The special session of the World Health Organization’s (W.H.O.) Executive Board came at a time when reports of new cases of Ebola have been in decline. The purpose for such a rare special session, however, can only be attributed to the mismanaged response to the Ebola crisis last March that tarnished the W.H.O.’s reputation.
The Executive Board of the W.H.O., designed to direct policy of the organization, adopted a resolution aimed to provide a more effective response to international health emergencies. New measures included both an emergency fund and a body of reserve healthcare workers to be quickly deployed during a public health crisis. Similar efforts were proposed but not implemented following the influenza pandemic in 2009. This resolution will be proposed in May to the 194 member states of the W.H.O., who will vote on instituting the proposition. A resolution of this kind is extremely rare in the W.H.O., yet perhaps it marks the beginning of wider reforms within the organization.
Dr. Margaret Chan, the W.H.O.’s director general, has supported the organization taking a larger role in emergency response efforts. Dr. Chan applauded the Executive Board’s resolution, referring to its initiatives as part of an “action-oriented agenda”. In reality, the proposed resolution is reactionary. In preparation for future pandemics, the W.H.O. is merely concerned with public health situations following an outbreak. The organization’s promotion of response-oriented reforms is problematic due to its inherent priority of containment over prevention of infectious diseases. Such a preference risks future pandemics repeating the same escalation and receiving a comparable response to that of the Ebola outbreak.
The international community’s response to events such as the public health crisis in West Africa clearly exemplifies the concern for containment over prevention. The fear instilled into the public psyche by Western media paralyzed international actors like the W.H.O., resulting in the slow global response and the subsequent escalation of the pandemic. The Ebola outbreak calls attention to the political implications of securitizing health, in which the threat is understood as a unidirectional one emanating from the Global South. This Western conception of risk leaves little room for tackling the root causes of the issue. The priority of pandemic containment and the national security narrative thus overshadows prevention and its perception of health as a development concern.
In the context of the Ebola outbreak, the security perspective proved disastrous. Many of the underlying factors exacerbating the outbreak in Liberia, Guinea and Sierra Leone can be linked to poverty and vulnerable healthcare systems. For instance, scarce resources have driven the consumption of infected bush meat, which presents an ongoing issue despite Ebola concerns. In addition, a strong healthcare infrastructure could have prevented what Peter Piot, a co-discoverer of Ebola, describes as a pandemic that is “easy to contain.” He continues by arguing, “It’s not a question of needing high technology. It’s about respecting the basics of hygiene, and about isolation, quarantine and protecting yourself”. Framing health as a security rather than development issue in the Ebola outbreak ultimately impeded a greater understanding of the underlying causes and challenges. This shortcoming prompted a policy of containment.
The resolution proposed by the W.H.O.’s Executive Board risks perpetuating the global health system committed to the statist perspective and containment agenda due to its emphasis on response as opposed to preparedness. Although few will disagree over the necessity of a global response to pandemics, the W.H.O.’s new direction may encourage the same fearful containment narrative that allowed Ebola to spiral out of control. In effect, a narrow focus on response in the context of pandemics will only result in another inadequate reaction by the international community.
To avoid the escalation of another global health crisis, adjustments must be made to the way in which organizations, governments and the media understand public health. The W.H.O. and other international actors must provide proactive rather than reactionary responses to prevent future global health disasters. Such anticipatory measures toward emergency preparedness should include strengthening national health infrastructure and providing education on key health concerns to prevent outbreaks of international concern. Although the W.H.O. has attributed its unacceptable reaction to a lack of funding, scholars including Piot remind us that prevention and containment are “not a question of needing high technology”. This reality provides an encouraging outlook for managing future global health emergencies.
Such lessons on taking a proactive rather than reactionary response to global health can be extended beyond the W.H.O. to other non-state actors. The World Bank is currently developing a new emergency fund that could be accessed when certain thresholds are reached, such as a high death toll or an international health emergency. Although funding for future pandemics certainly represents a positive step forward for global health, the conditions required to tap into the fund represent the same shortcoming of the new W.H.O. resolution. Rather than the World Bank providing funds for preventative efforts through development, the organization runs the risk of allowing public health crises to escalate in the name of containment. The World Bank must recognize that providing significant funds to vulnerable health systems prior to public health emergencies is much more responsible and effective.
Following the Ebola outbreak, the securitization of health has elevated its policy significance and unlocked previously unattainable funding. As demonstrated by the W.H.O. resolution, a majority of the funds have been dedicated to emergency response alone. This direction for broader W.H.O. reforms threatens to escalate future pandemic outbreaks. In order for the international community to learn from its mistakes, attention must be shifted from the containment narrative to proactive and development oriented responses.