Abstract
BackgroundAs the 2014 Ebola virus disease outbreak (EVD) transitions to its post-endemic phase, its impact on the future of global public health, particularly the World Health Organization (WHO), is the subject of continued debate. Criticism of WHO’s performance grew louder in the outbreak’s wake, placing this international health UN-specialized agency in the difficult position of navigating a complex series of reform recommendations put forth by different stakeholders. Decisions on WHO governance reform and the broader role of the United Nations could very well shape the future landscape of 21st century global health and how the international community responds to health emergencies.DiscussionIn order to better understand the implications of the EVD outbreak on global health and infectious disease governance, this debate article critically examines a series of reports issued by four high-level commissions/panels convened to specifically assess WHO’s performance post-Ebola. Collectively, these recommendations add increasing complexity to the urgent need for WHO reform, a process that the agency must carry out in order to maintain its legitimacy. Proposals that garnered strong support included the formation of an independent WHO Centre for Emergency Preparedness and Response, the urgent need to increase WHO infectious disease funding and capacity, and establishing better operational and policy coordination between WHO, UN agencies, and other global health partners. The recommendations also raise more fundamental questions about restructuring the global health architecture, and whether the UN should play a more active role in global health governance.SummaryDespite the need for a fully modernized WHO, reform proposals recently announced by WHO fail to achieve the “evolution” in global health governance needed in order to ensure that global society is adequately protected against the multifaceted and increasingly complex nature of modern public health emergencies. Instead, the lasting legacy of the EVD outbreak may be its foreshadowing of a governance “shift” in formal sharing of the complex responsibilities of global health, health security, outbreak response, and managing health emergencies to other international structures, most notably the United Nations. Only time will tell if the legacy of EVD will include a WHO that has the full support of the international community and is capable of leading human society in this brave new era of the globalization of infectious diseases.
Highlights
As the 2014 Ebola virus disease outbreak (EVD) transitions to its post-endemic phase, its impact on the future of global public health, the World Health Organization (WHO), is the subject of continued debate
This piece provides a summary of the current international debate and discourse on global health governance reform measures post-EVD, focusing on the WHO and the future role of the United Nations in the broader global health architecture. This is accomplished by examining a series of reports issued by four highlevel commissions/panels convened to assess WHO’s performance and broader governance reform post-EVD. This includes recommendations from the WHO Interim Assessment panel established by the WHO Executive Board (Interim Panel); an external independent panel jointly convened by the Harvard Global Health Institute-London School of Hygiene & Tropical Medicine (“Harvard-LSHTM panel” comprised of members from academia, think tanks and civil society); the Commission on a Global Health Risk Framework for the Future (CGHRF) convened by the U.S National Academy of Medicine; and a separate High-Level Panel on the Global Response to Health Crises appointed by UN-Secretary General Ban Ki-moon (Kikwete Panel)
What is clear is that the WHO needs to modernize in order to adapt to a new century of shared global health security, given ongoing threats from the emergence and re-emergence of infectious diseases, such as EVD and the Zika virus, and the inevitability of future outbreaks with pandemic potential
Summary
Is the “Evolution” of Global Health Governance Underway? Influenza viruses evolve in two different ways including antigenic “drift” (e.g. small genetic mutations occurring continuously over time) and “shift” (e.g. major, abrupt changes/reassortment leading to different virus subtypes with high virulence and pandemic potential) [4]. The CGHRF generally advocated for strengthening WHO’s capacity to lead in pandemic preparedness and response by further reinforcing previous recommendation to create a WHO Center for Health Emergency Preparedness and Response, though independently overseen by a Technical Governing Board [41] It called for the involvement of the World Bank and International Monetary Fund (IMF) to help finance and strengthen implementation of IHR core capacities. Other reform measures that garnered cross-panel support included the urgent need to increase WHO’s assessed contributions, developing mechanisms to enhance cooperation with non-state actors, strengthening global disease surveillance and IHR core capacities (including creating incentives/disincentives for IHR compliance,) and establishing better operational and policy coordination between WHO, UN agencies, and other global health partners [36, 37]. Current WHO Director-General Dr Margaret Chan’s tenure is coming to an end, meaning any long-term reforms will
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