The WHO has failed the Ebola disaster

What is the point of elaborate and expensive international bureaucracies if they are unable to deal with cross-border crises?

The United Nations' World Health Organization (WHO) has completely botched the Ebola disaster sweeping West Africa.

That's not my assessment, but the assessment of the WHO itself.

Ebola has now killed more than 4500 people, mostly in Liberia, Guinea, and Sierra Leone.  It's the largest outbreak of the virus in history.

Over the weekend the Associated Press published details of an internal WHO report outlining the organisation's mistakes, information failures, staff incompetence, and governance problems tackling the crisis.

"Nearly everyone involved in the outbreak response failed to see some fairly plain writing on the wall," the document apparently says.

The report isn't public — it's a draft — and WHO doesn't want to talk about it until it has been "fact-checked".  But WHO's failures have been publically and tragically evident long before now.

Months before WHO declared Ebola a global health emergency in August, aid agencies in West Africa were saying the disease was out of control.

In March, Médecins Sans Frontières was talking about "an unprecedented epidemic regarding the distribution of cases" in Guinea.  WHO spokespeople actively rejected that characterisation.

Even as late as July 30 WHO leadership said it was "pessimistic" to suggest that the Ebola outbreak was an international health emergency, as this Washington Post article reports.

It wasn't until August 8 that WHO finally relented and announced that the Ebola outbreak was "an extraordinary event" demanding an extraordinary response.

This is exactly the sort of crisis WHO was created to prevent.  But it delayed, denied, and obfuscated for months.

WHO was formed at the end of WWII, but its roots stretch back to the mid-19th century.

It's hard to think of a better candidate for international collaboration than infectious disease.  Outbreaks of cholera in Western Europe in 1832 and 1849 led to the first international efforts on health.  The reasoning was simple.  Cholera, and other diseases like the plague and yellow fever, paid no heed to national borders.  Controlling them would require cooperation.

This policy need remains.  The Ebola crisis demands an international solution.  Individual countries need assistance.  Liberia is one of the poorest countries in the world.  Ebola is one of the hardest diseases to manage.  And cooperation is needed to prevent it from spreading.  Ebola's long incubation period — up to 21 days — means it can travel far from the place of infection.

So this is exactly the sort of crisis where international organisations should be proactive.

But WHO is directed by the World Health Assembly — an assembly of the health ministers and delegations of its 194 member states.

And that assembly is more interested in nanny state paternalism and sociology-masquerading-as-medicine than infectious disease.

The May meeting of the assembly opened with a speech by the Director General that WHO would "end childhood obesity" and focus on the health consequences of climate change and inequality.

The assembly spent its time talking about non-communicable diseases (cancer, diabetes and so forth), nutrition, and gender-based violence.

As the Ebola crisis has been developing WHO leadership has been hard at work hosting an anti-tobacco conference and pushing for increased cigarette taxes.

You may think these are all important topics.  Yet they're far away from what international health cooperation ought to be best at:  the management of cross-border pandemics.

Non-communicable diseases demand national solutions.  Pandemics demand international solutions.  Resources are scarce, and WHO increasingly spends them on the former rather than the latter.

Nor is WHO's distance from its core mission justified by any reputation for bureaucratic excellence.

The organisation has been criticised for decades for being heavy politicised, for its cronyism, for its excessive bureaucracy, and for its unwieldy structure.  (So it's a pretty typical United Nations body in that sense.)

One former WHO assistant director general wrote after the 2010 Haiti cholera outbreak that WHO was dysfunctional and coming "closer and closer to irrelevancy".  Global health academics write about WHO's "crisis of leadership".

Recent funding problems caused by the global financial crisis have led it to focus even more on non-communicable diseases.  As for pandemics, WHO's plan has been to promulgate health regulations and let individual countries sort themselves out.  But this isn't much help for poor countries like Liberia.

Now, as the New York Times reports, the entire pandemic and epidemic scientific team at WHO has just 52 permanent employees.  Until this year it had just one Ebola expert.

WHO can complain about budget troubles all it likes but in a $4 billion organisation this is pathetic.

Thank God for civil society organisations like Médecins Sans Frontières.

Perhaps nothing WHO could have done would have prevented the crisis taking the course it has so far.  Tackling infectious disease is hardest where institutions and infrastructure are worst, as they are in Liberia.

But that's a hypothetical.  The fact is, by its own assessment, WHO failed badly.

The Ebola crisis has exposed a dangerous weakness in the international security framework — a weakness caused by caused by bureaucratic incompetence and a deliberate decision to emphasise non-communicable diseases.