WHO in critical need of healing itself

Health workers carry a body of a person that they suspected died form the Ebola virus at a new graveyard on the outskirts of Monrovia, Liberia. (Photo: AP)

When executive board members of the World Health Organisation sat down for their annual meeting in Geneva in January, many powerful figures spoke forcefully of the need to reform the leading global authority on health and disease.

“It’s time to stop talking,” Stewart Jessamine, New Zealand’s director of public health and a WHO executive board member, told the delegates. “We have to change.”

Jimmy Kolker, a leading member of the US delegation, told the meeting the WHO must “recognise how crucial this moment is for the future of the organisation, and the resources and the trust that are in the balance”.

For years the WHO has talked about streamlining its complex structure, governance and financing to make it more efficient. Critics say the organisation needs deep reforms to allow it to show clear leadership in promoting health and to respond decisively to disease emergencies that may span many countries. But progress has been painfully slow.

Margaret Chan, director-general of the WHO since 2007, acknowledged the concerns of delegates and agreed with Jessamine: “Yes, it’s time to stop talking,” she said.

She promised to act swiftly on reforming the WHO’s emergency responses. “We are committed to implementing a single programme, with a single line of accountability, a single budget, a single set of business processes, a single cadre of staff and a single set of performance benchmarks,” she said.

The pressure for change has been building after a series of missteps by the global health body. In 2015, while still smarting from accusations it overreacted to the 2009-10 H1N1 flu pandemic, the WHO faced withering criticism for not reacting fast enough to the Ebola crisis in West Africa. The organisation’s Lyon-based International Agency for Research on Cancer (IARC) has become a target of ridicule among some health experts for issuing confusing warnings on everything from the air we breathe to the meat we eat to the phones we use. And the WHO is now being questioned about its response to the Zika virus.

Public health specialists, non-governmental organisations and some of the WHO’s biggest donors say the organisation is unwieldy, poor at coordinating responses to epidemics, and too thinly spread. And increasingly it struggles to set its own priorities because many of its donors give it money earmarked for specific projects.

Some experts inside and outside the organisation say those flaws mean the WHO’s lead role in global health is now at risk. Nils Daulaire, who was until recently the US representative on the WHO’s executive board, said the WHO “is not functioning well” and cannot “survive in its present form for another decade”.

He said global officials who engage with the WHO regard it as bogged down by internal processes and often forced by its members to take on more than its resources can manage.

“I’ve heard from a lot of former colleagues representing other countries that are major contributors to WHO, and other institutions that contribute financially, that either (the WHO) has to get fixed in a relatively short period — five to 10 years — or they’re going to take their marbles and go elsewhere,” said Daulaire.

Reuters spoke to more than a dozen people who know the WHO and its leadership well. All said the world needs the WHO to succeed. But most were also frustrated and even angry with its current state — sentiments that were on open display at January’s meeting in Geneva. Chan told delegates that she recognised the concerns. “We hear you loud and clear on your expectations on how you would like to see us reform the programme,” she said.

A WHO spokesman, Tarik Jasarevic, said changes to the agency’s response systems “are already under way” and would include the establishment of a single programme for outbreaks and emergencies. He said The WHO “is also committed to an independent mechanism of assessment and monitoring of the performance of the organisation, reporting to the governing bodies.”

The WHO is unique among UN agencies because its structure includes six regional offices, each with its own director elected by regional member states. Beneath them is a sprawling network of around 150 country offices.

Charles Clift, who led a 2014 report for the Centre on Global Health Security at Britain’s Chatham House entitled “What’s the World Health Organization for ,” said the complexity “is one of the main reasons why the WHO, in many ways, is dysfunctional”. Clift, who was secretary of the WHO’s commission on intellectual property rights, innovation and public health from 2004 to 2006, describes the structure as “not one but seven WHOs” — the Geneva headquarters plus the regional offices whose directors are answerable not to Chan but to their own member states.

The flaws in the structure were evident in the Ebola crisis. Despite repeated warnings by the charity Medecins Sans Frontieres (Doctors Without Borders) that national governments were not on top of the seriousness of Ebola’s spread, WHO officials in Geneva declared the outbreak “relatively small still” in April 2014. It wasn’t until August, when the epidemic was out of control in West Africa, that Chan declared it a global emergency. “The lack of a direct line of control from Geneva to what was happening at country level was probably one of the main reasons for why they were so slow,” said Clift. Chan said late in 2015 the WHO had been “overwhelmed” by the Ebola outbreak, which she said “shook this organisation to its core”.

Some health officials fear the current scramble over the Zika virus is another example of the WHO’s lack of coordination. As members of the executive board met in Geneva, the health body’s regional office in the Americas issued an alarming statement. The little-known Zika virus was spreading fast, it said, and threatened to infect millions. The spread of the virus is thought to correlate with a rise in birth defects in Brazil — but no causal link has been proven. The regional office’s statement caught WHO headquarters by surprise: No one had bothered to tell it the statement was going to appear.