News

Go back

Ebola: If not WHO, then who?

Published 13 Jun 2015
Zoe Hawkins

This year, the world learnt the cost of budget cutting and self-reporting when it comes to global health security. The World Health Organisation (WHO) is the United Nations’ (UN) coordinating body for global health, which provides leadership, research, and technical assistance to member states. The WHO pursues the admirable, if not ambitious, constitutional objective of ‘the attainment by all peoples of the highest possible level of health’. This year, West Africa experienced the most severe Ebola epidemic since the disease was discovered in 1976. The epidemic has devastated Sierra Leone, Liberia and Guinea, with 25,000 cases and more than 10,000 deaths, according to the US Centre for Disease Control and Prevention. This scenario is literally what WHO was made for.

A lab technician is getting ready with his PPE to enter the Isolation ward of the government run hopital of Kabala, Sierra Leone to take blood sample from a suspected ebola case and will ensure the sample will either be flown by UN helicopter or driven to the capital as soon as possible. Photo by UNMEER/ Martine Perret. 18 December 2014

A lab technician is getting ready with his PPE to enter the Isolation ward of the government run hopital of Kabala, Sierra Leone to take blood sample from a suspected ebola case and will ensure the sample will either be flown by UN helicopter or driven to the capital as soon as possible. Photo by UNMEER/ Martine Perret. 18 December 2014 Some rights reserved

Where was WHO?

However, there is an overwhelming consensus that WHO failed to deliver. The first case occurred in Guinea in March 2014, however WHO did not announce a global health emergency until early August. Médecins Sans Frontières (MSF), the world’s largest medical humanitarian aid organisation, released a report stating that the inaction of WHO and resulting vacuum in global health leadership meant ‘months were wasted and lives were lost’.

The failure of an institution is sometimes less discernable in its absences, and instead more evidenced by the presence of others stepping into the void. A large proportion of the medical burden fell into the lap of MSF, leaving their International President, Joanne Liu, wondering ‘how is it that the international community has left the response to Ebola… up to doctors, nurses and charity workers?’. Similarly, the United States military felt compelled to unilaterally deploy ‘Operation United Assistance’ to Monrovia, Liberia in September 2014 to help contain the crisis. In addition, United Nations Security Council (UNSC) Resolution 2177 urged WHO to ‘strengthen its technical leadership and operational support to Governments and other partners’.

What Went Wrong?

One has to wonder how a pathogen as threatening as Ebola could seemingly evade the international reach and sweeping mandate of WHO. However, on closer inspection, the outcome of this epidemic was arguably inevitable for several reasons. Firstly, both the size and constitution of WHO’s budget constrains its ability to respond to such a crisis. In absolute terms, the responsibilities and aspirations of WHO far exceed its funding. According to the New York Times, after the Global Financial Crisis of 2008 WHO was forced to cut nearly $1 billion from its two-year budget, leaving it today at $3.98 billion. In comparison, the US Centre for Disease Control and Prevention operates on annual allowance of $6 billion: three times more resources than its international counter-part.

Perhaps more important though, is the make up of the limited funding received. The compulsory dues from UN member states only contribute 20% of the organisation’s funding, with the remaining amount being resourced from voluntary donations. The issue here is not only the availability of such donations, but the limitations this can create in regards to how the money is spent. Donating money offers privileges of reserving, or ‘earmarking’, funds for specific purposes, such as targeting a particular disease or region. As WHO’s Director General Margaret Chan conceded, the ‘budget is highly earmarked, so it is driven by what I call donor interests’. The Melinda and Bill Gates Foundation is a perfect example of such powerful donors. In 2008, WHO Malaria Chief Dr Arata Kochi voiced his concern that the influence exerted by the Foundation ‘could have implicitly dangerous consequences on the policy-making process in world health’. Thus, the current funding model undermines WHO leadership, prioritises donor interests and fails to provide a reserve of the flexible funds required for unforeseen emergencies, such as Ebola.

In addition, the lack of accountability measures amongst WHO member states undermines the guarantee of a rapid response. The 2005 International Health Regulations obligate states to maintain disease surveillance and notify WHO of any Public Health Emergency of International Concern (PHEIC) within their borders. Whilst self-reporting is a good idea in theory, this approach offers no tangible accountability mechanism: no incentives or sanctions for states failing to uphold their responsibility. This leaves room for intentional misreporting, but also neglects less developed countries that do not have the resources to self-monitor effectively.

Looking Forward

The WHO must restructure its budget design so that flexible funds are immediately accessible in the time of emergency. Member state dues should be increased in order to decrease the extent to which it relies on voluntary donations. This would allow for the accruement of a no-strings, emergency epidemic fund which will facilitate a more rapid response to the next outbreak of this kind. Secondly, new mechanisms must be designed in order to enforce independent monitoring of member states. This epidemic is evidence that self-reporting is insufficient in safeguarding global health. The organisation must take measures to incentivise states to accurately self-report, and also execute ad hoc verification programs in order to insure no outbreaks are going undetected.

With so much at stake, these reforms to funding and monitoring must be implemented in order to restore the legitimacy of WHO and prevent a repeat of this year’s Ebola epidemic.


 Zoe Hawkins has just completed a Bachelor of International & Global Studies, majoring in Government and International Relations, at the University of Sydney. She has pursued her interest in political science overseas, completing a six-month academic exchange at the University of California, Los Angeles (UCLA) in 2014. Her research on International Relations has been published in the both The Sydney Globalist and the UCLA student political science journal.