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CMAJ Global health response to crises needs reform
C
narvikk/iStock
alling the delays in then. You need to do somedeclaring Ebola an thing that gets the world movinternational health ing much earlier.” emergency “significant and MSF pushed for such an unjustifiable,” an indepenintermediate alert. “If we don’t dent panel reviewing the somehow trigger a response World Health Organizabefore we hit the public health tion’s (WHO) handling of emergency of international the crisis slammed the orgaconcern, we’re always going nization, its member counto wait for the catastrophe to tries and the wider United happen,” said Liu. Nations (UN) in its report MSF is also pleased that released July 7. the panel recommended incenThe report vindicates crittives for countries to report icism from Médecins Sans An independent panel reviewing the WHO response to Ebola has outbreaks and disincentives or recommended an intermediate-level alert for disease outbreaks Frontières (MSF), one of the that are not yet an emergency. sanctions against countries — main medical and humanitarsuch as Canada during the ian agencies on the ground nect between humanitarian and health Ebola crisis — that bring in during the epidemic, but MSF Internaagencies, both UN and governmental, as trade or travel bans in violation of the tional President, Montréaler Dr. Joanne well as nongovernmental agencies. “The International Health Regulations. Such Liu said, “I don’t take any pride in that.” humanitarians did not quite understand bans “not only frighten people out of She says MSF’s goal is “that next time the risk that Ebola brought,” said panel declaring, but they also make it very difaround we can respond in a timely fashchair Dame Barbara Stocking, former ficult to deliver a proper response,” as ion when the red flags are raised.” chief executive of Oxfam GB (Great supplies and health care personnel may The report detailed a perfect storm of Britain). The UN’s World Food Probe unable to enter or leave affected counfactors causing delays and ineffective gramme is the lead on logistics and UNItries, explained Stocking. response during the epidemic’s emerCEF leads on community engagement in “The fear factor was hampering the gence in the spring of 2014, many emergencies, but she said both are unacresponse,” agreed Liu. “The way it is involving the WHO and other UN agencustomed to health emergencies and were right now, if you declare you have cholcies. In the years before the epidemic, not brought in quickly enough. A UN era in your country, you become the WHO’s member states held contribumission to deal with the crisis “took pariah of your region,” with potentially tions steady, leading to a serious loss of months” to set up. “What you don’t need disastrous economic consequences. purchasing power; budgets were tightis a new UN mission being established “There needs to be a way to support these ened. The staff at the WHO’s regional right in the middle of a crisis.” countries.” office for Africa was severely cut Recommendations in the report aim at But Liu emphasized attitudinal shift. between 2011 and 2013 to only 10. The a major shake-up of the WHO, other UN “Another thing that we cannot overlook WHO failed to heed warnings from agencies and the International Health is the political will to find an answer. those staff and from groups such as Regulations. “We looked at WHO and its Even if all this was fixed, if there is no MSF. function as a health-emergency agency, political will in countries, we’re still Smarting from criticism that it had and for it to function properly for that, it going to be faced with the same story.” been alarmist in declaring H1N1 will need to be changed quite a lot. But Stocking says the report will feed influenza an international emergency, we think that is perfectly possible,” said into the current review of the Internathe WHO did not declare an emerStocking. tional Health Regulations. gency for Ebola until August 2014, One of the key recommendations is Liu said efforts to improve handling although the scale of the epidemic had to have an “intermediate level” alert for of future outbreaks are “great to a certain become clear in May or June. It also disease outbreaks that are not yet an extent, but we should keep our eye on failed to challenge local governments emergency. “The full public health the ball of the current epidemic. We for their inaction and lacked a culture emergency of international concern is don’t want to sound alarmist, but we to deal with large-scale, long-term and very much a yes or no thing,” Stocking need to be realistic. It is not over.” — multicountry emergency response, said said. “It is quite a difficult decision to Carolyn Brown, Ottawa, Ont. the report. take. Just waiting for the full final [deciThe report also documented a disconsion] is too late. You’re too far in by CMAJ 2015. DOI:10.1503/cmaj.109-5115
©2015 8872147 Canada Inc. or its licensors
