“The panel considers that WHO does not currently possess the capacity or organisational culture to deliver a full emergency public health response,” the report says.
More than 11,000 people have died in the latest outbreak of Ebola, which began spreading in late 2013. Some have argued for replacing the WHO, but the panel said it must still take the lead in world health disasters.
The WHO must “re-establish its pre-eminence as the guardian of global public health”, it says, but that will mean major changes to the way it works.
Part of the blame for its inadequacies is placed at the door of member states, which the report says have not fulfilled their responsibilities under the WHO’s international health regulations. They are required to collect data and carry out surveillance to pick up infectious disease outbreaks at an early stage but they failed, the report says.
Others violated the regulations by imposing bans on travel to the affected west African nations – Sierra Leone, Liberia and Guinea. These and other measures “significantly interfered with international travel, causing negative political, economic and social consequences for the affected countries,” the report says.
The WHO itself is criticised for “significant and unjustifiable delays” in declaring a public health emergency, which belatedly fired the starting gun for the international response to Ebola.
The general flouting of the rules put in place to keep the world safe from infectious disease cannot continue, according the report. “The panel considers this situation, in which the global community does not take seriously its obligations under the international health regulations (2005) – a legally binding document – to be untenable.”
Organizational and financial issues must be addressed immediately, it says. Less than 25% of the WHO’s budget comes from core funds contributed by member states and there are no core funds for emergency response. “The longstanding policy of zero nominal growth policy for assessed contributions has dangerously eroded the purchasing power of WHO’s resources, further diminishing the organisation’s emergency capacity,” the report says. It recommends a 5% increase.
It says there should be incentives for countries to declare an emergency – at the moment many would be unwilling because of the dire impact on trade and the economy – and disincentives to countries imposing travel bans and other measures that interfere with trade.
It recommends that there be a WHO centre for emergency preparedness and response which can take the lead in avoiding and dealing with outbreaks, overseen by an independent board, and that the independence of WHO’s country officers be reinforced.
“At country level, the WHO representative must have an independent voice and be assured of the full support of the regional director and the director-general, if challenged by governments,” the report says.
Jeremy Farrar, director of the Wellcome Trust, said: “The recommendations outlined by the independent panel should give WHO the mandate it needs to lead the global response to future health crises. The proposal to establish a WHO centre for emergency preparedness and response is encouraging.
“It’s essential that this new body is accountable and can show leadership in the face of emerging health threats, with the authority and independence to act quickly when needed. The support of the global community is also crucial if we are to avert another catastrophe on the scale of Ebola.”