Margaret Chan, Director-General of the World Health Organization, speaks at a special high-level meeting regarding the Ebola virus outbreak in west Africa during the 69th United Nations General Assembly in New York City, on Sept. 25, 2014.
Other groups on the ground are “begging WHO to lead the coordination of the response,” Aylward wrote in the e-mail to Chan, according to two people.
After Chan read the message, the 67-year-old director-general called all the team leaders to her office and asked why not one of them had informed her of the situation, one of the people said. No one responded. The following day, she called Luis Sambo, WHO’s regional director for Africa, telling him to cancel all travel plans and organize an urgent meeting with officials in affected and neighboring countries.
“I asked for a detailed briefing to help me to appreciate what is at stake, what is the increased response we need,” Chan said today. She declined to comment on the sequence of events. Sambo’s office said it had no immediate response, and it would consider Bloomberg’s request to speak to him.
Stop Ebola
“The details of the response will get a proper review later,” Chan said. “I am very committed to transparency and accountability, but now I need to bring my team to focus our attention on scaling up our response to stop the Ebola outbreak.”
Though Chan set in motion the replacement of the heads of the three affected West African countries at the end of June, the last one departed this month, one person said.
The difficulty in hiring and firing employees on the basis of competence spans the entire United Nations, yet the WHO is the only branch where regional heads get selected by secret vote rather than hand-picked by the director-general, said Julio Frenk, who worked at the agency from 1998 to 2000 and is now dean of the Harvard School of Public Health.
“There’s a lack of transparency and a lot of political manipulation,” Frenk said.
No doctors
There are other reasons why straightforward interventions that had worked so well — and so quickly — in the past to contain Ebola in other countries weren’t powerful enough to stop the outbreak this year.
The three countries affected are among the poorest in the world, and had only recently emerged from years of conflict and civil unrest. Only one or two doctors were in place to serve large communities before the virus appeared, with health professionals concentrated in cities. Isolation wards, even basic infection and control measures, were virtually non-existent, according to the WHO.
Hand tied
The WHO‘s response capacity was likewise weak and eroded following budget cuts, according to an Oct. 8 report in the Lancet medical journal. Its operating budget is a third the size of the CDC’s, Gostin and Georgetown University colleague Eric Friedman wrote in the article.
Contributions that donors are obliged to pay declined to 25 percent of the agency’s revenue in 2010-2011 from 80 percent in 1978-1979, according to an analysis piece by David Legge, from the School of Public Health at La Trobe University in Melbourne, published two years ago in the British Medical Journal. The remaining voluntary contributions get earmarked for particular projects, depriving the agency of the flexibility it needs to shift funds around.
Amid the cutbacks, the agency’s outbreak and response arm lost more than 1,000 staff, half of them in the Africa region, two of the people said. The departed included Michael Ryan, director of global alert and response, and Tom Grein, an experienced field epidemiologist. The remaining staff members were overstretched by outbreaks of a respiratory virus in the Middle East, two strains of avian influenza, armed conflict in Syria, and a drive to eradicate polio in Pakistan.
“WHO is operating with one hand tied behind its back,” said Fran Baum, a professor of public health at Flinders University in Adelaide, South Australia.
Leadership style
WHO’s regionalized structure, and the political barriers it creates, has long frustrated the member countries trying to deal with international crises, said Michael Leavitt, U.S. secretary of health and human services from 2005 to 2009. Politics and bureaucracy can also interfere with the outbreak reporting and response, he said.
“In an emergency, that becomes a very serious problem,” Leavitt said. “It requires something with a more autocratic approach.”
Gro Harlem Brundtland, the WHO’s director-general during the 2003 SARS outbreak, didn’t let such impediments stop her issuing a call for health authorities worldwide to work together to stop the infectious lung disease in its tracks within days of it being brought to the agency’s attention.
Lately, the agency has lost the confidence of some member states, said Gostin of Georgetown University. Many civil society groups that advocate for health causes around the world have also grown to dislike dealing with WHO because of failures to cooperate, he said. He recalled a meeting on global health law in Johannesburg where he wore a WHO shirt to speak on the podium.
“I was roundly booed,” he said. “It’s not that they distrust global health organizations; they distrust WHO.”
Đăng ký: VietNam News
