WHO begins race to meet WHA commitments

The 68th World Health Assembly closed Tuesday with a number of decisions under its belt. Member states approved a global technical strategy for malaria, for one, and a global action plan to combat antimicrobial resistance was adopted as well. But there was no doubt that Ebola took center stage at the just-concluded annual event. It was the subject of the World Health Organization director-general’s opening speech, a session was dedicated to lessons learned from the crisis, and it was the foundation for which member states decided on the fate of the multiple proposals laid out before them over the past week. Ebola’s prominence in this year’s assembly is in stark contrast from just over a year ago, when the virus’ very name was mentioned only once throughout Margaret Chan’s opening speech, sandwiched between the world’s increasing microbial problems and the other viruses like the Middle East respiratory syndrome that presumably diverted some of WHO’s attention and capacity away from Ebola, particularly during the first few months of the outbreak. The director-general very much set the tone when in her speech, she committed to five “fundamental changes” within her organization and in the way it responds to emergencies. The changes she mentioned have been floated around for months — member states requested vital reforms in January while an expert panel charged to assess the organization’s initial response to the Ebola outbreak released its recommendations a week before the assembly. These included the much-talked about creation of a global health emergency workforce, and the establishment of a $100 million emergency fund, which the assembly concluded will be financed entirely by voluntary contributions, and will be piloted over two years. Much of the two items’ structure is still in discussion. But Dr. Bruce Aylward, WHO assistant director-general and head of the organization’s overall Ebola response, noted in a news conference Tuesday that the director-general has already put them to work toward operationalizing the workforce and the fund over the weekend. He said the WHO leadership has already started a process to put all the recommendations together, and began engaging with the advisory group who will help guide the organization in moving all these, including the setting up of a review committee in August to look at how to strengthen the International Health Regulations, toward implementation. Chan has committed to a tight timeline for all the changes: end of 2015. The urgency comes as no surprise. Throughout the assembly, it was apparent there is huge pressure on the organization to deliver. Whenever they had the chance, member states and delegates from different institutions voiced their hopes for a changed, strengthened and a more fit-for-purpose WHO. Some matched their hopes with a willingness to provide the organization the means to make these changes, while others had their own reservations. In the end, member states approved the organization’s request of an 8 percent increase in its budget — but not through Chan’s initial proposal of a 5 percent increase in assessed contributions, which one member state representative, during discussions on the budget, argued is “next to impossible.” This is the first increase the organization will have under Chan’s watch, a WHO spokesman confirmed to Devex. Actual disbursements, however, may still be an uphill battle. While the organization has committed to improving “compliance, accountability, transparency and alignment” across all three levels of the organization, the ball is still in the member states’ court; some members were adamant that it’s not time for an increase. Funding has been one of the main issues many experts said diluted WHO’s capacity to respond robustly to the Ebola outbreak. And while the organization has upped its response since, money appears to still be a problem. On Tuesday’s news conference, Aylward emphasized how the Ebola situation remains far from over. While the number of cases has gone down to significant levels from about a year ago, Guinea and Sierra Leone continue to report new cases, totaling 12 in the previous week. These cases don’t 100 percent come from responders’ established contact list, which means a number of cases are still going unreported. But financing poses a huge challenge. Aylward said “We got promises in the pipeline, but there hasn’t been a sea change in financing, and there won’t be,” Aylward said, noting that there has been “fantastic generosity, but we still need more.” The World Food Program, for instance, provides logistical support to the organization and would need $50 million in the next six months to sustain assistance, including keeping its helicopters on air. WHO, for its part, needs $350 million to sustain its operations until the end of 2015, but might face a $150 million gap. David Nabarro, the U.N. secretary-general’s special envoy on Ebola, is expected to provide a full picture of the financing needs in the coming week. “There is no reason Ebola cannot be beaten, but financing is increasingly becoming the most glaring potential reason for failure,” Aylward said. To read additional content on global health, go to Focus On: Global Health in partnership with Johnson & Johnson.