Reforming the WHO

Organisational failings

 

The extent of the Ebola epidemic that took hold in west Africa in 2014 was made worse by failings on the part of the World Health Organisation (WHO). So concluded an international panel of 20 experts asked to examine the public health disaster which has claimed more than 11,000 lives in Liberia, Sierra Leone and Guinea.

Set up in 1948 by the United Nations to lead the global fight against disease and illness, WHO can claim credit for its efforts on many fronts. However, the monolithic organisation can be slow-moving; the co-chair of the panel said the most egregious failure was WHO’s delay in sounding the alarm early in the Ebola outbreak. Although key figures in the WHO were aware the highly infectious disease was getting out of control in March 2014, it took until August to declare the situation an international health emergency, a delay the experts said was enormously costly.

Referencing failures in technical judgment and political leadership at WHO the expert report called for 10 major reforms aimed at preventing and responding to future major disease outbreaks. A key proposal is the creation within the WHO of a unified disease outbreak response centre with “clear responsibility, adequate capacity and strong lines of accountability”.

A more recent illustration of ongoing problems within the WHO, albeit in a different context and of less immediate impact, was the misleading presentation by a WHO constituent body of the risks associated with eating processed meat. In a disjointed message, the International Agency for Research on Cancer (IARC) confused carcinogenicity and the risk of developing cancer, while muddying the waters by implying red meat was an equivalent risk.

The scale of suffering, death and social and economic effects of the Ebola epidemic must never be repeated. But neither can the depth of reform needed to take place in the world health body be underestimated. The question remains: will political leaders ensure the sclerotic culture of the WHO is challenged and replaced?

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