With Liberia declared Ebola-free as the last one of the three hardest-hit West African countries just a few weeks ago, the world is still in recovery from the devastating effects of the outbreak. The World Health Organization (WHO) was criticised for a too slow response given the severity of the epidemic. A shocking and scary global epidemic often allows for the revision of current practices and capabilities, but the global health stage has seen little to no change despite numerous calls for urgent reforms. The window of opportunity for change is rapidly closing, as the global attention shifts to more prevailing issues.
Three independent panels, created by different global health actors, assessed the response to the Ebola outbreak. The Ebola Interim Assessment Panel, established by the Executive Board of WHO worked under a mandate whilst remaining independent from the organisation. On the other hand, the Independent Panel on the Global Response to Ebola, convened by the London School of Hygiene & Tropical Medicine and the Harvard Global Health Institute, was formed as a result of a consensus among the academic circles that an independent, civil society-driven assessment was needed. The third panel, formed by the US National Academy of Medicine, worked not only on the Ebola response, but also on a broader assessment of risk preparedness, and produced a report outlining a Global Health Risk Framework for the Future. Despite stemming from different sources, the panels’ central recommendations converge on a number of issues to frame a revised agenda for the future of WHO and its outbreak response capabilities.
The Global Health Programme at the Graduate Institute, together with the London School of Hygiene & Tropical Medicine, the Harvard Global Health Institute and the Chatham House Centre on Global Health Security organised a panel discussion titled ‘Ebola: A Game Change in Global Health?’ to highlight the critical recommendations of these panels and to present them to the wider public before the onset of the WHO Executive Board meetings.
As summarised by Suerie Moon, Study Director of the Independent Panel on the Global Response to Ebola the panels encouraged improved monitoring and external assessment of countries’ disease prevention, identification and treatment capabilities, in opposition to self-reported data, and funding which corresponds to the findings of the assessment. Moreover, the funding model should move towards increased domestic funding, and while all panels agreed on the immense difficulty of this in certain countries and regions, even a small and gradual shift towards greater local ownership of the resources was seen as crucial. This would also enhance community involvement for the maintenance of health systems and infrastructures, which in turn improves the local level resilience in health emergencies.
Poor infrastructure and unstable economic and political environment lead to quick and uncontained spread of infectious diseases, and therefore strengthening overall infrastructure and especially the local health systems is vital for improved epidemic response capabilities. Without proper systems for early detection, containment, and treatment, health emergencies often transform into humanitarian emergencies of enormous scale. Thus, building and maintaining appropriate health systems should be a high priority for both domestic and global health financing. As with any type of risk, the earlier it is controlled, the lower the economic and human cost will be. Strengthening national and international health capacities is efficient and recommendable regardless of one’s disciplinary approach.
Moreover, all panels agreed that the WHO funding model has to depart from the tradition of earmarked funds to specific projects and departments, as this prevents the organisation not only from responding rapidly to disease outbreaks, but it also restricts its maneuvering space in terms of preventative measures, and determining where the current need for financial and technical assistance is the most pressing. As the co-chair Ashish Jha explained, earmarking funds was seen by the Independent Panel on the Global Response to Ebola as either a sign of distrust towards the organisation or as a means of control, particularly when exerted by the economically stronger donors. Increased transparency was recommended as a cure for the lack of trust, whereas building sustainable and protected financing models can overcome the restrictive nature of the earmarked funds.
All panels agreed on the inadequacy of the current procedure of determining a Public Health Emergency of International Concern (PHEIC). Ilona Kickbusch, member of the Ebola Interim Assessment Panel, stressed how the current system only allows the declaration or not of a serious emergency, and past cases have included misjudgments with both too hesitant and too hasty announcements of a PHEIC. The panels therefore expressed the need for an intermediate risk alert, which would allow for increased global attention, funding, and assistance, without paralyzing trade connections and restricting travel, as the full PHEIC tends to do, especially in developing areas dependent on foreign investment and visitors.
Furthermore, all three panels recommended a creation of an independent centre for emergency preparedness and response. The centre should remain independent, while working closely with WHO and have its own protected and guaranteed funding. The aim of the centre is to bring the currently separate areas of humanitarian and emergency response together, strengthening collaboration to coordinate all aspects of health emergency response as one.
Peter Sands, a former banker and the chair of the US national Academy of Medicine panel, brought refreshing and poignant outsider perspective to the way the health sector is governed, criticising it for being severely underfinanced, particularly in comparison to other sectors dealing with potential high risk. The world is severely underprepared and underfunded in protecting human life from disease outbreaks, even when the direct impacts, as lives lost and money spent, are far higher in health emergencies than in other risks, such as financial crises -which the world is far better protected from. The audience of global health stakeholders and interested students embraced the remarks of Sands and proposed him equally earnest questions during the extensive question and answer session, intended specifically for allowing concerns and questions from the audience to be heard.
The event highlighted the urgency of the reforms, as the next global epidemic could start tomorrow, and if the global health community is not ready now, when will it be? As the window of opportunity for change is closing, WHO and its member countries need to show the political will and financial commitment for better response and prevention mechanisms for future health emergencies now.