It is generally not a good sign when a virus becomes prominent in the public consciousness. The Ebola epidemic was one of the enduring and tragic stories of 2014, with terrible humanitarian and economic consequences. It also revealed a darker side to the speed and interconnectivity of today's globalised world.
The world has dug deep to provide much needed finances, medicines and personnel, and there are hopes that the outbreak will end in 2015 if everything goes to plan. In time, attention can shift to long-term recovery in affected countries.
Whether the world will heed the lessons from Ebola remains less clear. Hannah Wurf and I explore this issue in the latest Lowy Institute G20 Monitor.
Most objective assessments would agree the outbreak was poorly handled and the international community should have done more, and more quickly. It appears that the World Health Organization (WHO) was simply overwhelmed by Ebola. At the peak of the crisis, Director-General Margaret Chan declared that the WHO is a technical agency and that health care remains the responsibility of national governments. [fold]
Health policy does remain, for the most part, a domestic policy area managed within national borders. Even for internationally-transmitted infectious diseases, there is a focus on actions at the national level, with each country expected to detect, assess, report and respond to public health risks of international importance. But the capacity of health systems around the world vary considerably. It appears that the entire African continent was ill-prepared to manage emerging health threats just before Ebola struck.
What is needed is a technical body that monitors vulnerabilities, identifies gaps, informs policymakers and coordinates responses. The WHO, with its current funding, structure and staff, does not seem able to provide the necessary oversight. Yet there is no other organisation that can match the reach or representativeness of the WHO. As Bill Gates points out, the problem isn't that the system didn't work well enough, it is that we hardly have a system at all.
The problem is truly global, and solutions need to be developed at a multilateral level. It is sure to be high on the agenda at the UN World Health Assembly in May. However, the risk is that while these discussions advance technical solutions, without high-level political leadership they will not be able to address the deficiencies in the health architecture that Ebola has exposed. Until that political leadership comes, the world will continue to hope the next fast-spreading health crisis will prove controllable.
This kind of situation appears tailor-made for G20 attention, given the forum's membership and its focus on the international 'rules of the game'. A G20 focus on global health governance would also build on the political support given to the international crisis response by G20 Finance Ministers in Cairns and Istanbul, and on the commitments included in G20 leaders' Brisbane communique and statement on Ebola.
Wurf and I focus on three areas that would define an appropriate, clear and well-targeted global health governance agenda:
- Politically reinforce the WHO as the central organisation for health crises, strengthen its mandate for cross-border infectious diseases and secure its funding structure.
- Improve health-risk surveillance and ensure that decision-makers are informed of evolving health risks that could derail economic activity.
- As Larry Summers advocates, incentives need to be structured for the development of vaccines, diagnostic tests, and medicines that primarily benefit the poor.
Together, these initiatives would be an important step forward in the global management of future health crises, and recognition that the challenges that developing countries face pose global risks. The tragedy of Ebola is top-of-mind and it would be a shame to waste that momentum.
Photo courtesy of Flickr user DFID.