The following editorial appeared in The New York Times.
The World Health Organization’s anemic performance in handling the Ebola outbreaks in West Africa may yield one positive outcome: sweeping, and long overdue, institutional reforms to improve its ability to respond more quickly to the next outbreak of a lethal infectious disease. Scrambling to answer growing criticism, the WHO’s executive board recently endorsed changes to enhance the agency’s rapid response capabilities.
The reforms call for well-trained public health workers to rush to the aid of beleaguered countries and an emergency fund to support their initial operations, among other advances. One big question, which can only be answered in practice, is whether the organization’s 194 member states will set aside their typical politicking on behalf of national self-interests and allow it to function as the global health leader it ought to be.
As of Feb. 6, Ebola had infected more than 22,000 people and killed more than 9,000 of them, mostly in the three West African nations of Guinea, Liberia and Sierra Leone, with a smattering of cases in other countries. The number of new cases of Ebola had been falling steadily in those three countries but recently ticked back up for the first time this year in all three, according to the WHO’s latest weekly report. There were 124 new confirmed cases, up from 99 the week before.
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That could be a momentary statistical aberration or a harbinger of worse to come as the rainy season makes it increasingly difficult to reach remote areas where the virus may still be lurking.
The agency’s lapses in confronting the Ebola outbreaks have been blamed, rightly, on poor leadership at its headquarters in Geneva and its regional office in Africa. Dr. Margaret Chan, the director general and a Hong Kong pediatrician who got her job thanks to pressure from the Chinese government, failed to respond quickly when Ebola first emerged in West Africa.
Only after a nongovernmental organization, Doctors Without Borders, repeatedly warned that the epidemic was out of control and the virus had spread to the populous neighboring country of Nigeria did Chan finally declare the outbreak a public health emergency of international concern.
The agency’s regional office in Africa was also slow to respond, partly because it was staffed by politically appointed people of little competence and partly because it feared that declaring a widespread emergency would tarnish the reputation and international trade of afflicted countries.
The resolution adopted by the WHO’s executive board signals a heightened willingness to be more aggressive and could go a long way toward addressing these deficiencies. It calls for the agency to create a global cadre of public health workers trained to deal with a crisis, to establish a $100 million emergency fund that could be tapped quickly without waiting for donations from advanced nations to come dribbling in, and a commitment by the executive-director to ensure that regional staff members are selected for their expertise. The proposals are expected to be approved by the agency’s governing body, the World Health Assembly, in May.
In another promising sign of change, a highly regarded physician from Botswana was appointed last month as the new regional director for Africa. She promised to introduce competency tests for the staff and audits of job performance by outside consultants, among other changes.
But the long-term issue of adequate financing for the WHO will remain. Budget cuts reduced the agency’s ability to monitor outbreaks even before Ebola arrived in West Africa. And the agency has not been given power to demand actions it thinks member nations should perform. With the epidemic appearing to ebb in West Africa, the danger remains that the drive for reform could lose steam as well.