If the World Health Organization (WHO) is to better protect humanity from the great epidemics, will change fundamentally. This is the conclusion of an independent committee to evaluate the treatment of Ebola outbreak in West Africa, which killed more than 11,000 people WHO. The report, released today, is very critical of some aspects of the response from WHO and makes recommendations for major reform of the structure and processes of the organization's decision-making, including the proposed create a new Center for Emergency Preparedness and response in WHO.
But the report also concludes that the WHO needs more power, more money and more support from Member States to fulfill its role. "I think this is an open and important report," said Preben Aavitsland epidemiologist epidemiological Kristiansand, Norway, which helped develop the International Health Regulations (IHR), a 05 treaty that defines what powers who in an international crisis health. "The authors are not afraid to make bold proposals."
Founded in 1948 as a United Nations agency, WHO is "the attainment of all peoples of the highest possible level of health." But there is broad agreement that botched its response to the Ebola outbreak last year. in March, a group of six independent members led by Dame Barbara Stocking, the former general director of Oxfam UK, was appointed to watch what went wrong and what should be changed. panelists questioned WHO sources and outside experts, met with representatives of many relief organizations, and flew to the affected countries in West Africa.
in the report, the defects of the WHO panel to several problems, most notably for "significant unjustified delays und" declaring the outbreak a public health emergency of international concern (PHEIC). WHO has not label the epidemic USPI formal recognition of the threat to global health, until August 8, more than 4 months after the outbreak was detected. By then, nearly 2,000 cases were reported.
The report acknowledges that the assessment of the situation at the beginning of the epidemic was complicated by several factors. Patients were hidden or being hidden by the family members, for example, and there was a collective denial about the scale of the epidemic in the affected countries. However, WHO should realize that the situation was out of control earlier, the report said.
"In the early stages of the Ebola crisis, the messages were sent by the experienced staff at headquarters and the Regional Office for Africa, even after deployment in the field, on the severity of the crisis. Either they did not reach senior executives or senior managers do not recognize their importance, "the panel wrote. Part of the problem was the WHO's organizational culture, which does not support "open and critical dialogue between senior management and staff or allowing risk-taking and critical approaches to decision making." The fears about the contest three African governments and the implications for trade and the economy kept the WHO to declare a PHEIC earlier, the authors ask.
instead of the current system, in which a home is a PHEIC or it is not, the report proposes to create "a new stage intermediate alert." But this would only complicate matters more, says Aavitsland. "I think it is better to lower the threshold for reporting of a PHEIC. The intention was never to make the threshold so high that it was regarded as a global crisis."
the report also concludes that, rather than establishing a new organization to address global health crises, WHO should be made "fit for purpose." to this end, it proposes to increase funding for the wHO 5% and to immediately establish a new wHO Centre for health and emergencies that could both fight against an epidemic and provide humanitarian aid, two tasks that are currently separated within the WHO. The center should be overseen by an independent board, write the authors, led by "a strong leader and strategic thinker with political, diplomatic, coordination of crisis, organization and management skills."
the new center is the most far-reaching proposal, said Aavitsland who think it is a good idea. But it can not go down well with the leadership of wHO, he adds, because it would effectively to create a state within a state.
increased funding is also unlikely to materialize, says John-Arne Röttingen, responsible for the control of infectious diseases at the public health Institute in Oslo Norway there. just a few weeks, the World Health Assembly (WHA), plans to raise the "contributions" were fresh-member countries -mainly rejection, he notes. "We just tested the appetite of Member States to invest, so I had hoped [the panel] would come with stronger language, "says Röttingen. (The panel wrote that it was "extremely disappointed" by the decision WHA and "requests the Member States to reconsider this decision" at the next meeting.)
The report criticizes WHO to take too time to coordinate the response to the epidemic and for not mobilizing community leaders, particularly women, from the beginning. It took too long to prioritize culturally appropriate messages to ensure support of affected populations, the report said.
the authors reserve a portion of their language most damning to the way WHO handled the communications, however.. "the Panel is clear that the WHO has failed to engage proactively with senior media and was unable to get command over the epidemic narrative This weakness has had repercussions in many areas of the response; better communication approach could improve confidence in WHO and reduced levels of fear and panic. "
the report has positive words for the WHO as well. Some were afraid that the role of the agency in the research and development of therapies and vaccines for Ebola could divert the fight against virus field. instead, "WHO should be commended for this work, as he stepped up to fill a void at a critical stage of the epidemic," the authors write. "the WHO should be involved in research and development for future emergencies. "Yet Röttingen said he had hoped for more concrete proposals and a statement of the responsibilities of countries to support research and development for neglected diseases.
the report also takes aim at the United Nations. Although the leadership of the United Nations was needed to galvanize a response, the United Nations Mission for emergency interventions resulting from Ebola (UNMEER) has not was very successful, they write. "What you do not need is a new UN mission being created in the middle of the crisis," Stocking said at a press conference Tuesday. during the Ebola outbreak, a coordination center set up by several countries in the Guinean capital, Conakry, has been closed, after which it took months for a new UN center in Ghana to go , she says. "It really does not make sense," said Stocking.
members of WHO states get their share of criticism as well. For example, over 40 countries have taken measures that interfered with traffic such as international tests Ebola quarantines or required-that are not recommended by WHO, a clear violation of IHR. "Accordingly, the affected countries faced not only political consequences, serious economic and social, but also the obstacles to receive the necessary staff and supplies."
To avoid such excessive reactions in the future, the authors propose to establish mechanisms that allow WHO to punish the country for inappropriate care. They also want to give countries an incentive to notify WHO health possible threats as opposed to deny or minimize their importance, eg by an insurance plan that allows countries to access emergency funds after WHO risk assessment.
The fundamental problem is that member states have been reluctant to truly embrace the meaning of the IHR, said Aavitsland. "In fact, they give up some power of their status at the WHO, the world community, when an international public health emergency is declared. But they are not willing to do it," he said. The only WHO currently has recourse against countries that do not play the rules is naming and shaming them and that does not work well, he said.
In fact, a 2011 review of the IHR, which Aavitsland helped produce, has some of the same points. But this report was never acted upon. "It was simply recognized and recommendations were not really discussed in detail," says Aavitsland. It was a mistake with far-reaching consequences, the new report notes. Had the recommendations been implemented, "the international community would have been in a much better position to deal with the Ebola crisis, "the authors write. They expressed their hope that this time action follow words. "The world simply can not afford another period of inactivity until the next health crisis."
This is the greatest danger, said Michael Osterholm, director of the Center for Research on Infectious Diseases and politics at the University of Minnesota, Twin Cities. "The good news is that this is a report that we can pass to the next level. But that means little unless it is translated into action." The next 30 to 60 days will show the actual weight of the report, he predicted.
Stocking acknowledged that getting the report implemented will be a tough act. "The more public pressure we get on this, the better," she said at the press conference today.
In a first response, WHO welcomed the report and noted that a committee to review the RSI will be convened by Margaret Chan Director General. there, "Member States can discuss the group's recommendations, including the idea of establishing an intermediate level of alert for an alarm earlier than a full public health emergency of international interest, "the WHO said in a statement sent to reporters
* update, 7 July 13:15 .. This story has been expanded from its original version to include quotes from Rottingen, Stocking and Osterholm
0 Komentar