Ebola Spread After WHO's 2010 Warning Ignored, Agency Says

A WHO review committee convened in 2010 in the aftermath of the swine flu epidemic called for international collaboration to form an “extensive global public health reserve workforce” to counter crises and outbreaks of disease, the Geneva-based health agency said in a report issued Thursday.

“The world did not respond to these recommendations, with none of these measures fully in place to support a response that could last for many more months to come,” the report said.

WHO has faced widespread criticism for its response to Ebola, which has sickened more than 20,000 people and killed more than 8,400, most of them in Liberia, Sierra Leone and Guinea, in the past year. The agency lacked adequate personnel and tools to beat back the deadly epidemic, according to the report.

“WHO went into battle against this virus with no army of reinforcements to support a sustained response, no war chest to fund a surge, and weapons that date back to the Middle Ages,” the report said.

Funding cuts at the agency before the outbreak resulted in reduced units for detecting and fighting epidemics. The battle against the disease was also plagued by missteps in WHO’s local response, such as when some medics weren’t issued visas, and bureaucratic hurdles that halted funds at borders.

Learned Severity

Director Margaret Chan has said she learned of the severity of the epidemic in late June -- three months after the agency first got reports of cases -- and assumed personal direction of the effort. Chan replaced the heads of WHO’s national offices in the three most-affected countries.

The epidemic exposed WHO’s weaknesses that have roots in a regionalized, politicized structure, said Lawrence Gostin, a professor of global health law at Georgetown University in Washington.

“There was no agreement between the African offices and Geneva on how the epidemic was going to be handled,” Gostin said. “You can’t have that kind of muddled, confused action in an emergency.”

Public Emergency

WHO declared Ebola virus a public health emergency of international concern in early August. Long before then, the agency began carrying the “lion’s share” of logistical and technical support for work to fight the outbreak, the report said.

The efforts of Doctors Without Borders, the U.S. military and other nations such as France and the U.K. were far greater than the WHO’s, Gostin said. While WHO was in charge of the response to swine flu, the agency was “comparatively irrelevant” in the fight against Ebola, he said.

“It’s fanciful to say that the WHO was in logistical control or even coordinated what went on,” he said.

Doctors Without Borders, the medical relief organization, has also said WHO reacted slowly to the Ebola outbreak. A spokeswoman declined to comment immediately on Thursday’s report.

A number of events and factors, both inside and outside the WHO, contributed to the seriousness of the outbreak, said Gregory Hartl, an agency spokesman. The epidemic is centered in some of the world’s poorest countries, which enabled many cases to go undetected, he said.

“Had we known then what we know now, certainly we as WHO would have reacted differently,” he said in a telephone interview.

WHO is in the middle of a “reform process” that will consider how much the agency can contribute to fighting emergencies and has scheduled a special session of its executive board Jan. 25 to determine how to control Ebola.

“WHO needs improvement, and that’s what this special session on the 25th of January is about,” Hartl said.