WHO Agrees to Establish Contingency Fund in Wake of Ebola Crisis

29 January 2015

The World Health Organization’s (WHO) Executive Board signed off on Sunday on plans to establish a contingency fund that will empower the organisation to respond quickly and independently to international health emergencies, as part of a broader set of reforms aimed at ensuring a more rapid, coordinated response to Ebola-like threats in the future.

The planned contingency fund would aim to ensure adequate resources for the WHO’s preparedness, surveillance, and response work, said the resolution, which was approved by the 34 member state-designated individuals that make up the Executive Board.

The fund still needs formal sign-off by the World Health Assembly, and Director-General Margaret Chan has thus been asked to prepare possible options on the fund’s size, scope, financing sources, and sustainability.

The resolution also focused on issues such as improved WHO coordination of the deployment of foreign medical teams; invites Chan to consider assigning a “Special Representative” within the Geneva-based organisation to be in charge of all aspects of WHO coordination regarding the outbreak; and requests that Chan set up mechanisms for using “emergency stand-by capacities” on medical assistance, in consultation with member states.

The Ebola virus has ravaged West Africa over the past 12 months, with WHO figures from this week placing the total number of cases – both confirmed and suspected – in Guinea, Liberia, and Sierra Leone at 22,057, of which 8795 have led to deaths. These three countries have been the hardest-hit by the disease and have also suffered severe socio-economic setbacks as a consequence.

In recent weeks, there have been fewer new cases reported, leading some to hope that the worst of the crisis may be passing. However, David Nabarro, the UN Secretary-General’s Special Envoy on Ebola, told WHO member states on Sunday that the disease “will not be gone in any country until it is gone from every country.”

Despite the downtick in new cases in the region, the global health body’s response to the outbreak has drawn harsh rebukes on several fronts for what critics say was an initially sluggish and poorly organised response, which the WHO Director-General openly acknowledged during Sunday’s special Executive Board session.

The crisis had revealed “some inadequacies and shortcomings in this organisation,” Chan told the Executive Board, warning that “never again should the world be caught by surprise, unprepared.”

Medicins Sans Frontiers (MSF) has been among the more vocal critics of the international response to Ebola. In its intervention on Sunday, the organisation suggested that many Ebola deaths were the result of “international negligence,” citing the global community’s failure to develop medical products to tackle a disease like Ebola earlier on, given that it was first discovered nearly four decades ago.

Vaccine development a priority

One of the international shortcomings that has particularly drawn notice in the wake of the Ebola outbreak is the lack of economic incentives in developing remedies for neglected diseases. “Vaccine development only began after we realised Ebola was a threat to the world,” Venezuela remarked at Sunday’s Executive Board meeting, a sentiment that others reportedly echoed.

The global health body is now leading efforts to fast-track the development of vaccines, therapies and improved diagnostics against this disease. However, a Strategic Advisory Group of Experts on Immunisation recently criticised the implementation of WHO’s overall Global Vaccine Action Plan (GVAP).

In an assessment report released late last year, the experts have asked countries to pay urgent attention to access to vaccines, and “to change the rules of the game on vaccine affordability,” possibly by sharing pricing information. While the report was not specific to Ebola, the experts did note that “disruptive situations” like this sort of major disease outbreak can also hamper the delivery of vaccines.

The Resolution resulting from Sunday’s WHO Special Session does not indicate special health-related flexibilities for developing countries, other than referring to the Global Strategy and Plan of Action on Public Health Innovation and Intellectual Property. This strategy, adopted by the WHO in May 2008, called for the improvement of transfer of technology, delivery and access to medical resources and sustainable financing mechanisms.

The WHO Executive Board is set to consider a proposal by Argentina, Brazil, India, and South Africa later this week to extend this Global Strategy until 2022, according to a report by the NGO Knowledge Ecology International.

Chan has said that the WHO also hopes to change the way that new medical products reach markets, with Sunday’s Executive Board resolution indicating that the global health organisation could play a “leadership role” in both prioritising research for Ebola and in linking pooled funds to global health research and development efforts on emerging neglected and tropical diseases.

Even as the outbreak begins to show signs of abating, many countries, such as India and Brazil, have pledged to continue supporting therapeutic research and the availability of vaccines and improved diagnostics to tackle Ebola.

WHO member states urge reform

In a speech to the UN Security Council last September, Chan had labelled the Ebola outbreak as the “greatest peacetime challenge that the United Nations and its agencies have ever faced.”

While the Ebola crisis has brought the WHO’s limitations to the fore, the questions about the global health body’s capabilities and reach are not new. Chan noted on Sunday that a 2010 review found that the organisation in its current form is not sufficiently equipped to address “severe and sustained” health emergencies that carry global impact.

The “WHO we have is not the WHO we need,” said Tom Frieden, Director of the US’ Center for Disease Control and Prevention. Learning from the Ebola crisis, the US official explained, represents a “special moment” to change these incapacities, with the contingency fund approved on Sunday being one step in this direction.

Liberia, one of the countries worst affected by the outbreak, has called for a technically strong WHO that is independent and equipped to enforce the International Health Regulations (IHR) agreed in 2005. While these regulations are the only internationally agreed rules specifically aimed at preventing and controlling the international spread of disease, some critics have charged that their provisions lack enforceability.

Economic impact, food insecurity

The economic impact of the Ebola crisis has particularly severe in West Africa, though officials have said that the economic ramifications of the outbreak have spilled over to other parts of the African continent. (See Bridges Weekly, 16 October 2014)

The World Bank, in two new reports released earlier this month, confirmed signs of economy-wide slowdowns in both Sierra Leone and Liberia. Concerns were raised in Liberia’s case over the massive shedding of jobs, with nearly half of the country’s households reportedly being unemployed, along with the likelihood of smaller harvests as farmers struggle to put work teams together.

Food insecurity has been flagged as a growing problem in Liberia, with many unable to afford basic foodstuffs such as rice. Similar issues have been raised in Sierra Leone, the reports found, with job losses there blamed primarily on the “indirect effects of necessary preventative measures” to limit the spread of disease, along with Ebola’s overall negative impact on the economy.

Sierra Leone, Guinea, and Liberia have all suffered severe disruption in their routine health systems, services, and infrastructure since the disease first began to spread. The African Union has lately warned about the possibility of “donor fatigue,” emphasising the importance of robust and predictable funding that will continue until the last Ebola case has been remedied.

“We are not sure if we can meet the Millennium Development Goals now,” Liberia’s official said at Sunday’s WHO meeting. The Millennium Development Goals are a set of eight time-bound goals agreed by the UN in 2000, revolving around the overarching goal of eradicating poverty. These goals are set to expire later this year.

International aid group Oxfam called this week for a multi-million dollar scheme designed similar to the post-World War II Marshall Plan in order to help the West African countries affected most by Ebola get back on track, economically and otherwise.

“The world was late in waking up to the Ebola crisis, there can be no excuses for not helping to put these economies and lives back together,” said Oxfam Executive Director Winnie Byanyima.

The UN’s Nabarro has similarly noted that the WHO and the UN Mission for Ebola Emergency Response (UNMEER) still need additional financial support to tackle the virus, with the official suggesting that extra US$1 billion will be required in 2015. 

ICTSD reporting; “Ebola Brings West African Economic Development to Screeching Halt,” VOICE OF AMERICA, 14 January 2015; “Ebola crisis: Oxfam calls for recovery Marshall Plan,” BBC NEWS, 27 January 2015.

Africa, WHO
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