Slow WHO response let outbreak flourish
Account of missteps ‘wake-up call’
LONDON — Poor communication, a lack of leadership and underfunding plagued the World Health Organization’s initial response to the Ebola outbreak, allowing the disease to spiral out of control.
The agency’s reaction was hobbled by a paucity of notes from experts in the field; $500,000 in support for the response that was delayed by bureaucratic hurdles; medics who weren’t deployed because they weren’t issued visas; and contact-tracers who refused to work on concern they wouldn’t get paid.
WHO director general Margaret Chan described how she was “very unhappy,” when in late June, three months after the outbreak was detected, she saw the scope of the health crisis in a memo outlining her local team’s deficiencies.
The account of the WHO’s missteps, based on interviews with five people familiar with the agency who asked not to be identified, lifts the veil on the workings of an agency designed as the world’s health warden yet burdened by politics and bureaucracy.
“It needs to be a wake-up call,” said Lawrence Gostin, a professor of global health law at Georgetown University in Washington. The WHO is suffering from “a culture of stagnation, failure to think boldly about problems and looking at itself as a technical agency rather than a global leader.”
Two days after receiving the memo about her team’s shortcomings, Chan took personal command of the agency’s Ebola plan. She moved to replace the heads of offices in Guinea, Liberia and Sierra Leone and upgraded the emergency to the top of a three-tier level.
“I was not fully informed of the evolution of the outbreak,” Chan said Friday. “We responded, but our response may not have matched the scale of the outbreak and the complexity of the outbreak.”
The spread of Ebola on three continents, with cases in Spain and the U.S., has increased focus on the leadership needed to battle such a disease.
Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention in Atlanta, faced calls to resign from Republican lawmakers this week, and President Barack Obama on Friday turned to a trusted adviser to lead the U.S. Ebola response.
Ron Klain, a former chief of staff to Vice-President Joe Biden, was named the Ebola point man and will report to national security adviser Susan Rice and to homeland security adviser Lisa Monaco, the White House said.
WHO received its first report about Ebola cases in Guinea on March 21, though it took more than three months to convene a meeting of regional health ministers or open a regional co-ordination centre.
The aid group Doctors Without Borders was concerned the virus had spread to Conakry, Guinea’s capital, as early as April and called the outbreak “unprecedented,” said Meinie Nicolai, president of the group’s operational centre in Brussels. As late as May 18, the WHO suggested the contagion was under control.
“We were accused of panicking,” Nicolai said. “I think they considered this epidemic much too lightly.”
The WHO’s higher echelons began to comprehend the alarming reality on the ground when Pierre Formenty, the agency’s top Ebola expert, gave a slide presentation to a steering committee of the Global Outbreak Alert & Response Network, known as GOARN, in Geneva on June 24.
Formenty’s charts showed how the outbreak was outstripping the capacity to respond on the ground.
By the third week of June, more than 500 Ebola cases were reported, including 338 deaths. The number of new infections was doubling every 24 days.
Eight weeks later, the tally reached 2,914, eclipsing the case total reported in the 24 previous Ebola outbreaks combined. Cases are on track to top 9,000 this week.
Formenty described how a greater proportion of patients suffered only respiratory symptoms, making them harder to detect — in contrast with other Ebola outbreaks, one person said.
Aylward, a 22-year WHO veteran, said he immediately emailed Chan and another senior colleague to relay the latest developments.
After Chan read the message, the 67-year-old director-general called all the team leaders to her office and asked why not one of them had informed her of the situation, one of the people said. No one responded. The following day, she called Luis Sambo, WHO’s regional director for Africa, telling him to cancel all travel plans and organize an urgent meeting with officials in affected and neighbouring countries.
“I asked for a detailed briefing to help me to appreciate what is at stake, what is the increased response we need,” Chan said Friday. Chan declined to comment on the sequence of events.
“I am very committed to transparency and accountability, but now I need to bring my team to focus our attention on scaling up our response to stop the Ebola outbreak,” said Chan.
Though Chan set in motion the replacement of the heads of the three affected West African countries at the end of June, the last one departed this month, one person said.
The difficulty in hiring and firing employees on the basis of competence spans the entire United Nations, yet the WHO is the only branch where regional heads get selected by secret vote rather than handpicked by the director-general, said Julio Frenk, who worked at the agency from 1998 to 2000 and is now dean of the Harvard School of Public Health.
“There’s a lack of transparency and a lot of political manipulation,” Frenk said.