WHO adopts reforms to repair reputation after bungling Ebola

GENEVA — The World Health Organization has proposed reforms that could overhaul its structure after botching the response to the biggest-ever Ebola outbreak, a sluggish performance that experts say cost thousands of lives.

On yesterday, several dozen of WHO's member countries approved a resolution aimed at strengthening the UN health agency's ability to respond to emergencies, though many of the details have yet to be worked out and it's unclear what concrete changes will result.

"The WHO we have is not the WHO we need," said Dr. Tom Frieden, director of the US Centers for Disease Control and Prevention. He said decisions at WHO were often made for political rather than scientific reasons.

WHO's chief, Dr. Margaret Chan, acknowledged yesterday that WHO was too slow to grasp the significance of the Ebola outbreak, which is estimated to have killed more than 8,600 people, mainly in Guinea, Liberia and Sierra Leone.

Critics say the kinds of reform being adopted are long overdue.

"The groundswell of dissatisfaction and lack of trust in WHO over Ebola has reached such a crescendo that (without) fundamental reform, I think we might lose confidence in WHO for a generation," said Lawrence Gostin, director of the WHO Collaborating Center on Public Health Law and Human Rights at Georgetown University.

"Ebola revealed all of WHO's inherent weaknesses and the international community saw painfully what it was like to see WHO not being able to lead. That resulted in thousands of deaths that were completely avoidable," he said.

In a resolution adopted by WHO's executive board, nearly 60 countries called on the agency to take "immediately necessary steps" to enact measures including the creation of an emergency fund to respond to health crises. Britain's Chief Medical Officer, Dr. Sally Davies, announced the U.K. would donate $10 million to the proposed fund.

The resolution also called for the establishment of a reserve of health workers to battle epidemics, but didn't specify how large this workforce would be. WHO conceded that, despite public expectations that it can respond quickly to health emergencies, it simply is not designed to do that.

The proposed changes undermine WHO's own decision two years ago to slash its outbreak department and challenges the agency's past insistence that its expertise is in issuing technical guidance, not acting as a first responder.

Countries also proposed that WHO's director-general should be able to "add or change staff with appropriate expertise at the country and regional level." In an internal draft document obtained last year by The Associated Press, officials at WHO's Geneva headquarters blamed its Africa office for botching initial efforts to contain Ebola.

Dr. Bruce Aylward, who is leading WHO's response to Ebola, said country and regional offices hadn't yet signed off on these reforms and that hammering out those details might be challenging.

"A lot of this is still to be discussed, what this will actually look like," he said.

Gostin said no other agency has a mandate to protect public health that could easily replace WHO.

"If we didn't have a WHO, we would need to create one," he said. "But we need to make them politically accountable for their failures and force them to be leaders."