financial factors.
This report does acknowledge that this Ebola outbreak was unprecedented in both size and scope, that the WHO was simultaneously dealing with several other major disease `hotspots’ (MERS in Saudi Arabia, H7N9 in China, and the declaration of Polio as a PHEIC) during the spring of last year.
Among the report’s recommendations:
At present, WHO does not have the operational capacity or culture to deliver a full emergency public health response. A number of options have been suggested by different organizations and individuals: (i) a new agency should be established for health emergencies; (ii) the emergency part of the health response should be led by another United Nations agency; or (iii) investments should be made so that the operational capacity of WHO for emergency response is fully in place.
The panel recommends that the third option should be pursued with vigour. Establishing a new agency would take time to put in place and substantial new resources would be required to establish its basic administrative systems, and operational response capacity. A new agency would, in any case, have to rely on and coordinate with WHO for public health and technical resources, creating an unnecessary interface. Similarly, if another United Nations agency were expected to develop health operational capacity, it too would need to coordinate in depth with WHO, especially with respect to the International Health Regulations (2005). All this suggests that, as WHO already has the mandate to deliver on operational response, it would be a far more effective and efficient use of resources to make WHO fit for purpose. This will require the resources and political will of the Member States.
The final report is expected in July.