[Ip-health] Politico: World’s doctor gets second chance on Ebola

Thiru Balasubramaniam thiru at keionline.org
Tue Jul 31 03:36:44 PDT 2018


World’s doctor gets second chance on Ebola

Tedros Adhanom Ghebreyesus has set WHO on a path to redemption four years
after its most high-profile failure.


7/29/18, 6:22 PM CET

Updated 7/31/18, 10:13 AM CET

WHO Director General Tedros Adhanom Ghebreyesus is "on the right track" in
the fighting Ebola outbreak |

Nobody wants a deadly Ebola outbreak, but for the world health chief, the
latest episode has been invaluable.

The World Health Organization’s Tedros Adhanom Ghebreyesus this month
declared an end to an Ebola outbreak that started in May in the Democratic
Republic of the Congo, four years after the agency’s high-profile failure
to contain the spread of the virus throughout West Africa.

It’s a notable win for an organization struggling to regain momentum after
major institutional shortcomings in handling disease outbreaks — from Ebola
to avian flu to the respiratory virus SARS. After waiting months to act,
the U.N. agency lacked funding and capacity to deal with the Ebola crisis
of 2014 and 2015, which killed more than 11,300 people in some of the
world’s poorest countries. This time around, 33 people died.

As its member countries and in particular the United States take an
increasingly isolationist approach to global health, the Geneva-based
agency is desperate to show it’s still worthy of bankrolling.

“What was at stake … by not getting this response right was really a risk
that the world might begin to question our capacity to manage the risk and
impact of disease outbreaks,” said Ryan Morhard, a project lead in global
health at the World Economic Forum. “What Dr. Tedros and the WHO has shown
is that that is an organization worthy of our support and our commitment.”

“One thing which is different than before is WHO is better prepared now” —
Tedros Adhanom Ghebreyesus

The DRC Ebola response is being read as evidence WHO is learning from the
mistakes of the past and that international collaboration on global
epidemics is going strong. But it remains to be seen if the director
general has cracked the WHO’s institutional problems and can apply the same
playbook to future disease outbreaks.

“It can be replicated,” Tedros said in a phone interview from the Republic
of Congo. “One thing which is different than before is WHO is better
prepared now,” he said. The WHO chief last week took a ferry from DRC’s
Kinshasa to next-door Brazzaville after visiting the region to declare it

Other global health experts say more time is needed to be able to judge the
WHO’s comeback, cautioning against reading too much into one win. The
agency’s priority list of diseases includes Ebola, Zika and Lassa fever,
which are constantly evolving. Only last week researchers in Sierra Leone
discovered a new strain of Ebola in bats, though it’s not yet known if it
can make humans sick.

“We shouldn’t get overconfident,” said Ashish Jha, director of the Harvard
Global Health Institute and co-chair of a searing independent review that
catalogued the failures of the WHO’s 2014 Ebola response.

Tedros speaks with medical staff at an Ebola treatment center in Itipo, DRC
| Junior D. Kannah/AFP via Getty Images

The DRC effort was a clear success — and showed the potential of the new
Ebola vaccine used to shut down the outbreak — but it should not be taken
“as evidence that somehow all of the problems of the global response have
been fixed,” Jha said. “See it for what it is, which is one success story
under really pretty ideal circumstances.”

But he admits Tedros is on the right track, especially following a decade
of lukewarm leadership at the WHO under its former Director General
Margaret Chan.

“Dr. Tedros has an agenda, has a plan, and is out there trying to convince
member countries to follow that plan,” Jha said.

A man with a plan

Hours after the Ebola outbreak was declared in the DRC on May 8, Tedros
authorized $2 million from the WHO’s contingency fund for emergencies. Four
days later he arrived in Kinshasa, later moving to Bikoro to assess the
situation alongside the DRC government.

Tedros attributes that quick response in part to his move to overhaul the
flow of information that the WHO receives on global disease outbreaks. When
the former Ethiopian health minister started at the WHO last July, he would
get an email update once a week — something he quickly decided wasn’t
cutting it.

WHO staff have since developed a “near real-time” disease outbreak
dashboard, which Tedros says he regularly refreshes from his iPad wherever
he is. “In order to make the world really secure or more safe, that kind of
mindset is very important. It’s round the clock 24/7,” he said. “That kind
of thinking can help us to identify the challenges we have and improve the
system continuously.”

“They call him ‘the people’s WHO director’ because he’s trying to be in
place with people on the ground and not just sit in Geneva at a distance” —
Devi Sridhar

Tedros has also pushed to reshape the WHO’s financial and tactical response
to outbreaks, though he says many of those structural reforms began under
his predecessor Chan in the wake of the agency’s delayed response to Ebola
in Sierra Leone, Liberia and Guinea.

