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Toughen up, WHO: sanction outbreak dissenters

Changes to the World Health Organization’s funding model, skill mix and engagement with emerging international health institutions such as Me?dicins Sans Frontie?res (MSF), will restore its reputation following criticism of its handling of the Ebola outbreak, according to an editorial published in the Medical Journal of Australia.

Associate Professor Sanjaya Senanayake, an infectious diseases specialist at the Australian National University, wrote that it was important for WHO “not to remain a toothless tiger”.

Criticism of the WHO in the wake of the Ebola epidemic is well documented and includes its failure to declare a public health emergency of international concern (PHEIC) early in the outbreak; a failure to adapt to the emergence of new health agencies such as MSF, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Bill and Melinda Gates Foundation, and the GAVI Alliance; the skill mix of mainly medical and administrative personnel leaving deficiencies in other areas; the need to provide an internal separation between its technical and political and governance sections; the restructuring of its regional offices; and a funding model that relies of voluntary funding for over 70% of its budget.

“Rather than viewing these [newer] organisations as challengers to the WHO’s pre-eminence, they should be considered as skilled and resourced allies that the WHO can partner with and delegate to,” Professor Senanayake wrote.

Restructuring the funding model via contributions from member states “would be preferable to the financial uncertainty of the current arrangement and would provide an affirmation by member states of their support for the WHO,” he wrote.

Further criticism of WHO has pinpointed the political pressure placed on the Director-General not to declare a PHEIC.

“The WHO should incorporate punitive elements into its constitution for member states that fail to comply with its instructions, especially in the setting of an acute epidemic, where time is of the essence and protracted debate is impractical,” Professor Senanayake wrote. “UN sanctions backed by member states are evidence that such a more punitive approach is not novel; and the WHO is part of the UN. Therefore, sanction is one possible strategy that the WHO could use on such occasions.

“With the right structure, powers and learning how to engage other new global health institutions in its core functions, we can be optimistic about the WHO’s role in maintaining global health security.”