Ebola: WHO is in Charge?

Alphen, Netherlands. 20 October. As EU foreign ministers finally meet to discuss the Ebola epidemic and Liberian President Ellen Johnson Sirleaf makes a desperate open plea to the world to get its act together the disease is taking hold.  According to the World Health Organisation (WHO) more than 4500 people have already died of Ebola in West Africa. Well in excess of 9500 people are infected of whom 70% are expected to die.  WHO estimates there could be as many as 10,000 new cases each week by early December. 

Three actions are desperately needed to stop Ebola spreading and then establishing itself as a perennial disease.  First, the provision of effective preventative and curative healthcare is needed across West Africa and indeed beyond.  Second, a longer-term strategy is needed to properly establish basic but robust healthcare systems.  Third, an end is needed to the brain drain of qualified West African medical practitioners to the West.  Britain’s National Health Service is a major recruiter from the region.

However, the control of pandemics (which Ebola is not as yet) also needs the world to take a new approach. Specifically, a Global Disaster Action Centre is needed for which healthcare would be a major responsibility and which would act in a similar way to the US Centers for Disease Control or CDC (even though the CDC has not covered itself in glory of late).  Such a Centre would be ideally focused on the UN Security Council (UNSC) and supported by military-style structures with a Situation Centre at its core that would assimilate and interpret real time intelligence and analysis to provide support for command decisions.  Logistics would need to be pre-positioned and provided by the five Permanent Members of the UNSC and reinforced by other members of the G20 group of rich and emerging rich states.  Such a centre would act as emergency reinforcement for national health professionals and help properly and better co-ordinate the vital work of the non-governmental community.

All well and good but…Many years ago when I was a callow youth in the salad days of my strategic evolution my boss seconded me to the United Nations to design a ‘strategy’.  This was probably because a) I kept asking awkward questions of the powerful at home; and b) because whilst the UN of the day was huge on “strategy” it viewed the word “action” as a crime against bureaucracy and thus it was probably felt I could no harm.  The good news was that I got to spend time at the UN both in Geneva and New York. 

One of the UN agencies unfortunate enough to ‘benefit’ from my strategic guidance was WHO.  At WHO I found a core of seasoned, brave and dedicated medical field people surrounded by a strange assortment of fellow-travellers.  There were sons and daughters of African and Asian potentates who may or may not turn up for work alongside officials seconded from one Soviet bloc state or another of whom not a few had the title ‘colonel’ or some other such military appellation.  The former knew nothing about anything whilst the latter knew nothing about health the ‘function’ of whom was not at all ‘clear’, if you know what I mean.  With the end of the Cold War I hoped things might have changed, now I wonder.

Last week an internal WHO report was leaked cataloguing the egregious errors made by the UN in first identifying and then containing the West African Ebola plague.  This was not exactly a surprise to me and suggests that within the UN bureaucracy personality and politics still remains more important than strategy and action.  The plain fact is the UN and its agencies are simply not geared for crisis management in spite of the many ‘offices’ that claim to be crisis managers in some form or another.

Blame for the Ebola failure cannot be laid solely at the many marble portals of the UN.  As the predictably tardy EU response demonstrates the somewhat misnomered ‘international community’ has been predictably lamentable, fragmented, tardy and haphazard – too little, too late.  As per usual it is not until the Americans and the wider West take action that anything substantive happens, although it is good to see China taking its international responsibilities ever more seriously.  Some 4000 US military personnel are now engaged in Liberia.  The British are sending additional forces and resources to Sierra Leone and the French likewise to Guinea whilst the EU is providing medevac.

Tragically, in a world ever more connected and interdependent global crisis response is anything but.  So why does something like a Global Disaster Action Centre not already exist?  There are three reasons.  First, the lack of trust in the UN Security Council between P5 members as the world slides back towards echoes of the Cold War and the frictional geopolitics that paralyses effect policy and strategy.  Second, the eternal donor gap in which UN members pledge support but rarely if ever deliver it prevents the systematic application of forces and resources.  Third, the complete lack of pledges from a host of UN members for which Africa in particular remains the Dark Continent little understood and even less cared about.

Over the past decade there have been several immense natural disasters ranging from a 2006 tsunami that is estimated to have killed at least 200,000 people to deadly typhoons and hurricanes and now an outbreak of plague that in some African countries could have the same population-scything effect as Europe’s fourteenth century Black Death.  Each time the world’s inadequate response has turned a crisis into a disaster.

Therefore, the Ebola crisis must be seen as a ‘wet-run’ for future crises – both human and natural.  Prevention, engagement and consequence management are the three pillars of effective crisis management.  However, such structures, strictures and sutures need to be worked up.  This is because effective crisis response requires government to government action, individual governments to function effectively and rapidly from top to bottom and civil society to play a full role through awareness, prudence and if needs be engagement.

Last week the British Government held a best-practice exercise which for the first time in many years involved ministers.  Too often in the past ministers have excused themselves from such efforts and sent officials instead.  Consequently, crisis preparedness was politically decapitated and not just in Britain.  This high-level absence helps explain why crisis response mechanisms have for so long lacked experienced, committed political command and leadership. 

As President Johnson-Sirleaf writes: “The time for talking or theorising is over.  Only concerted action will save my country, and our neighbours, from experiencing another national tragedy.  The words of Henrik Ibsen have never been truer: “A thousand words leave not the same deep impression as does a single deed””. 

For the sake of humanity here are my thousand words.

Julian Lindley-French