BRIAN HOOK:THE U.N. AGENCY THAT BUNGLED EBOLA
http://online.wsj.com/articles/brian-hook-the-u-n-agency-that-bungled-ebola-1413931419
Handling epidemics isn’t the World Health Organization’s forte—unless fighting against sugary drinks counts.
The Ebola outbreak has again revealed an international health system that lacks the plans and capabilities to fight an epidemic or pandemic. Atop the pyramid of this health system sits the United Nations’ World Health Organization, whose 1948 charter gives it “directing authority” for “international health work.”
In lieu of another round of incremental reforms at the WHO and another appeal for budget increases, it is time to try something else. We need a new organization within the international health system to prevent, detect and verify outbreaks—and respond rapidly to them.
The WHO’s record of handling epidemics over 30 years reveals a health system that is getting worse, not better. On at least four occasions the U.N. organization has failed to deal with major outbreaks of communicable disease.
In the 1980s, the WHO underestimated the scale of the AIDS epidemic and was plagued by infighting and poor coordination. The U.N. Economic and Social Council concluded in 1994 that the AIDS crisis was beyond the WHO’s capabilities to coordinate, so the U.N. created a new entity, the Joint U.N. Program on HIV/AIDS, or Unaids. Although the WHO opposed the new program, history has shown that Unaids, with its clear, narrowly defined mission, has been more effective in addressing the AIDS epidemic.
In 2009 the World Health Organization was slow to address the H1N1 flu pandemic. It later commissioned an expert panel to investigate its mishandling of the crisis. The report released in 2011 slammed the WHO for making crucial errors, including a lack of transparency, poor external communication, management conflicts, and a “needlessly complex” definition of pandemic and its phases. H1N1 ended in 2010 and we were fortunate the strain had a lower mortality than initially feared. Notably, the panel concluded that the world isn’t ready to handle a major health disaster.
In 2010 the World Health Organization found itself in Haiti contending with a deadly cholera outbreak inadvertently introduced by U.N. peacekeepers from Nepal after the earthquake. The WHO worked to halt its spread from rural areas to Port-au-Prince, the capital. The disease proved much faster than the WHO’s bureaucracy and spread beyond Haiti to the Dominican Republic, Cuba and Mexico, killing thousands.
Which brings us to Ebola, which is now in seven countries. On Oct. 1, the Belgian microbiologist and physician who co-discovered the virus in 1976, Peter Piot, wrote for Time magazine that this was an “avoidable catastrophe.” He should know—Dr. Piot was also the first director of Unaids. He blames the international health community for failing to act from the beginning of the Ebola crisis this summer and assigned special blame to the WHO’s regional office in Africa, calling it “not competent” in an Oct. 17 interview with the Associated Press.
An internal WHO document obtained by the AP and released last week confirms Dr. Piot’s conclusion: “Nearly everyone involved in the outbreak response failed to see some fairly plain writing on the wall.” The internal document blames politically motivated appointments, bureaucracy and a lack of reliable information.
The WHO director general, Margaret Chan, has said the time would come for an inquiry into the WHO’s handling of the Ebola crisis. But we don’t need to wait for another external review to tell us what we already know. The broad conclusions will mirror what the H1N1 panel found three short years ago: that the World Health Organization faces systemic difficulties, it made a number of avoidable mistakes, the world is still unprepared to handle a severe pandemic, and so on.
The list of internal problems that cause the WHO to fumble when faced with an epidemic is no secret. They are widely known: The director general has insufficient authority and power; the WHO’s Africa regional office isn’t competently run and has a self-serving management; and an array of disparate programs within the WHO—such as the current crusade against processed sugar and sugar beverages—have diverted time, attention and money from higher priorities, such as tracking and responding to epidemic diseases.
We can make another futile run at fixing the WHO and pretend to be startled when the next health crisis is botched. Or we can follow the precedent established by Unaids and create a new organization that reflects the realities of 2014, not 1948, when the WHO was created.
Nowhere was the need for this new international health organization made clearer than in Guinea when the lead responder to the Ebola outbreak was a volunteer organization, Médecins Sans Frontières, or Doctors Without Borders. The world needs a new disease-fighting force that—unlike the WHO—readily incorporates nongovernmental organizations, foundations and private groups into emergency operations. Doctors Without Borders, Samaritan’s Purse, Institut Pasteur, World Vision, International Medical Corps and others have a presence around the world, particularly in the tropical hot spots where these zoonotic diseases originate. These are the players who increasingly lead transformations in global health, eclipsing the WHO and its model of statist solutions.
The new organization would be within the U.N. but independent from the WHO. It would be a lean institution with expertise and capabilities to identify emerging epidemics and act quickly to prevent the spread of a deadly virus before it hits major population areas. This means giving it the operational capabilities drawn from the public and private sectors and the diplomatic authority to mobilize and manage the response to a global health emergency.
Such an enterprise would need a strong director with clear chain-of-command authority, something the WHO has always lacked. One idea worth reflection is whether to house the disease-detection capability in an independent body that wouldn’t suffer the same conflicts the WHO feels when deciding whether to embarrass or expose a dysfunctional government or one that hides evidence of an outbreak.
The push for a new agency must come from donors fed up with a global health system that can’t deliver when it really matters. The U.S., the largest donor to the World Health Organization, should work closely with other states, the U.N. secretary-general and NGOs to rethink our preparedness and create something new and innovative before we face a more easily communicable, potentially civilization-altering pathogen.
Mr. Hook, a former assistant secretary of state for international organizations, is the founder of Latitude, a Washington, D.C.-based consulting firm.
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