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Bulletin of the World Health Organization News WHO’s new emergencies programme bridges two worlds Peter Salama tells Fiona Fleck how the World Health Organization’s (WHO) new emergencies programme is changing the way the agency helps countries prepare for and respond to health crises. Q: WHO’s new health emergencies programme aims to create one single Peter Salama is leading the World Health Organization’s programme, with one workforce, one (WHO) efforts to reform its emergency work. He was budget, one set of rules and processes appointed Executive Director of WHO’s new Health and one clear line of authority. How Emergencies Programme at the level of Deputy will you do this with WHO’s governance Director-General last year. Before that, he held senior structure of seven entities: headquarters posts at the United Nations Children’s Fund (UNICEF) (HQ) plus six Regional Offices? including Regional Director for the Middle East and A: The programme has one work- North Africa, Global Coordinator for Ebola and Chief of force – and that is the critical point – one WHO set of people we can rely on in emergen- Peter Salama Global Health. Before joining UNICEF in 2002, Salama cies, whether they are at regional level was an epidemic intelligence service officer at the or at HQ, and, increasingly, we want International Emergency and Refugee Health Branch of the United States the heads of Country Offices to see Centers for Disease Control and Prevention, and a visiting professor in nutrition themselves as an integral part of the at Tufts University in the United States of America. He has worked with Médecins programme with the same philosophy, Sans Frontières and Concern Worldwide in Asia and sub-Saharan Africa. He so that no matter where we are based graduated in medicine in 1993 from Melbourne University and in public health we are focused on the same outcome. in 1997 from Harvard University. He was also a Fulbright and Harkness fellow And that outcome is to support WHO in public policy. Country Offices to deliver the needed response in the most difficult settings around the world. We have clear lines of authority for that single workforce. In cratic Republic of the Congo (DRC), organization, improving communica- addition, in what we call Grade 3 emer- Zika in Latin America and across the tions with countries and identifying gencies, the highest level of emergency world and an emergency in northern gaps in countries. Some of the techni- requiring the largest mobilization of Nigeria due to population displacement cal units that form the backbone of internal and external resources, emer- and food insecurity, as well as outbreaks the programme have been neglected gency teams in Regional and Country of Rift Valley fever on the Mali–Niger over the years and we are building back Offices may be supervised directly by the border, cholera in Haiti after Hurricane critical expertise so that WHO can be Director-General if necessary. However, Matthew and many other situations. the world’s best in areas where it needs I think that the collaborative spirt of the Some things have changed compared to be. This means ensuring we have ac- new programme is just as important as to the Ebola outbreak response. In all of cess to the world’s best disease-specific formal lines of authority, protocols and these responses, we continued to learn expertise and a strong system for detect- standard operating procedures (SOPs). and improve. WHO has been able to de- ing new events. We still need to establish tect situations more quickly and respond more robust and predictable financing more rapidly than before due to several for the programme and ensure that our factors. One is our incident management partners are fully on board. There’s a The collaborative system that was introduced with the new lot to do, but I am optimistic that the “spirit of the new programme which allows information to programme is on track. programme is just as be shared better across the organization, important as formal and which makes our coordination and Q: The United Nations (UN) introduced lines of authority, planning mechanisms clearer. Another the cluster system in 2006 to improve coordination in emergencies, whereby protocols and is the Contingency Fund for Emergen- cies. In most cases the initial tranche of one agency coordinates others in the standard operating money was delivered within 24 hours of response. As leader of the health cluster, procedures. the request, which has helped us deploy how is WHO improving coordination of people and deliver money more quickly its partners in emergencies? ” than before. Another factor is that col- A: It’s a big challenge, partly because laboration between the Regional Offices we are bridging the disparate worlds and HQ is stronger now that we have a of infectious diseases and the world of Q: WHO’s response to the 2014–16 Ebola common understanding that this is a humanitarian relief. For example, during virus disease outbreak in West Africa was partnership. the yellow fever outbreak in Angola and heavily criticized. How has WHO’s emer- DRC, WHO worked well with its part- gency response changed since then? Q: What more needs to be done? ners in the International Coordinating A: We have dealt with the yellow A: We are clarifying our roles and Group on Vaccine Provision – Médecins fever outbreak in Angola and the Demo- responsibilities at each level of the Sans Frontières, the International Com- 8 Bull World Health Organ 2017;95:8–9 | doi: http://dx.doi.org/10.2471/BLT.17.030117 News mittee of the Red Cross and the United beginning in 2006. So the organization’s Our programme is building core ca- Nations Children’s Fund (UNICEF) role in outbreaks and emergencies is not pacities, for example, for implementing – because they are used to making deci- new. What is new is that WHO is be- the International Health Regulations sions together when vaccines are scarce. coming more systematic in its response in countries: what we are delivering in The partnership works well. During the to such crises. WHO is not competing parts of this programme is a global pub- Ebola outbreak, due to its scale, in addi- with these three large humanitarian lic health good and should be treated as tion to the haemorrhagic fever partners and development agencies, but seeking an investment and not a recurring cost. who are used to working on outbreaks, to combine its technical and normative a whole new set of partners from the comparative advantage with a renewed Q: The Guidelines Review Committee humanitarian sector were needed. These operational capacity to be a more now has a fast-track procedure for different sets of partners were not used predicable partner in the humanitar- developing guidelines in emergencies. to working together and WHO needed ian response. WHO needs to be at the Have you used this? to be the bridge. heart of these health partnerships with a A: We do a lot of normative and strong convening and coordinating role, technical work and we use the Guidelines Q: How is WHO bringing the worlds of and as a provider of last resort, which Review Committee procedure regularly, infectious diseases and humanitarian means that if any gaps remain in the for example, for interim guidelines on relief closer together? health response, WHO must fill these. Zika. Our normative technical work A: We have just finalized a set ranges from the development of a of procedures with the Office for the Q: Some commentators say there are framework of event detection and sur- Coordination of Humanitarian Affairs too many players in the humanitarian veillance – a common standardized tool (OCHA), as part of the work of the Inter- and health response and that too few for risk assessment to be used by WHO Agency Standing Committee. These pro- of them are qualified to deliver what is and partners so that we have a common cedures provide criteria for when OCHA needed. What is WHO doing to ensure way of assessing risks in outbreaks – to should activate the humanitarian system that its partners in health emergencies the development of technical standards in response to a major infectious disease can deliver the necessary? and long-term strategies for infectious outbreak, in consultation with WHO A: In the past, sometimes too many hazards. and the countries and humanitarian partners delivering clinical health care agencies concerned. That way we avoid in natural disasters landed in countries the need to create a separate agency, as without sufficient quality control or was the case during the 2014–16 Ebola coordination. That was the driver for In 2017, we will outbreak. These procedures bridge the WHO’s work on emergency medical “continue to focus on two worlds. In the past, if we had an in- teams. Now we have around 75 teams, the most vulnerable fectious disease outbreak, WHO led the from governments and civil society, priority countries and response by activating expert networks, working with WHO and others on continue to build such as the Global Outbreak Alert and standby to join the humanitarian re- capacity at global and Response Network, while working in sponse and support national capacity. regional level. parallel with humanitarian agencies. But We have developed a formal process of during the Ebola outbreak, the cluster quality control and peer review in their ” system was not activated, when it should selection, training and verification. I have been and, as a result, the response do not agree that there are too many could have been better coordinated. Un- partners in health emergencies. In some Q: What is the outlook for the pro- der the new system, it will be clear from countries there are too few.
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