[Ip-health] TWN Health Info: WHO capacity on disease outbreaks and emergencies to be enhanced

K.M. Gopakumar kumargopakm at gmail.com
Sun Jan 25 05:04:08 PST 2015

*Title :* TWN Health Info: WHO capacity on disease outbreaks and
emergencies to be enhanced
*Date :* 25 January 2015


TWN Info Service on Health Issues (Jan15/01)
25 January 2015
Third World Network


*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

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 (

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:

   - “to review the current state of the Ebola response and make
   recommendations on further steps to stop the Ebola epidemic;
   -  to discuss strengthening WHO’s capacity to prepare for and respond to
   future large-scale and sustained outbreaks and emergencies”.

 The WHO Secretariat has circulated two working documents and five
information documents for the Special Session. These are:

   - Current context and challenges; stopping the epidemic and preparedness
   in non - affected countries and regions (EBSS/3/2)
   - Ensuring WHO’s capacity to prepare for and respond to future large
   -scale and sustained outbreaks and emergencies (EBSS/3/3)
   - Fast-tracking the development and prospective roll-out of vaccines,
   therapies and diagnostics in response to Ebola virus disease (EBSS/3/INF./1)
   - Building resilient health systems in Ebola-affected countries
   - EBSS/3/INF./2)
   - Highlight of efforts made to date towards preparing non-affected
   countries and regions to respond to potential importation of EVD
   - (EBSS/3/INF./3)
   - IHR and Ebola (EBSS/3/INF./4);
   - Ebola at end-2014: ‘Getting to Zero’ (EBSS/3/INF./5).

 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)”. (

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)”. (

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:

   - WHO’s mandate and its role in outbreak, humanitarian and emergency
   response and preparedness
   - Reforming WHO crisis management mechanisms – systems and structures
   - Expanding WHO capacities, networks and partnerships
   - Funding mechanisms for emergency responses
   - Performance management and accountability.

 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

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 23January 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:

   - *Current context and challenges; stopping the epidemic; and global
   preparedness*(Leadership and Coordination; Health Systems; Medical
   Assistance; information; Preparedness; Therapeutic Drugs and Vaccines);
   - *Ensuring WHO’s capacity to prepare for and respond to future
   large-scale and sustained outbreaks and emergencies *(WHO Structure and
   Human Resources; Research and Development; Resources; Communication;
   Evaluation and Next Steps).

 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 2016.)

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

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

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.+

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