WHO's Director-General recently put the so-called failure of WHO to respond rapidly and adequately to the Ebola epidemic squarely on the shoulders of the member states, who year after year have restricted WHO's budget options and never contributed to the emergency fund that was called for after the H1N1 influenza scare in 2009.
WHO has GOARN, a Global Outbreak Alert and Response Network, which ‘ensures that the right technical expertise and skills are on the ground where and when they are needed most’. This has been emasculated by budget redistribution demanded by its member states.
Twenty-five years ago, during the first Gulf War, the Swiss government presented the UN Secretary General Javier Perez de Cuellar with an outfit called Task Force ‘Scorpio’, a fully trained and equipped team of international experts with Swiss passports and its own aircraft, capable of deploying within 24 h and ‘parachuting’ in to investigate the presence of nuclear, chemical, biological, or highly explosive material anywhere in the world. It was never deployed and was disbanded after the war. A proposal in 2003 to revive it as a Swiss/European WMD Task Force went nowhere. It is essential for proper functioning that team members train together wearing personal protective equipment to get accustomed to the essential team discipline and to the constraints of wearing personal protective equipment with its limitations to communication.
WHO was on the ground a week from first confirmation of the disease and is still there for the long haul after the UN Mission for Ebola Emergency Response (UNMEER) has declared victory, packed up, and gone home without waiting for the last case to leave the hospital, with hundreds of contacts still in quarantine and many, many contacts lost to follow-up. But I am certainly not disputing the fact that the UN contribution of air transport and logistics was essential to success in the field.
WHO is expected to take care of the world's health on a budget of $3 billion – the same as that of the 2,500-bed New York Presbyterian Hospital! – with most of it earmarked for health issues other than outbreaks of infectious diseases. This at the express directive of its member states.
WHO is not the world health police. It cannot order a country to turn its national soccer stadium in the middle of its capital into an Ebola treatment center, over the objection of neighboring residents, despite the advantages of ease of communication and logistics. Residents know that patients interned there could easily enter into the city, contaminating others en route.
WHO cannot punish a government for not complying with basic infection control precepts because that country lacks equipment, supplies, infrastructure, and trained health workers. Sanctions would be counterproductive.
After the influenza H1N1 pandemic of 2009, the epidemic preparedness staff were cut by 30%. In the beginning, ‘the Sierra Leone government said they had Ebola under control, and didn't need WHO …. The focus [in WHO] had turned to the growing problems of non-communicable diseases (NCDs) – lifestyle-related heart attacks, strokes, cancers and diabetes – in response to the demands of the member states that make up its executive board. ‘But some in Geneva were more concerned about the potential devastation to West African economies that declaring an international emergency would cause – which did indeed prove the case’ (1).
Was it WHO's fault that an Ebola-infected man from Liberia hospitalized in Dallas led to the infection of two nurses – a month after WHO had declared the epidemic a Public Health Emergency of International Concern – leading to the totally unreasonable stigmatization and bankruptcy of a bridal-wear store in another state altogether, visited by the nurse the day before she fell ill?
Was it WHO's fault that torrential rains made roads impassable and severely hampered construction of new facilities for treating Ebola patients? Or that in Magazine Wharf, one of the slums in Freetown, Sierra Leone's capital, there is only one toilet for 1,000 people? The bulk of the problem was the parlous state of those countries’ health services and infrastructure, now acknowledged at the UN General Assembly by President Ellen Sirleaf of Liberia, and lack of communication both within and between countries. Or that screening of travelers across porous West African borders was (and still is) inadequate, or that Ebola patients, even including some physicians and nurses, ignored self-quarantine and traveled widely, spreading the infection?
Yet, the headlines continue to pillory WHO for not preventing thousands of deaths in those countries. International health aid from foreign governments and non-government organizations has been provided for those countries for decades, with little to show for it. If the international community wants WHO to get involved in epidemic control, let its member states provide the requisite funds to operate their own aircraft and logistics arm (the UN provided aircraft and other logistical support to WHO though UNMEERS and its humanitarian agencies), and providing funds for international health police to enforce the International Health Regulations (but it is difficult to see how this could be done).
WHO has nothing to apologize for over its actions in response to the Ebola epidemic.
Institute of Medical Biochemistry
Centre for Health Sciences
Federal University of Rio de Janeiro
Brazil
Email: [email protected]
Author information
John ‘Jack’ Woodall, PhD, is a viral epidemiologist, formerly staff member of The Rockefeller Foundation, CDC, WHO, and the Federal University of Brazil, retired and based in Rio de Janeiro, Brazil.
Conflict of interest and funding
The author has not received any funding or benefits from industry or elsewhere to conduct this study. Task Force ‘Scorpio’ was founded by Robert Steffen, MD, of the Institute of Social and Preventive Medicine, University of Zurich, Switzerland, and co-founded by John ‘Jack’ Woodall, PhD, then at WHO/Geneva and leader of the WHO delegation to the Biological Weapons Convention.
Reference
- Ebola is all but over, but the postmortem is just getting started. The Guardian, 30 September 2015. Available from: http://www.theguardian.com/world/2015/sep/30/ebola-inquest-un-united-nations-world-health-organisation [cited 25 January 2016]..