Info Service on Health Issues (Jan15/01)
WHO capacity on disease outbreaks and emergencies to be enhanced
Geneva, 25 January (K M Gopakumar) – A Special Session of the World Health Organization’s Executive Board is expected to adopt a resolution to enhance the organization’s capacity to respond to disease outbreaks and emergencies.
The special session on Ebola is meeting on Sunday 25 January 2015 at the WHO Headquarters in Geneva prior to the 136th Session of the Executive Board (EB) that will take place from 26 January to 3 February.
The special session achieved importance in light of criticism of WHO’s delayed response to the Ebola crisis. The crisis also exposed the Organization’s structural constraints such as the budgetary constraints due to heavy dependence on voluntary funds from Member States instead of assessed contributions, which virtually eliminates the freedom to divert existing resources to respond to outbreak of diseases or other health emergencies.
Further, it also exposed the unidirectional approach of WHO to focus on norms and technical standards without adequate funding for emergency operations and health system development. According to the Peoples’ Health Movement there was a 50% budget cut of WHO’s outbreak and crisis response from USD 469 million in 2012-13 to USD 228 million for 2014-15 (http://www.twn.my/title2/resurgence/2014/290-291/cover01.htm).
The draft resolution sponsored by groups of Member States is titled: “Ebola: Ending the current outbreak, strengthening global preparedness and ensuring WHO capacity to prepare for and respond to future large-scale outbreaks and emergencies with health consequences.”
Informal negotiations started on 22 January and continued over the weekend with disagreement still outstanding on the reference to intellectual property rights in the preamble as well as several operational paragraphs (details below).
The special session on Ebola is convened with following objectives:
The WHO Secretariat has circulated two working documents and five information documents for the Special Session. These are:
The morning session will focus on the document titled “Current context and challenges; stopping the epidemic and preparedness in non-affected countries and regions (EBSS/3/2)”. (http://apps.who.int/gb/ebwha/pdf_files/EBSS3/EBSS3_2-en.pdf).
The afternoon session will focus on the document titled “Ensuring WHO’s capacity to prepare for and respond to future large -scale and sustained outbreaks and emergencies (EBSS/3/3)”. (http://apps.who.int/gb/ebwha/pdf_files/EBSS3/EBSS3_3-en.pdf).
The second document EBSS.3/3 contains the following five proposals to enhance the capacity of WHO to respond effectively to diseases outbreaks and health emergencies:
The document summarises the rationale for the above proposals by stating that “… Though WHO has often been called on to support Member States as they respond to crises, the unprecedented complexity and scale of the current Ebola outbreak demonstrates that the Organization’s capacities, methods and approaches are not necessarily scalable or adaptable to novel or larger challenges. Further, WHO’s focus on technical support and normative guidance has left a gap in institutional capacity for and appreciation of the importance of operations”.
The document states further that, “WHO’s institutional identity has traditionally been driven by its normative and highly technical work. However, these overarching emphases have resulted in a culture that resists embracing operations, an essential element of emergency response”. The Secretariat seeks a clear mandate to develop and maintain operation capability on the ground.
The three proposals discussed below are believed to be the most important proposals. These proposals are based on the recommendations of the International Health Regulation Review Committee.
The proposals on reforming the system and structures of WHO’s crisis management mechanism aim at providing flexibility to the Secretariat for the resource mobilisation, recruitment and deployment of human resources and landing mechanism.
These proposals are viewed as an implicit admission of the criticism that budget constraints delayed WHO’s response to the Ebola crisis. Currently nearly 25% of the budget is funded from the assessed contributions of the Member States. There is littlie flexibility to divert the resources from the voluntary contributions to meet emergency needs such as the Ebola crisis.
The document also states: “Budgeting for emergencies faces the same challenges that all WHO financing faces; namely, alignment, predictability, vulnerability, flexibility and transparency”.
Three significant proposals
The first proposal to reform the WHO structures is the establishment of single command. The proposal reads: “To genuinely leverage WHO’s expertise, strengths and resources, the emergency response programme would be merged across all three levels of the Organization, with departments or units in each WHO office. The structure would be headed by a lead, or incident command during a response, with substantial delegated authority, giving the programme both singular leadership and direct reporting lines”.
Secondly, the Secretariat proposes the creation of a global health emergency workforce, which can be mobilised and deployed quickly to meet health emergencies. According to the document, “The lack of effective human resource surge capacity has severely limited the ability to scale a response to meet assessed needs in many emergencies”.
The idea of a global health workforce originates from the recommendation of the International Health Regulation Review Committee. However, during the Ebola emergency, the World Bank revived the idea of establishing such a work force. The proposal from the Secretariat is an attempt to articulate the primacy of WHO in health matters.
