WHO Steps up Its Role in Health Emergencies
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News WHO steps up its role in health emergencies The World Health Organization is on the brink of a major transformation into an agency that is fully mandated and equipped to respond to outbreaks and humanitarian emergencies. David Nabarro talks to Fiona Fleck. Q: How did you first become interested in working in emergencies? David Nabarro is committed to ensuring that the United A: When I started out as a physician Nations’ (UN) system responds effectively to health during the early 1970s, I wanted to work emergencies. Since 2005, he has held leading positions with communities, rather than in hospi- in the office of the UN Secretary-General, including as tals, particularly in places where people special envoy on Ebola since 2014, focusing on the were unable to access health services. I response to the outbreak in West Africa. Before that worked in Kurdistan in northern Iraq he was Senior Coordinator for avian and pandemic in 1974, in rural Nepal, eastern India influenza. He also serves as the Secretary-General’s and then Bangladesh. But my interest Nations United in community health was there before David Nabarro special representative for food security and nutrition I studied medicine. I wanted to under- and since July has chaired the advisory group on reform stand what was needed for people to be of the World Health Organization’s (WHO) work in outbreaks and emergencies less distressed, and not to suffer when ill with health and humanitarian consequences. From 1999 to 2005 he led the – wherever they lived, and whether they Roll Back Malaria initiative and, later, the department for health action in crises were poor or wealthy. When I worked in at WHO. Nabarro studied at Oxford University and University College Hospital areas affected by conflict I realized that in London, and qualified as a physician in 1973. He attained a master’s degree the challenges are the same as anywhere in public health from London University in 1979, worked extensively in south- else but that it’s more difficult to ensure east Asia and east Africa, taught at the London and Liverpool schools of tropical that people can access the health care medicine and served in the United Kingdom government. In 1998 he became they need. a Fellow of the Royal College of Physicians. Q: Can you tell us about your appoint- ment as the UN Secretary-General’s special envoy for Ebola in 2014 and how time when we did not know how big has consistently provided the technical the outbreak triggered soul-searching the outbreak would become, with some guidance, analytical expertise and capac- and reconsideration of the way health projections that more than a million ity to lead and this has been valued by emergencies are addressed? people would become infected. all involved in the response. At the same A: The outbreak was bigger than time, the UN helped to bring together anything we’d seen before and moving different UN agencies and partners, each so fast that organizations had to develop with their sets of skills and can do this in and revise their action plans while they It is never future. As a new entity offering additional were being implemented. The presidents one“ organization capacity for overall leadership, liaison of the most affected countries were alone that responds with governments, donor engagement asking the UN to play a leading role in to an emergency, and logistical support, UNMEER was ensuring they were properly supported. partnerships are unprecedented and unlike any other UN They felt abandoned. Flights to their essential. operation in which I have been involved. countries had been cut. They weren’t Q: In what sense? receiving the help they needed. I was ” A: If you get it right, a leadership working with [WHO Director-General] and coordination body such as UN- Margaret Chan, the Secretary-General MEER can bring the players together [Ban Ki-moon] and senior advisers like the conductor of an orchestra. In- as they sought a massive scale-up in Q: The Report of the Ebola Interim As- dividual musicians may play beautiful support of the affected countries. The sessment Panel released this year found melodies, but the power of harmony Secretary-General proposed a totally that coordination was weak between emerges through the skills of the con- new mechanism, based on what is used WHO and its UN and nongovernmental ductor. We need to do more of this at the for UN peacekeeping operations, to partners on many levels – financial, UN. There are thousands of nongovern- give extra muscle and coordination to logistical etc. – during the outbreak mental groups – and some businesses as the international response. It became and that WHO lacked staff capacity well – that yearn for effective coordina- known as the UN Mission for Ebola to respond adequately. How can the tion and clear direction. It is never one Emergency Response or UNMEER for response to such emergencies be more organization alone that responds to an short. UNMEER was approved by the effective in future? emergency, partnerships are essential. UN General Assembly and endorsed by A: There were concerns about wheth- the UN Security Council in the middle er WHO sounded the alarm soon enough Q: One of the challenges for a more of September 2014: it was implemented in the early months of 2014 and others are effective response to outbreaks and in record time. It was developed at a examining this. Since August 2014 WHO health emergencies cited in the interim 824 Bull World Health Organ 2015;93:824–825 | doi: http://dx.doi.org/10.2471/BLT.15.031215 News panel assessment was WHO’s decen- major organizations that respond to while others were building an outbreak tralized governance structure allowing health risks in humanitarian settings. response capacity at WHO. Those initia- regional and country offices a measure The proposals are in the advisory group’s tives were wound down. Are they being of autonomy. How does the new ap- first report to the Director-General revived now in the new programme? proach address this potential bottleneck and she will now be exploring ways in A: I left WHO in 2005. I understand for responding to health emergencies? which they can be implemented. Mak- that the WHO budget became very A: The advisory group proposes a ing the shift will not be easy, but it has tight between 2006 and 2009. This led new WHO programme on outbreaks to happen. This is a change that WHO’s to cut-backs. Our advisory group on and emergencies that spans the whole Member States and its partners want. outbreaks and emergencies proposes organization and answers to one point a new programme that enables WHO of authority, the Director-General. The Q: WHO is an established player in re- to fulfil expectations and to do so in a new programme should have a single sponding to outbreaks. How will the new predictable and dependable way. That platform that works across the orga- programme change the Organization’s means harnessing the existing capacity nization and supports operations – i.e. approach and that of its UN partners to respond to health emergencies within getting people and materials quickly and to responding to natural disasters and the Organization and delivering well. safely to where they are needed, support- conflicts? This change is urgently needed because ing them while they do their work and A: The new approach will provide the Organization is too easily stretched enabling them to travel out when neces- WHO with the tools and resources to when responding to outbreaks and sary. Sometimes WHO staff have been respond more independently and pro- emergencies. As a result, it is neither ready to deploy to where they are needed actively to emergencies than it has been predictable nor dependable in these cir- but have been delayed because there was able to do so far. Ideally, WHO should cumstances, and that means that com- no capacity across the Organization to be able to use its sentinel (surveillance) munities and the world are vulnerable. mobilize them. network to determine independently The new approach represents a radical whether a health outbreak constitutes an shift and is seen to be urgent and neces- Q: How can WHO achieve a more effec- outbreak of international concern and sary by leaders the world over. There is tive response? then mobilize a response, together with no going back now. A: The unified programme and partner organizations, at the appropri- platform should use procedures that ate level – which could be a country- Q: In addition to the US$ 100 million are specially designed for outbreak and level response for smaller outbreaks or a contingency fund and pandemic emer- emergency work. This means creating a regional-level or international response gency financing facility, how will the new culture of rapid response that is new for for larger ones. programme be funded? much of WHO, but which is routinely A: Our advisory group is propos- practised by humanitarian organiza- Q: Will the new approach lead to more ing a strategy for mobilizing resources. tions. They have well-developed inter- prevention efforts? We have a number of ideas that are still relations, they know what to expect of A: Preparedness is key to addressing under discussion. No other interna- each other, and engage on the basis of outbreaks early on. By investing in better tional health organization can work in shared values, trust and mutual respect. basic health systems and surveillance major outbreaks of disease or in health Typically WHO’s way of working is to networks, we should be able to detect emergencies, especially cross-border provide advice.