WHO Is Going to Be In Charge? The World Health Organization’s Lack of Guidance In The 21st Century – Blessing Ikpa

When the first cases of Ebola was first documented in Yambuku, Zaire (present-day Democratic Republic of the Congo) in 1976, the lack of technology and knowledge led the World Health Organization (WHO) to not take necessary actions as needed. As information was made readily available as to how to combat Ebola, the fight to end the epidemic became more strategic. 300 people died due to Ebola in this time, but with the help of  the Center for Disease Control and Prevention (CDC), Ebola had been eradicated for the time being.

With the second outbreak of Ebola to hit present-day DRC, many people became frustrated as to the lack of resources being readily available. Knowing what the disease entails, why wouldn’t a vaccine be prepared for when the next outbreak was surely going to hit the area? Many other outbreaks were noted by Laurie Garrett, Senior Fellow for Global Health at the Council of Foreign Relations, and others couldn’t understand why WHO still has not taken the initiative to step in and find preventable ways to treat this disease. When Ebola was first discovered in the United States, many people were quick to find a solution and prevent the disease from causing an outbreak. This has left people to wonder whether consideration is only given to developed countries who have the economic and sustainable means to combat such a disease.

The World Health Organization centers itself around being the globally known institution in which people can lean on in terms of national disasters, epidemics and other prominent health crises. Time and energy has been spent into reconfiguring WHO, but not as much resources have been poured into building up local and national health systems, primarily in developing countries. In Garrett’s article, “How the WHO Mishandled the Crisis,” detailed examples are given as to how the WHO failed with other grave outbreaks such as HIV and Swine Flu. WHO has portrayed themselves in an unfortunate light, with being too fixated on governance and politics and not giving much consideration to actual situations that need to be addressed.

With WHO having the governing power and authority that they possess, more efforts should be placed in elevating local and national health systems. When outbreaks are first beginning in an area, it is imperative that local physicians have the knowledge of what is going on and how to combat the outbreak before it becomes an epidemic. There is a level of frustration when consultation with WHO goes nowhere. By the time WHO effectively steps in (concerning developing countries), hundreds of people have died and there is still no solution to the actual disease itself. Coming from a place of understanding, WHO has been gridlocked into deciding between action or inaction. There has been a discussion surrounding when WHO should intervene and if it is too early to intervene within a country. Yet, WHO would not have to spend so much time deciding whether or not to intervene medically if local and national health systems were able to decipher for themselves what needs to be done.

When the WHO confirmed an Ebola outbreak in March 2014, it was not until five months later that WHO declared the outbreak as a Public Health Emergency of International Concern (PHEIC). This goes back to the inefficiency in the WHO being able to detect outbreaks and effectively work alongside local health systems in order to contain the outbreak. It’s not possible to keep every person alive who comes into contact with the disease, but the high numbers of people dying because of ineffectiveness on the ends of local health systems and WHO is unacceptable.

The World Health Organization, along with other prominent institutions in the United Nations, are focused on their status among powerful countries. Especially with powerful countries who are often high-dollar donors to international institutions, keeping the donors happy is something many organizations face on a daily basis. Yet, as powerful as WHO and the UN are, there needs to be effective pushback towards these countries.

Yes, WHO was able to respond in a more timely manner to the outbreak of Zika (even though the outbreak was not nearly as large as Ebola), but this does not deter from their inefficiency as an international organization. This does not correlate to the WHO learning their lesson from the Ebola epidemic. Rather, they have overcompensated in terms of trying to stay ahead of outbreaks, which is admirable. But can we confidently believe that WHO has learned from the past? Does WHO only learn when outbreaks reach the Western world and/or donor countries? Hopefully, WHO will learn to work alongside local and national health systems in order to advance the health and protection of all people.

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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.