Microbes have no respect for borders. In our increasingly interconnected world there are increasing opportunities for the rapid spread of infections.
More than ever global public health security depends on international cooperation. The World Health Organization (WHO) was founded in 1948 to coordinate these affords. Its accomplishments include overseeing the eradication of smallpox and yellow fever and pioneering the programs that now immunize most of the world’s children against measles, polio and yellow fever.
In recent years serious medical emergencies have increasingly appeared.
Diseases like HIV, EBOLA, SARS (severe acute respiratory syndrome), and now ZIKI have challenged the world community. They pose a threat through A combination of factors like genetic mutations, rising resistance to antimicrobial medicines and weak health systems. These outbreaks are not solely medical problems but also social problems as well. Diseases are much more prevalent where malnutrition, unclean water and inadequate sanitation exist.
The World Health Organization has been severely criticized for its handling of the Ebola disease. It came on the scene too late. The disease spread for months before being detected because much of the work of spotting outbreaks was left to desperately poor countries ill prepared for the task.
Unfortunately, this tragic scenario is being repeated with the current outbreak of Zika. Why is this happening? Why wasn’t WHO on the job?
There are two reasons. The most important is that WHO has been badly weakened by budget cuts in recent years, making it difficult to respond in parts of the world that needs it most. Its outbreak and emergency response unit have been slashed. Veterans who have led fights against diseases have left and scores of positions have been eliminated.
In the past WHO received about 50 percent of its money as ‘assessed contributions” from member states. WHO could mostly do what it wanted with this money. It could set its own priorities. Because of the global financial crisis member states drastically reduced its assessed contributions and it is currently down to about 20 percent and partly responsible for its slow response to the Ebola outbreak. About 80 percent is now made up by “voluntary contributions”. Almost all these donations come with string attached including stipulations that the money must be used for certain projects and diseases. WHO has lost its ability to set its own priorities.Currently, only about 15 percent of its budget is used for outbreak and crisis response, in effect crippling that program. In 2011 a $300 million budged shortfall forced WHO to lay off a quarter of its employees.
A second reason for WHO’s difficulties is its unwieldy structure which includes six regional offices, each with its own director elected by regional member states. Beneath them is a sprawling network of around 150 country offices. Such a structure is an invitation for trouble, politicking and makes communication very difficult.
Overseeing WHO is the World Health Assembly which meets periodically in Geneva and is attended by the nations of the world.
When executive board members of WHO held their annual meeting in January, many spoke forcefully of the need for reform. There is a strong need to streamline its complex structure, governance and financing to make it more efficient and responsive. The world needs a strong WHO. It is particularly important to have a strong surveillance program to spot potential health emergencies. Richer countries should be particularly interested in funding such programs as diseases could spread to developed countries. It is reminiscent of what happened during the Industrial Revolution. The major cities of London and New York experienced Typhoid and Cholera traveling from the slums to the residential area of the wealthy. Only then were sewer systems build and clean water supplied for the whole population.
One lesson learned from the Ebola epidemic is the importance of listening to the local people affected. Sensitivity to local concerns and local practices is vital. One example is the traditional practices such as burial rites which was a major source of infections. In Sierra Leone, for example unsafe burials stopped when aid workers joined forces with communities to develop alternative burial approaches that were both safe and appropriate.
The current concern is the epidemic of mosquitoes carrying the Zika virus.
WHO expects the Zika outbreak to spread to almost every country in the Americas .The Zika virus has links with birth defects in newborns.
The Zika epidemic started in Brazil. It is concentrated among young, poor, black and brown women, a vast majority living in the countries least developed regions. They live in substandard crowded housing in neighborhoods where stagnant water is the breeding ground of disease.
Health ministers in Brazil, Columbia and El Salvador have recommended that women postpone pregnancy. This is offensive to many women and ridiculous in the context of strict abortion laws, high levels of sexual violence against girls and women and lack of contraceptives.
An intriguing technological fix is being considered. The threat of the Zika virus, which is running rampart in Latin America and threatens the US has spurred the US Food and Drug Administration to approve field trials of genetically modified mosquitoes. The GMO male mosquitoes are released into the wild and don’t produce viable offspring. When females mate with the GMO males, they lay eggs that hatch but the larvae die before adulthood.
Trials in Brazil and Panama have been successful. FDA approved trials in the Florida Keyes. Many local residents have expressed concerns about the consequences of releasing these GMO mosquitoes into the environment.
We think the world needs a well funded, streamlined WHO and a strong outbreak and surveillance team that can be immediately sent to contain an outbreak before it can spread and cause havoc.
Dr. Sylvain Ehrenfeld, the IHEU and National Ethical Service representative to the UN and Dr. Reba Goodman member of ECSBC.
