WHO board eyes emergency-response reforms in light of Ebola

Recent global health emergencies, such as West Africa's Ebola outbreak, have put a spotlight on some limits on the World Health Organization's (WHO's) capacity to quickly respond, and the agency's executive board will consider proposals for improving its ability to handle emerging crises when it meets at the end of January.

The proposals for shoring up WHO preparedness and response are part of a special session on Ebola slated for Jan 25, the first day of the board's meeting. In its agenda materials, the WHO said the unprecedented complexity and scale of the Ebola outbreak has revealed that its capacities and approaches aren't easily adapted to new or larger challenges, and its historic focus on technical support and guidance have led, for example, to a culture that resists embracing operations—a key feature of any emergency response.

Several health experts have said the outbreak was made worse by the initial slow response by the WHO and other groups and have called for a full review of the response to pinpoint what went wrong as a way to better prepare the world for future emergencies.

Proposals target operations, finance, and staffing

The WHO spelled out five proposals that it said would enable it to successfully lead in future public health emergencies. They include expanding the emergency management risk mandate, especially its operational role; reforming crisis-management mechanisms; expanding capacities, networks, and partnerships; securing adequate funding for emergency response; and integrating performance management and accountability.

The WHO said the first step would be to merge its outbreak and humanitarian/emergency response activities into an all-hazards entity, which would maximize efficiency and effectiveness and foster accountability, better positioning it for the leadership that the world expects.

To expand response capacity, the WHO proposals address the need for having enough of the right experts on its regular staff and for expanding partnerships in surge situations, such as the Global Outbreak Alert and Response Network (GOARN). As other examples, the WHO said it has only a skeleton staff to handle logistics and that greater use of anthropologists could help it better address cultural factors that affect emergency response actions.

For funding, adequate, sustained, and dedicated financing for WHO emergency response operations is needed, with a reserve budget to address rapid response scale-ups when needed, the WHO said. It added that a special fund for emergencies, which some of the agency's regional offices have, could help support its emergency response functions.

World Bank surveys show impact on households

In other Ebola news, the World Bank Group today released the results of mobile telephone surveys of people in Liberia and Sierra Leone, which paint a stark picture of how the outbreak is affecting families and the economies, even in areas that haven't been disease hotspots.

The surveys show that though the disease pattern has been more promising for Liberia, both countries continue to experience job losses, with households having to take short-term actions to cope, creating a drag on both economies.

According to the Liberia survey, nearly half of household heads are out of work, despite an infusion of response-related jobs in construction and healthcare. Hardest hit are private-sector workers in urban areas. Women are especially vulnerable in the stagnant labor market, because they are more likely to work in the hard-hit nonfarm, self-employment occupations.

Many Liberian farmers who responded to the survey said their harvests were smaller this year because the Ebola virus precluded them from working in groups. Three quarters of respondents said they worried about having enough food, with two-thirds saying they didn't have money to buy enough rice, which costs 40% more than a year ago.

For Sierra Leone, the report estimates that since the July-August period 9,000 wage workers and 170,000 other workers have been sidelined by Ebola-related problems, such as indirect impacts of the response and general disruptions to the economy. The survey revealed that food insecurity is high, though it's not clear if Ebola is having a negative impact on the country's harvest.

The analysis found evidence of decreased use of non-Ebola-related health services in Freetown, where postnatal clinic visits have dropped.

Kristen Himelein, the World Bank's poverty economist for the two countries, said in a press release today that the phone surveys are a useful tool for bridging the gap between country-level growth analyses and observations on the ground. "From a poverty perspective, we are particularly concerned about households being forced into coping strategies that may harm their long-term prospects to improve welfare, and now we can follow this in real time."

More vaccine information, case counts

  • The WHO filled in more details about the status of Ebola vaccines that are in development. On Jan 8 it convened an expert group to discuss findings from the first trials of the two leading vaccines and to sketch plans for the next studies. In an updated background document today it said phase 2 trials are expected to launch in February in West African countries that have had no Ebola cases or only a few: Cameroon, Ghana, Mali, Nigeria, and Senegal. It said the phase 2 trials will explore safety and immunogenicity in larger, more diverse groups of people, to include elderly people, children, and those living with HIV. Phase 3 studies of the two vaccines are expected to begin in the outbreak countries early this year. The WHO also mentioned other vaccines that are being developed but are not yet in clinical trials, including a vaccine from Novavax and one from Russia's health ministry, expected to enter clinical trials in the second half of 2015. The WHO said strategies for deploying vaccines and treatments are being developed, but final decisions on introducing them will be made by the countries' health ministries.

  • In an update on the number of Ebola infection in the three hardest-hit countries, the WHO today said 21,171 cases have been reported, with death toll rising to 8,371. Since the agency's last update on Jan 9, the new totals reflect an increase of 85 illnesses and 82 deaths. Today's numbers include cases reported from Sierra Leone as of Jan 10 and Liberia as of Jan 7.

See also:

Jan 9 WHO proposals for preparing and responding to large-scale, sustained outbreaks and emergencies

Jan 12 World Bank press release

Jan 12 updated WHO Q and A on Ebola vaccines, therapies, and diagnostics

Jan 12 WHO press release

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