“She left a very good reform program, which we just built on it,” Tedros
said of Chan. “You can take this as a relay actually — one passing to the
other one and that is why we have a better system now.”

Tedros’ mantra for his tenure has been that people who need the WHO the
most should play a bigger role in its operations, and he has sought to
engage local communities on issues from disease to helping tiny island
nations build better health infrastructure to cope with extreme weather. At
the start of the DRC outbreak, around 30 health care workers from Guinea
with experience from the West African outbreak were brought in to teach
local teams how to administer the Ebola vaccine, Tedros said.

“They call him ‘the people’s WHO director’ because he’s trying to be in
place with people on the ground and not just sit in Geneva at a distance,”
said Devi Sridhar, professor of global public health at the University of
Edinburgh, who co-chaired the West African Ebola outbreak review panel with

However, having experienced eight previous Ebola outbreaks, the DRC was
better prepared than any of the West African countries that had never
encountered Ebola before.

“WHO has not yet been challenged in its capacity for a truly out of control
outbreak,” Larry Gostin, head of the O’Neill Institute for National and
Global Health Law and a WHO adviser, wrote in an email. “The jury is still
out whether in the long term WHO is up to the tasks. But early indicators
are highly favourable.”

Tedros’ mantra for his tenure has been that people who need the WHO the
most should play a bigger role in its operations | Fabrice Coffrini/AFP via
Getty Images

One of those indicators is Tedros’ ability to raise money. The WHO relies
on contributions from its members relative to wealth and population size,
but is increasingly reliant on voluntary contributions that come from
countries or large non-profits, which can be earmarked for specific

“People like to say the reason why WHO struggles is because there may not
be enough money. I would argue that the reason they don’t have enough money
is because they often struggle,” said Jha of Harvard. “Money follows

The successful containment was also in part due to the widespread
deployment of an Ebola vaccine from U.S.-based drugmaker Merck & Co, which
had been tested by the WHO and organizations including the Wellcome Trust
and the GAVI after research efforts mobilized around Ebola. More than 3,300
people were vaccinated in the DRC, including health care workers and family
members of those infected with the deadly virus.

The buy-in

The WHO raised $63 million for its DRC Ebola response, which was $6 million
above the call put out by the organization.

Tedros attributes this to his success in getting the organization on the
ground quickly.

“People will believe you if you say ‘OK I am there in the middle of the
epicenter of the outbreak and this is what’s happening and this is the kind
of support we need,’” he said. “It was not hypothetical, it was just the
real situation we were reporting … I think that convinced donors.”

The United States pledged up to $8 million, despite earlier calls by
President Donald Trump to cut money earmarked for global Ebola response.

“The expectations are high for real movement on this and if there isn’t
movement, I think it certainly has the potential of harming WHO” — Ashish
Jha, director of the Harvard Global Health Institute

While the Ebola victory is hugely symbolic, Tedros says it’s one small
piece of a bigger agenda he’s been building over the past year to guarantee
universal health coverage and tackle non-communicable diseases and the
health impacts of climate change. Universal coverage was one of the topics
he discussed with health officials in both the DRC and the Republic of
Congo during his recent visit.

But these are all areas that risk putting the WHO in conflict with the
Trump administration’s recent messaging on global health. The U.S. has been
exerting pressure to change language in international declarations related
to breastfeedingand using intellectual property flexibilities to reduce
drug prices, as well as lobbying for sugar taxes to be removed from the WHO
recommendations on non-communicable diseases.

The U.S. is responsible for a quarter of the WHO’s budget.

The success of the emergency Ebola response may not directly translate into
success on some of Tedros’ bigger picture issues, says Jha of Harvard,
observing that achieving universal health coverage relies on individual
governments getting on board.

“There is some risk here given how much of a bet WHO has made on universal
health coverage,” Jha said. “The expectations are high for real movement on
this and if there isn’t movement, I think it certainly has the potential of
harming WHO.”

Sridhar of the University of Edinburgh pointed to the U.S. National
Security Council, where the White House has not yet filled a vacancy for
the head of global health security. “It becomes difficult to think of the
U.S. as a reliable partner,” she said. “You still have really good people
[working for the U.S. government]. It’s just a question of at the highest
level is that going to make a difference in key negotiations?”

Tedros himself says he’s not worried about the threat of a downgraded
commitment from the Trump administration. “What I know is that I met the
president last year and he swore that the U.S. will continue to support
WHO,” Tedros said.

Sarah Wheaton contributed reporting.

Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org

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