WHO's Ebola response forcing agency to reflect, reform

The World Health Organization is debating how to reform itself after botching the response to the Ebola outbreak, a sluggish performance that experts say cost thousands of lives.

On Sunday, WHO's executive board planned to discuss proposals that could radically transform the United Nations health agency in response to sharp criticism over its handling of the West Africa epidemic.

"The Ebola outbreak points to the need for urgent change," said Dr. Margaret Chan, WHO's director-general. She acknowledged that WHO was too slow to grasp the significance of the Ebola outbreak, which is estimated to have killed more than 8,600 people, mainly in Guinea, Liberia and Sierra Leone.

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Critics say the kinds of reform being debated are long overdue.

"The groundswell of dissatisfaction and lack of trust in WHO over Ebola has reached such a crescendo that unless there is fundamental reform, I think we might lose confidence in WHO for a generation," said Lawrence Gostin, director of the WHO Collaborating Center on Public Health Law and Human Rights at Georgetown University.

'Completely avoidable' deaths

"Ebola revealed all of WHO's inherent weaknesses and the international community saw painfully what it was like to see WHO not being able to lead. That resulted in thousands of deaths that were completely avoidable," he said. "If that doesn't light a fire for reform, I don't know what will."

In reports issued to its 34-member board earlier this month, WHO identified major holes in its ability to stop outbreaks and "a culture that resists embracing operations, an essential element of emergency response."

A year before Ebola broke out in West Africa, WHO's outbreak department slashed its staff to save $6 million. In proposals to be discussed Sunday, WHO appears to be backtracking on that decision, saying it must develop operational expertise beyond its "skeleton complement" of logistics experts. The agency also conceded that, despite public expectations that it can respond quickly to health emergencies, it simply is not designed to do that.

WHO declared Ebola to be a global emergency in August. But it wasn't until Jan. 12 that Chan officially assigned Bruce Aylward, the agency's lead official on Ebola, to work full time on the outbreak, according to an internal memo sent to WHO staff.

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Some experts expressed skepticism that the broad reforms being discussed by WHO would significantly change anything.

"If we try to reform everything, then nothing will be done," said Dr. Jean Clement Cabrol, a director of operations at Doctors Without Borders. He described certain parts of WHO specifically its Africa office, which was blamed by Geneva officials for blundering the early response as "dreadful."

Gostin said no other agency has a mandate to protect public health that could easily replace WHO.

"If we didn't have a WHO, we would need to create one," he said. "But we need to make them politically accountable for their failures and force them to be leaders."