The ebola crisis “exposed organisational failings” in the World Health Organisation (WHO) and has highlighted the need for it to make “fundamental changes”, an independent report has found.
The epidemic, which broke out in Guinea in December 2013, was not declared a public health emergency by WHO until August 2014 — which has been partly blamed for its rapid spread to neighbouring Sierra Leone and Liberia, resulting in more than 11,000 deaths.
WHO, which is part of the UN, has a number of responsibilities, including identifying any emergencies or hazards that pose a threat to human health and coordinating the response.
However, according to the report, WHO “does not currently possess the capacity or organisational culture to deliver a full emergency public health response”.
Other findings include a lack of a “culture of rapid decision-making”, with it tending to adopt a reactive rather than a proactive approach to emergencies.
The report said it must make urgent “fundamental changes, particularly in terms of leadership and decision-making processes”, with the help of its 194 member states.
The report panel said it recommends the creation of a single, unified WHO Centre for Health Emergency Preparedness and Response, to be based on the currently separate outbreak and humanitarian areas of work.
“A simple merger will not suffice — it will need new organisational structures and procedures,” it added.
Funding for emergency response was also found to be “lacking”, and the panel, which was headed by Barbara Stocking, a former chief executive of Oxfam GB, recommended that further investments be made with “vigour”.
Rather than setting up a whole new agency for health emergencies, as has been suggested by some parties, “it would be a far more effective and efficient use of resources to make WHO fit for purpose”, the report concluded.
Other criticisms include that “WHO does not have an organisational culture that supports open and critical dialogue between senior leaders and staff or that permits risk-taking or critical approaches to decision-making. There seems to have been a hope that the crisis could be managed by good diplomacy rather than by scaling up emergency action.”
The report also said WHO should have had a key role to play in the co-ordination of areas such as surveillance, “but it took a long time to get this started” — while in the early stages of the outbreak, discussions about vaccines and experimental therapies were “largely ad hoc”.
The report said if recommendations made by WHO in 2011 in response to the swine flu pandemic two years earlier been implemented, “the global community would have been in a far better position to face the ebola crisis”.
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