Enough for Ebola, but not for pandemics? Why WHO emergencies work needs reform

MANILA — The World Health Organization’s Health Emergencies Programme, while having demonstrated progress since its establishment in 2016, still requires areas of improvement, according to the independent committee tasked with the review of the program’s work.

The Ebola crisis in West Africa in 2014 highlighted weaknesses in WHO’s emergency work, and led to the establishment of the WHO Health Emergencies Programme. It was a huge reform effort that required the different levels of the organization — headquarters, regional, and country offices — to work together with a clear structure and processes.

The program has demonstrated significant progress since. It now manages up to 500 health events in a given year, and its overall work “has been marked by a high degree of operational success,” according to Felicity Harvey, chair of the WHE program’s Independent Oversight and Advisory Committee.

But some concerns remain, according to the committee’s latest evaluation report presented at this week’s 73rd World Health Assembly.

“It must be recalled that the current structure and design of the WHE program was shaped by the West Africa Ebola outbreak. Hence, it has the ability to respond to events of similar severity and size, but not a global pandemic,” Harvey told member states on Tuesday in a virtual session.

WHO reform is a major theme in this week’s WHA. In the lead up to the meetings, European countries, as well as the United States and Brazil put forward proposals to “strengthen” WHO, with a few overlaps.

These include differentiated levels of emergency alerts, strengthening the chief scientist’s office, delinking travel and trade restrictions, access to outbreak areas or “high-risk” zones, strengthening cooperation with the Food and Agriculture Organization, the World Organisation for Animal Health, and the U.N. Environmental Programme.

Australia, too, said it wants to see a “more independent and authoritative WHO,” particularly when there are novel disease outbreaks.

Some of the items in the proposals point to revisions to the International Health Regulations, an internationally binding treaty that outlines WHO and member states’ obligations in a public health emergency.

The IHR is currently undergoing a separate review — although not all member states agree to wide-ranging revisions. Russia said shortcomings in responding to COVID-19 “are not linked to problems with the IHR but the improper application” of the regulations.

Co-chairs of the Independent Panel for Pandemic Preparedness and Response also gave an update on the progress of their work, from the planning stage to implementation.

“A top priority for our work is to establish an accurate and authoritative chronology of epidemiological alert and response events related to COVID-19, setting out what happened and when,” said Helen Clark, former prime minister of New Zealand, and one of the co-chair.

Director-General Tedros Adhanom Ghebreyesus said WHO welcomes “any and all efforts to strengthen this organization,” in his opening remarks at the WHA.

“We're committed to continuous learning, continuous improvement, and continuous accountability,” he said, noting how “change is constant” for the organization.

He highlighted some of recent changes and innovations that have taken place since he’s been in office, such as the creation of new WHO divisions on science and data analytics. On Monday, WHO also unveiled a new dashboard that tracks countries’ progress to health-related Sustainable Development Goals.

Changes and caution

In its interim report to the 73rd World Health Assembly in May — a truncated version that mostly focused on the COVID-19 pandemic — the Independent Oversight and Advisory Committee found the program’s incident management support team overstretched, and its budget “too modest” to respond to such a global emergency.

In its latest report, it recommends a review of the program’s budget, as well as the Contingency Fund for Emergencies. The fund was set up to serve as a critical funding line for WHO at the onset of an emergency, but has suffered from chronic underfunding and at times was used for purposes other than its main function, the report states.

Financial challenges have had an impact on staffing. The committee notes the program still has 519 vacant positions to fill.

Some WHO member states acknowledged the need for sustained and predictable funding for WHO and its health emergencies program, and recognized the mismatch between countries’ financial contributions and expectations of the program.

However, the changes that are needed go beyond financing. There remains a need to clarify roles and responsibilities of different WHO offices, as well as lines of authority and accountability, and safeguard the program from being politicized.

“The IOAC reiterates that WHO’s work in outbreaks and emergencies must continue to adhere to humanitarian principles with great focus on impartiality, neutrality, and political independence,” according to the report.

It repeated recommendations for WHO to invest in security and address gaps in staff protection.

The committee cautioned that WHO’s efforts to centralize critical functions supporting the program could affect the speed in which it carries out its work, such as in recruiting for key positions. While there remains a team dedicated to support WHO’s emergency work in human resources, there is a perception with the program that processes “have become lengthier and more cumbersome, with additional layers of review for recruitment.”

It highlighted improvements in staff diversity within the program, but said “little progress has since been made with the organizational policy and systems.”

In a special report last year that focused on staff diversity and gender the committee urged WHO to develop a comprehensive diversity policy to improve the organization’s gender and geographical representation and ensure nondiscrimination on the basis of disability, religion, and sexual orientation.

It recommended the health emergencies program to pilot the policy’s implementation. The report was in response to a request by Tedros, who launched a review into allegations of racial discrimination and lack of diversity at WHO.

However, the committee noted that investigation “into the allegations has yet to be completed, while the reputation of the programme staff cited in those allegations remains seriously compromised.”

The report did not mention recent allegations of WHO staff allegedly involved in sexual exploitation and abuse in the Ebola response in the Democratic Republic of the Congo.

Yet during her intervention, Harvey said the committee emphasizes the importance of identifying “systemic issues and other factors with a negative or hindering impact on the prevention of sexual exploitation and abuse, and to implement institutional measures in all emergency settings in a systematic manner.”