Today sees the publication of the second major report analysing the failures in the global response to the Ebola crisis, produced by an independent panel convened by the Harvard Global Health Institute and the London School of Hygiene & Tropical Medicine (LSHTM). This follows the first report by the WHO-commissioned Ebola Interim Assessment Panel (EAIP) published in June this year. Three more major reports are due to follow in the next few months - by the National Academy of Medicine, a UN High-Level Panel and the International Health Regulations (IHR) Review Committee.
The latest report
The Harvard-LSHTM panel report is a great improvement on that of the EIAP. Its recommendations are based on a careful analysis of what went wrong with the national and international response. The failure to detect and report the outbreak in Guinea early enough and the fact that the initial response, once it was reported, was not robust were principal reasons why the outbreak spread to Liberia and Sierra Leone and the capital cities of all three countries. Then some of the governments were reluctant to admit the extent of the outbreak for fear of the international and economic repercussions, and international response teams were withdrawn from Guinea and Liberia in May 2014 when cases decreased while transmission of the disease continued, with Sierra Leone declaring an Ebola outbreak to the World Health Organization (WHO) in late May. Meanwhile the WHO’s in-country technical capacity was weak and, at this critical stage, in spite of urgings from Médecins Sans Frontières and others, the WHO did not mobilize global assistance – a failure of ‘technical judgement and political leadership’.
The report then goes on to criticize in measured terms the WHO’s failure to declare until 8 August, five months after Guinea and Liberia had first notified the WHO of their outbreaks, a Public Health Emergency of International Concern (PHEIC), saying it had ‘ample reason to raise international attention by convening the Emergency Committee or declaring a public health emergency of international concern earlier.’
Evaluating the report
The report is clearly a measured but evident criticism of the WHO and Director-General Margaret Chan’s leadership. Ashish Jha, co-chair of the Panel, was more forthcoming in the Lancet’s press release: ‘The most egregious failure was by WHO in the delay in sounding the alarm… The cost of the delay was enormous’. The recommendations for a Standing Emergency Committee, taking power from the director-general, and the recommendations on WHO reform reflect this criticism.
It also lends support for a wholesale reform of the WHO, although the how is not well defined in the report, which would unlock the willingness of member states to provide unrestricted funding to the organization. Given the experience of its five-year reform programme to date, one must question how realistic it is that the WHO’s member states will regard this as a deal they wish to do. This year’s World Health Assembly, which rejected a five-per cent increase in unrestricted funding, suggests otherwise.
On the other hand, it has a propensity for proposing new committees – the Standing Emergency Committee, the UN Accountability Commission, and the UN Security Council Global Health Committee − all of which might dilute WHO’s authority. And many have questioned whether all these new committees really address the central issue, which is how to tackle outbreaks swiftly and effectively so that they never become crises like Ebola.
A final point is that the WHO, with others, did a good job in the end on the research and development (R&D) agenda related to Ebola, including a successful but limited test of an Ebola vaccine. The recommendations in this area are sound, although the number of proposals for global funds to tackle R&D on outbreaks, antibiotics, vaccines, drugs and devices is increasingly confusing.
A multiplicity of reports
Apart from the five panels of global health experts (two of them self-appointed) offering advice to the WHO and the international community on the Ebola response, the WHO established in July its own Advisory Group on Reform of WHO’s Work in Outbreaks and Emergencies (AGROE) which has just produced its own first report. It has to be questioned whether, in a rational world, this would be the right way to proceed. The recommendations in AGROE’s first report already differ from those in the EIAP and Harvard-LSHTM. The imminent further reports will no doubt further muddy the waters. This proliferation of reports complicates decision-making for the WHO and the international community and also exacerbates the WHO’s natural defensiveness and politicizes the whole issue in ways that may not be helpful to achieving a better global response mechanism to disease outbreaks. Could there be a better way?
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