Shorn of language and resolutions, the World Health Assembly (WHA) will open today with a set of deeply irksome questions facing it and the world. Is there a pecking order for deaths and disease?
Or, does one public health disaster take precedence over another? For example is it even sensitive and appropriate to compare the 6000 Ebola deaths in West Africa with the one million annual tobacco deaths in India or are such comparisons odious?
Of course not, say the over 2000 delegates attending the World Health Organisation’s (WHO) annual gathering of health ministers and health professionals meeting in Geneva, but what remains unsaid will always be more important – Ebola with a capital E will be one of the key topics that will overshadow all else at the 68th session of the WHA. For one, there appears to be a universal recognition that the organization and connected bodies have failed to respond to the Ebola outbreak in Sierra Leone, Guinea and Liberia in West Africa. There is an even broader acceptance that the movers and shakers of the world of international public health have now to hammer together bits and pieces of their stories into a coherent whole which has left gaping holes in their narrative. A European diplomat told The News Minute (TNM) the first signs of the disaster were seen in the spring of 2014 (before WHA last year), but it was not addressed.
There is a vaccine in sight, but it will take time to quell the suspicion and fear among a people who ask why there is no vaccine for malaria but one for Ebola.
Angela Merkel leans in for antimicrobial resistance or more?
A surprise element in all this is the presence of German Chancellor Angela Merkel who arrives on Monday to make a keynote address. Speculation is rife about what her political message will be in addition to the fact that she is currently chair of the Group of 7 (G 7) industrialised countries and it likely to address the issue of antimicrobial resistance (AMR) in Ebola. This speaks to the growing resistance to existing antibiotics and lack of research on new ones. There are health professionals who believe that AMR is one of the greatest challenges of this century and research has dwindled has dwindled because funding has and unless this is addressed, the world could well move backwards instead of ahead. One of the speeches eagerly awaited is that of the German Chancellor to see if she speaks of the immigrants’ crisis washing up around European shores and how the continent can rise to the public health challenge posed by it.
With greater ambitions come increased strains on the budget and more importantly, who pays for what. Currently, the organisation’s funds come in two tracks – assessed contributions (which members states are required to pay) which account for 30 percent of the budget and voluntary contributions (which comes from donor agencies) which make up the seventy percent. Till a few weeks ago, the WHO was seeking an increase in the former category, but that has been shot by member states and they say a percentage increase is nit more important than real efficiency.
The organization does not want to work with the private sector when, in fact, many of its activities would come to a standstill if the private sector pulled out. Foundations are good to get funding from private companies – many of whom have set up foundations – are not. This, say a seasoned WHO-watcher who has served in senior positions in the private sector as well as with an NGO is WHO’s Achiles’s heel. For example, does the whole of health system which all countries talk about add up to the sum of all parts in a resilient way? The best way to describe this logjam is to call it Kafkaesque. In response, the WHO says it is put at a “…severe disadvantage by the fact that the core funds are so limited that they do not allow an appropriate base for response.” In other words, the coffer seems empty while the disease burden worldwide accelerates.
One solution is non-state actors, but this is a contentious issue with the world health body. This non-state category in reality is no category as everything that does not fit into a state category ends up in the heap of non-state actors and includes everyone from foundations to civil society, the private sector to academics most of whom do not see eye to eye. As a health expert pointed out, it is like putting toothpaste back into the tube after it has spread all over the place. Conversely, imagine where public health would be if the private sector whether it is transportation or communication was not present.
Sub-standard and fake medicines, a vaccine for Malaria and a broad-based discussion on climate change are also on the agenda as are proposals to see what can be done to assist neglected diseases that include many tropical diseases that also kill in very large numbers.
Don’t hold your breath – the heavens are not going to move next week. The organization that needs to bring in over 196 countries on board to agree to every line and comma has its own ways of functioning, its own protocols leading a participant to ask if WHO was relevant at all in today’s times. The answer to that is two –fold. What will replace the WHO if the current one established in 1948 is moribund and if there is acceptable answer to that, would it not make sense to make the organization leaner where it matters – at the headquarters in Geneva – and strengthen its parts in the six other regions of the world where it is present?