CMAJ, August 11, 2015, 187(11)
E343
CMAJ Global health response to crises needs reform
C
narvikk/iStock
alling the delays in then. You need to do somedeclaring Ebola an thing that gets the world movinternational health ing much earlier.” emergency “significant and MSF pushed for such an unjustifiable,” an indepenintermediate alert. “If we don’t dent panel reviewing the somehow trigger a response World Health Organizabefore we hit the public health tion’s (WHO) handling of emergency of international the crisis slammed the orgaconcern, we’re always going nization, its member counto wait for the catastrophe to tries and the wider United happen,” said Liu. Nations (UN) in its report MSF is also pleased that released July 7. the panel recommended incenThe report vindicates crittives for countries to report icism from Médecins Sans An independent panel reviewing the WHO response to Ebola has outbreaks and disincentives or recommended an intermediate-level alert for disease outbreaks Frontières (MSF), one of the that are not yet an emergency. sanctions against countries — main medical and humanitarsuch as Canada during the ian agencies on the ground nect between humanitarian and health Ebola crisis — that bring in during the epidemic, but MSF Internaagencies, both UN and governmental, as trade or travel bans in violation of the tional President, Montréaler Dr. Joanne well as nongovernmental agencies. “The International Health Regulations. Such Liu said, “I don’t take any pride in that.” humanitarians did not quite understand bans “not only frighten people out of She says MSF’s goal is “that next time the risk that Ebola brought,” said panel declaring, but they also make it very difaround we can respond in a timely fashchair Dame Barbara Stocking, former ficult to deliver a proper response,” as ion when the red flags are raised.” chief executive of Oxfam GB (Great supplies and health care personnel may The report detailed a perfect storm of Britain). The UN’s World Food Probe unable to enter or leave affected counfactors causing delays and ineffective gramme is the lead on logistics and UNItries, explained Stocking. response during the epidemic’s emerCEF leads on community engagement in “The fear factor was hampering the gence in the spring of 2014, many emergencies, but she said both are unacresponse,” agreed Liu. “The way it is involving the WHO and other UN agencustomed to health emergencies and were right now, if you declare you have cholcies. In the years before the epidemic, not brought in quickly enough. A UN era in your country, you become the WHO’s member states held contribumission to deal with the crisis “took pariah of your region,” with potentially tions steady, leading to a serious loss of months” to set up. “What you don’t need disastrous economic consequences. purchasing power; budgets were tightis a new UN mission being established “There needs to be a way to support these ened. The staff at the WHO’s regional right in the middle of a crisis.” countries.” office for Africa was severely cut Recommendations in the report aim at But Liu emphasized attitudinal shift. between 2011 and 2013 to only 10. The a major shake-up of the WHO, other UN “Another thing that we cannot overlook WHO failed to heed warnings from agencies and the International Health is the political will to find an answer. those staff and from groups such as Regulations. “We looked at WHO and its Even if all this was fixed, if there is no MSF. function as a health-emergency agency, political will in countries, we’re still Smarting from criticism that it had and for it to function properly for that, it going to be faced with the same story.” been alarmist in declaring H1N1 will need to be changed quite a lot. But Stocking says the report will feed influenza an international emergency, we think that is perfectly possible,” said into the current review of the Internathe WHO did not declare an emerStocking. tional Health Regulations. gency for Ebola until August 2014, One of the key recommendations is Liu said efforts to improve handling although the scale of the epidemic had to have an “intermediate level” alert for of future outbreaks are “great to a certain become clear in May or June. It also disease outbreaks that are not yet an extent, but we should keep our eye on failed to challenge local governments emergency. “The full public health the ball of the current epidemic. We for their inaction and lacked a culture emergency of international concern is don’t want to sound alarmist, but we to deal with large-scale, long-term and very much a yes or no thing,” Stocking need to be realistic. It is not over.” — multicountry emergency response, said said. “It is quite a difficult decision to Carolyn Brown, Ottawa, Ont. the report. take. Just waiting for the full final [deciThe report also documented a disconsion] is too late. You’re too far in by CMAJ 2015. DOI:10.1503/cmaj.109-5115
©2015 8872147 Canada Inc. or its licensors
CMAJ, August 11, 2015, 187(11)
E343
