Why you should care
Because we live in an age of global disease.
Vicky Hausman is a partner at Dalberg, a strategic advisory firm dedicated to global development; she is also regional director of its Americas region.
If global health emergencies seem to be appearing in increasingly rapid succession, it’s because they are. Zika, the latest case in point, follows Ebola, SARS, MERS and H1N1 … the list goes on. This, unfortunately, is the new normal. A confluence of global trends — climate change, population growth, globalization — is increasing our risk of pandemics both old and new.
With Zika, a mosquito-borne virus that has spread throughout the Americas, we have, so far, been relatively fortunate. The virus is not airborne and containment efforts are already under way, well before the Olympics will bring hundreds of thousands of tourists to the region. Still, the thousands of cases of microcephaly in newborns and the surge in the autoimmune disease Guillain-Barré, both of which are associated with Zika, are alarming. And the very little we know about the virus in its current context is cause for even more concern. We are still understanding its etiology and are probably years away from vaccines or treatment.
In the face of so many unknowns, a swift, cohesive and effective response is imperative. The increasingly global nature of emerging diseases and pandemics requires a global institution that can provide vision, guidance, resource mobilization and, where necessary, focused technical and surge capacity to intervene. The World Health Organization (WHO) continues to prove itself ineffective at the job.
The recent Ebola outbreak laid this bare. Months of crisis passed before WHO declared Ebola an emergency. In the face of weak country-level health systems, WHO faltered on the ground in detecting, reporting and responding. The outbreak raised existential questions about WHO: What is the value of having a World Health Organization if it cannot provide a minimum threshold of leadership — at the very least sounding the alarm — in the face of major global health crises?
After broad outcry, an independent panel of experts convened by the Harvard Global Health Institute and London School of Hygiene & Tropical Medicine was tasked with assessing WHO’s response to Ebola. They concluded that business as usual for WHO is unacceptable — and dangerous — and called Ebola “a defining moment for the health of the global community.” The group recommended that the organization be reformed rather than built anew, suggesting that WHO create a dedicated center for outbreak response, a protected budget and clear lines of accountability. Shortly after, WHO announced it would implement “fundamental changes.”
Zika comes on the heels of these calls for reform, and the current outbreak continues to expose the organization’s inadequacies. WHO again delayed recognizing the crisis; doctors in Brazil flagged Zika as distinct from chikungunya and dengue a year before WHO named it an emergency. The organization hasn’t put forth a clear plan to combat Zika, and it is not communicating quickly or clearly. There is, overall, a leadership void. While WHO is taking incremental and very welcome action on reform, it continues to be reactive, acting with hesitancy, instead of showcasing proactive leadership.
Fundamentally, the age of pandemics requires a different approach. WHO must get out in front and offer a steady, realistic and knowledgeable voice amid fear and speculation.
Leadership in response to a crisis such as Zika would quickly move beyond sounding the alarm into setting the vision and action plan for a response. This would include gathering evidence to speed effective decision-making. Ideally, WHO would provide normative guidance, including the best protocol to treat conditions associated with Zika, advice for travelers and pragmatic warnings that align with emerging data and take into account sensitivities regarding travel, trade and tourism. With countless organizations on the ground, investors funding response operations and researchers conducting R&D, WHO should have a bird’s-eye view into the web of responses and play a crucial coordination role to maximize efforts. And it should be prepared to support resource mobilization from the global community to activate these efforts, including providing surge capacity of technical expertise or in early response, particularly in countries with limited national capacity.
Despite WHO’s lackluster performance in recent crises, we also need to recognize as a global community that WHO alone — even at its optimal performance — is likely to be insufficient. We need locally and nationally coordinated resource mobilization. Investments in country capacity and national disease surveillance — much like those identified and championed under the U.S. global health security agenda — are also essential. WHO should play a role in leading this emerging architecture, but there are missing pieces beyond its own mandate and purview.
Zika is now in 33 countries. As it spreads and the public health consequences multiply, the question remains: Can WHO reform quickly enough to be effective in the face of rapidly emerging and evolving diseases?
The world cannot afford more wake-up calls. WHO needs to provide vision, guidance and swift, effective action — or we will need to quickly move from reform to alternatives.