To defeat the next outbreak, the WHO requires a rapid-response health corps that it can deploy to stop the disease in its tracks.
- By Jack C. ChowJack C. Chow served as U.S. ambassador on global HIV/AIDS from 2001 to 2003. He is currently visiting professor of global health at the Whitehead School of Diplomacy, Seton Hall University.
The West African Ebola outbreak is not only killing people; it is shredding the medical front lines and social fabric of the entire region. Doctors and nurses running into the breach to save lives have often contracted the virus and died. This means health workers face an agonizing choice between protecting themselves and their families by retreating from patients, or risking death to perform their duties. The stigma of contracting Ebola, or even of living in affected zones, also complicates the public health response by scaring some of the infected away from seeking care and deterring some health workers, too.
To make matters worse, those brave people fighting the virus are doing so without the backing of any substantial medical reserve force that could come in with fresh supplies and trained personnel. Neither the cluster of industrial countries that gives health aid to poor countries, such as those in the G7, nor international bodies like the World Health Organization (WHO) possess an at-the-ready, deployable battalion with trained health care teams, protective gear, and ample supplies of medicines.
That needs to change.
Ebola’s surprise attack against fragile countries, including Liberia, Sierra Leone, and Guinea, demonstrates the compelling need for a new international epidemic response corps that can go straight to a hot zone when needed. This "medical NATO," so to speak, would consist of a coalition of countries that would recruit specialty teams — comprised of doctors, nurses, and others — from respective national health agencies and systems. The alliance would appoint a doctor-in-chief, and all participating countries would jointly develop operational plans and conduct rehearsal exercises.
The teams would be deployed upon the WHO’s declaration of a global health emergency. They could be mobilized to suppress a disease either completely, or to such a level that a country could then handle the crisis on its own. They would have the authority to directly provide treatment drugs and implement prevention measures without political interference from a country in which an outbreak was happening. The corps would be equipped with airlift capacity for rapid insertion into disease zones, and would receive support from a robust supply chain that could immediately push mobile hospitals, equipment, and essential drugs into areas in need. Corps members could follow WHO treatment guidelines and access that organization’s disease-tracking systems. Once widespread transmission had been averted, the teams would return to their home countries.
Models of the operational capacity needed to build a medical NATO already exist across international organizations. United Nations peacekeepers are deployed to conflict zones; UNICEF supplies aid to needy children; and U.N. humanitarian groups stand ready to send search-and-rescue teams into disaster zones. The WHO could adopt the emergency response protocols of the U.N. High Commissioner on Refugees (UNHCR) and the World Food Program, both of which directly provide food and lifesaving aid amid war and disaster. (UNHCR touts its ability to mobilize 300 first responders within three days and to intervene in emergencies affecting 500,000 people.)
Moreover, countries with advanced health care systems as well as aid organizations already possess deep reservoirs of expertise from which specialty units could be formed and deployed. For example, the United States could supply teams from the Centers for Disease Control and Prevention (CDC) and the U.S. Agency for International Development (USAID), while the United Kingdom could volunteer experts from its Department for International Development (DFID). Enlisted health care teams from private hospitals and NGOs could also be assigned specific duties or geographic sectors to cover.
As the U.N.’s leading health agency, the WHO would be the natural base for such an international reserve corps, and the trajectory of the Ebola crisis indicates just how necessary it is to create this capacity. To its credit, the WHO responded to the Ebola outbreak by activating its outbreak-tracking system, mobilizing hundreds of experts, and declaring the epidemic an emergency. It also enlisted help from other U.N. entities and the World Bank, and it recently created a "road map" of how it will work with the international community to battle Ebola, with a price tag of $490 million. Yet these steps do not offer countries what they most urgently need: a concerted disease-fighting force that provides humane care to the sick and dying and actively works to prevent the spread of disease.
One reason the WHO cannot yet do this is the politics of sovereignty: Countries are wary of ceding authority to an external force. National leaders are sensitive to how international operations might roil domestic politics or even introduce new problems. Indeed, past aid interventions have spawned unintended consequences. It is widely held, for instance, that U.N. peacekeepers were the source of the cholera epidemic that hit Haiti in October 2010, in the wake of an already devastating earthquake, and which continues to cause suffering today. Furthermore, national health officials fear losing stature and incurring criticism if they concede the need for help.
This reluctance to cede control during a crisis puts the WHO in the conflicted position of having to stick to background technical work while facing incessant demands for immediate action.
The standard playbook for responding to epidemics calls for countries to wage their own battles, with the WHO placing technical advisors in government agencies and supplying guidelines for health departments. While this division of roles may make sense in more developed nations, it leaves poorer regions, where health departments are already underfunded, undermanned, overwhelmed, vulnerable to crippling epidemics.
Overcoming these outdated limitations will require a bloc of countries, wealthy and poor alike, to push for changes in how the WHO operates, and to create the international medical response force that West Africa and the rest of the world need. Ideally, this would create a reinforcing cycle: Fears about sovereignty would dissipate as the response corps did its work, and leaders would realize that early, concerted aid saves lives, averts panic, and preserves stability.
The virulence of diseases like Ebola, along with porous borders and the velocity of global movement, are all factors combining to spark a new wave of dangerous flashdemics. It is essential to rethink how a concerted global health defense can be mounted against today’s most potent threats. A global health emergency corps is clearly insurance worth attaining.