ONCE BITTEN, TWICE SHY: WHO’S FAILURES ON EBOLA, SUCCESS ON ZIKA.

Does the WHO’s response to the Zika outbreak suggest it has learned from the Ebola pandemic?

In March 2014, Ebola epidemic struck West Africa, spilled over into the United States and Europe and led to more than 27,000 infections and more than 11,000 deaths. Five months later on 8 Augusts, 2014, the World Health Organization (WHO) declared West African Ebola outbreak a Public Health Emergency of International Concern (PHEIC). The world Health Organization was criticized widely for the delays and mismanagement in its response to the Ebola crisis.

In 2016, two years later, there was a new public health crisis that emerged in the South American continent, the Zika virus. In contrast, the WHO declared Zika as PHEIC on 1 February 2016 much earlier than they did during the Ebola crisis, despite significantly fewer deaths. More precisely, the third Zika related death in Brazil was recorded ten days after the PHEIC announcement.

According to the WHO, four criteria must be met for a PHEIC to be declared. The outbreak must have a serious public heath impact; must be unexpected, must have the potential to spread and must have the potential that leads to travel and trade restrictions to and from the infected countries. The Zika and Ebola cases met all the above four criteria and hence were supposed to have same priorities under WHO.

According to experts, Ebola failure come because of the challenges that the WHO faced during the outbreak in West Africa such as:

  • By the time Ebola outbreak began in March of 2014, the relationship between Geneva and the African office had broken down.
  • The WHO was also dealing with three Grade 3 emergencies in Syria, Central African Republic, and South Sudan
  • The WHO’s African Health Office (AFHO) was comparatively very ineffective in reporting Ebola. The AFHOs failures were some of the improvements made by the Pan-American Health Office (PAHO) which had the expertise and showed professionalism needed that led to the success of Zika- virus outbreak response in the South Americas.

World Health Organization’s (WHO) quick response to the Zika virus outbreak in Brazil, is indicative of lessons learned from Ebola crisis in West Africa, in the wake of criticism.

Patterson argues that WHO officials blamed the slow Ebola response on budget cuts that did hit the programs on infectious disease control and poor communication between Ebola –affected countries and the WHO headquarters. This was improved by the WHO on how it responded to the Zika virus outbreak on the South American continent and also how it approached the funding.

Despite the ongoing budget pressure, at the beginning of the Zika outbreak in 2016, the need for a greater scientific knowledge on Zika virus drove its PHEIC announcement. And surely the WHO, after being accused of dragging its feet with Ebola, wanted to act quickly with the Zika virus.

WHO also care about its reputations as an organization with States, and by moving swiftly on Zika, the agency was trying to rebuild the reputation of efficiency and decisiveness that it lost during the Ebola crisis in West Africa.

Learning from Ebola, the WHO learned how to convey the Zika virus outbreak message to became a global political priority that easily resonated with an audience of policy makers and the citizens. As pointed by Patterson in Margaret Keck and Kathryn Sikkink, the  Zika outbreak was conveyed in a way that easily gained the global attention by stressing that the vulnerable and the innocent (pregnant women and newborns) were the victims, this easily swayed the policymakers into giving the outbreak a priority.  Unlike the Ebola outbreak, which had a high mortality rate and caused intense suffering, was conveyed to affect a broad swath of society, making it harder to frame the need for action to a particular group and hence did not work out very well with the global political priority.

Lastly, according to time magazine, WHO required about 1 billion dollars to fight Ebola in West Africa, but less than one-fifth of the budget was funded. The longer WHO delayed to declare Ebola PHEIC led to the virus spreading a lot more, leading to more deaths and became complex in management is a mistake WHO did not want to repeat. The agency had to use the minimum budget available while lobbying for funding and also had to contain the Zika virus faster than Ebola to avoid the criticism of the Ebola slow response two years ago.

There could be other factors involve in Zika success like the fact that Brazil was hosting the soccer world cup, and it was easy to convince donors of the financial damages Zika outbreak could pose during that period pointing out the lessons learned from the Ebola outbreak and its economic burden in the West African countries in 2014. This also led to the WHO, US congress, the Brazilian government and other donors working together to making sure Ebola mistakes are not repeated in the South American continent.

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One thought on “ONCE BITTEN, TWICE SHY: WHO’S FAILURES ON EBOLA, SUCCESS ON ZIKA.

  1. These are very insightful points, and do demonstrate a change in the behavior of the WHO. However, your argument that Zika was a very different situation that was easier to respond to politically (especially after the recent backlash) makes me worried that another Ebola could happen just as easily a few years down the road. If there was no international event being held in Brazil, if Zika only affected the sick and elderly, if Brazil wasn’t in such close proximity to the United States, would the world even know about the issue of Zika? Considering most don’t even show symptoms and it’s been difficult to prove the link between the virus and microcephaly, it seems it only became a world health emergency because of political reasons. Political reasons are also why the failure in Africa with Ebola was so pronounced.

    The problem with expecting the WHO to always respond appropriately to a medical emergency is that it will always be a political organization. Since it is made up of member states that control its budget, funding, and operations, it must always kowtow to the political atmosphere of the international community. This means its funding and autonomy will likely always be cyclical, and we can expect after enough time has passed for another emergency to occur that is egregiously mismanaged by the WHO, especially if it is in an area far from wealthy western governments. We shouldn’t put global health in the hands of a political organization unable to act impartially and apolitically. Instead, we should support humanitarian organizations like Médecins Sans Frontières who are more equipped to handle an on the ground emergency. Even if the WHO did learn important lessons, it would better serve as an umbrella organization coordinating information than as the preeminent global authority of what is and is not a crisis.

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