Thirdly, the creation of a funding mechanism for emergency responses is proposed. There are two special funds for emergencies already established by the WHO Regional Offices of South-east Asia and Africa. However, it is reported that the fund of the Africa region is not operational due to lack of funding. Earlier, the African Development Bank had refused to finance the emergency fund of the Africa region.
Resolution for adoption under negotiation
The Special Session of the EB is expected to adopt a resolution sponsored by groups of Member States. The draft resolution is titled: “Ebola: Ending the current outbreak, strengthening global preparedness and ensuring WHO capacity to prepare for and respond to future large-scale outbreaks and emergencies with health consequences.”
The resolution was initiated by the United States of America (USA) and obtained support from many countries that have joined as the sponsors of the resolution. As on 23 January the following countries expressed their willingness to sponsor the resolution: Algeria, Chile, China, Cuba, Egypt, France, Guinea, India, Indonesia, Israel, Liberia, Mauritius, Mexico, Monaco, Morocco, Norway, Senegal, Sierra Leone, South Africa, Thailand, Togo, the United Kingdom, the USA, Zambia, Zimbabwe, and the European Union.
However, despite intense negotiations, which started on 22 January and went on till 5.45 am of 25 January, the Member States could not conclude with a clean text. There are a few brackets still remaining. The negotiations will continue to sort out the differences.
The draft resolution incorporated most of the proposals in the Secretariat’s paper and also contains additional paragraphs to call on the Member States to take measures at the national and international level to respond to Ebola and other future health emergencies. (For details please see: http://apps.who.int/gb/ebwha/pdf_files/EBSS3/EBSS3_CONF1-en.pdf)
The resolution contains 18 preambular paragraphs (PP) and 58 operational paragraphs (OP). The OPs deal with the following clusters of issues:
There are brackets in both the PPs and OPs. The bracket in the preamble is on PP13 and 14 that reference intellectual property rights and the flexibilities under international law.
PP13 that has the support of developing countries reads as follows:
[PP13 Reaffirming the right to use, to the fullest extent, the provisions contained in the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement), the Doha Declaration on the TRIPS Agreement and Public Health, the decision of the General Council of the World Trade Organization of 30 August 2003 on the implementation of paragraph 6 of the DOHA Declaration on the TRIPS Agreement and Public Health, and when formal acceptance procedures are completed, the amendment to provide flexibility for the protection of public health]
To dilute PP13, the developed countries have proposed PP14 which reads:
[PP14 Recognizing that the protection of intellectual property can be important in the development of new medicines]
Bracketed OPs are OP32 and OP33 under the subheading of preparedness, OP 40-43 under the subheading of WHO structure and human resources, and OP48 on resources.
The resolution provides extensive powers to the WHO Director-General (DG) to take measures to respond in an emergency situation. It also provides an in principle approval to create a fund for emergency as well as the creation of a global health emergency workforce. Further, it also requests the DG in OP53 to establish a panel of outside independent experts, for an interim assessment “on all aspects of WHO response, from the onset of the current EVD (Ebola virus disease) outbreak, including within UNMEER (UN Mission for Ebola Emergency Response), in implementing the Emergency Response Framework, and in coordination, including resource mobilization, and functioning at the three levels of the Organization, to be presented to the Sixty-eighth World Health Assembly”.
(The 68th World Health Assembly will be in 2015.)
Apart from its concrete provisions, the resolution is widely observed as a political signal to ensure the primacy of WHO in health issues. WHO has come under attack for its slow response to the Ebola crisis. Critics pointed out that even though the confirmation of the Ebola outbreak was made in March 2014, WHO started acting in a decisive way only in August 2014 by declaring it as an Public Health Emergency of International Concern. Some critics also point out that there was no discussion, not even a mention of Ebola during the 66th World Health Assembly in May 2014.
Some of the critics suggested even the creation of a new UN body to respond to emergency situations. The World Bank attempted to appropriate the ideas of the creation of an emergency fund and a global health work force.
The resolution reaffirms WHO’s mandate of coordination of international health.
OP2 states: “Recalls and reaffirms the constitutional mandate given to WHO to act, inter alia, as the directing and coordinating authority on international health work, and to furnish, in emergencies, necessary aid upon the request or acceptance of governments, and recognizes the need to accelerate on going reform of the Organization”.
A developing country diplomat told Third World Network (TWN) that the resolution also includes the position of developing countries that the preparedness to meet health emergency should go beyond the International Health Regulations and should also address the health system as a whole.
Another important message in the resolution is in OP5 on the appointment of a special envoy on Ebola. OP5 states: “Invites the Director-General to consider assigning, immediately following the Special Session, for the duration of the outbreak, a Special Representative with the appropriate grade and authority to be responsible for all aspects of coordination at all three levels of the Organization and response for the current EVD outbreak”.
An observer told TWN that OP5 is a message for fixing the accountability of leadership of the health security division, which has allegedly failed to take note of the seriousness of the Ebola crisis.+