Global Health Risk Framework Governance for Global Health: Workshop Summary (2016) / Chapter Skim
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5 Challenges in Design of Governance for Global Health
5 Challenges in Design of Governance for Global Health
Pages 51-64
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From page 51... ...
If their ability to intervene is limited, this can add dif ficulty to the recommendation that WHO should promote and maintain global health security as a core function, but would also address their potential role in an outbreak. (Chan, Clift)
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From page 52... ...
This chapter focuses on applying what WHO and member states have learned about governance design from the challenges of the West African Ebola crisis, as well as other epidemics, to addressing future infectious threats. Workshop participants examined recent proposals for enhancing global preparedness and response to health emergencies, in regards to both the WHO system and other global health actors, and considered how existing global security initiatives and frameworks can coordinate their efforts to create more synergy and avoid gaps in communication, workforce, and resources.
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From page 53... ...
Chan acknowledged that the challenges WHO faced during the Ebola crisis fall into three broad categories: • The absence of national detection and response capacities, com pounded by poor infrastructure for both transportation and communication; • Weak preparedness and response capacity within the international community, including extremely limited surge capacity; and • The conflict between sovereignty and collective action against a shared threat. The problems created by the third category of conflict between the rights of sovereign states and the need for global solidarity represent the highest barrier to global health governance, according to Chan.
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From page 54... ...
Based on lessons learned in this epidemic, WHO is creating a blueprint for research and development during outbreaks of high-risk pathogens, Chan reported, which features a generic clinical trial protocol, arrangements for fast-track regulatory approval, and expedited development of new medical products.1 "All of these achievements were made possible by the unprecedented collaboration of multiple partners," she said, noting by example a field laboratory constructed in collaboration with 19 institutions and partners in two major networks. Chan urged all involved to be honest and learn together, so that changes driven by this epidemic make it possible not only to get to and maintain zero, but also to help the affected countries rebuild their health systems.
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From page 55... ...
WHO's Global Health Security Role A few participants asked whether Chan accepted WHO's perceived responsibility for promoting and maintaining global health security as legitimate, especially considering the operational or interference implications that responsibility may have in certain circumstances. Formally, the Director-General cannot interfere in sovereign states, Chan acknowledged, but she said she has spoken regularly with the presidents of Guinea, Liberia, and Sierra Leone, as well as with those of Mali, Nigeria, and Senegal, saying it is necessary to intervene at that level.
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From page 56... ...
To address this perceived deficit, the Chatham House report recommends that one of WHO's core functions should be promoting and maintaining global health security -- a responsibility that includes preparedness for health emergencies, supporting the implementation of the IHR, and polio eradication, as well as outbreak response, he noted. WHO's appropriate role in outbreaks is the subject of a longstanding debate that has intensified with the Ebola crisis, as Clift observed (Farrar, 2015; Garrett, 2015; Gulland, 2014; WHO, 2015b)
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From page 57... ...
, the Red Cross, or similar agencies who are working on the ground to provide direct services. If WHO has a limited role to help countries deal with their own problems, it is surprising that the organization designed and built Ebola treatment centers, Clift remarked.
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From page 58... ...
and AFRO4 became evident during Ebola. AFRO did not convene health ministers or open a regional coordination centre until 3 months after Ebola was confirmed in Guinea; the Guinea country office reportedly impeded aid and technical assistance." To some extent, this incoherence reflects conflicts that arise between the individual interests of its member states and the cause of global public health, as previously described by both Fineberg and Chan.
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From page 59... ...
Even so, the U.S. government believes that WHO should coordinate and mobilize the envisioned global health emergency workforce, which would incorporate GOARN, a new robust platform for managing FMTs, and WHO's role as Health Cluster lead in humanitarian response, he explained.
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From page 60... ...
The U.S. government agrees with the general view that WHO's declaration of a PHEIC in the Ebola crisis was late, particularly given the slow international response that followed it, McIff stated.
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Stocking characterized WHO as the guardian of global public health, managing health emergency responses and alerting the global health community to threats. McIff also emphasized WHO's preeminence as a coordinator of the many institutions that together ensure global health.
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From page 62... ...
Takemi noted the lack of alternatives to WHO as the coordinator of global health emergency response, and that no concrete suggestions have been put forward for collaboration between the UN humanitarian system and WHO. Stocking added that much remains to be done to develop an effective, timely outbreak response plan to coordinate both entities, as the humanitarian side is unfamiliar with the IHR, and the WHO side does not understand the humanitarian response network infrastructure.
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From page 63... ...
Global Health Emergency Workforce The global health emergency workforce could be comprised of separate components for infectious disease surveillance and detection, and for emergency response operations, both of which could serve as engines for capacity building, McIff observed. Such an opportunity presented itself when the African Union deployed health teams to West Africa to deal with a common threat to security, he noted, but better communication between WHO and the teams could have allowed them to work more effectively together.
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