A GLOBAL HEALTH RISK
FRAMEWORK FOR THE FUTURE
The role of the
Christopher Dye
The World Health Organization’s role
• Infectious disease challenges for
–
–
–
–
–
–
governance
finance
health systems
R&D
information
coordination
• Learning from Ebola &c
• Global health landscape
– 25-year increase in funding in MDG era, many players
– post 2015 development agenda
Ebola update: 7 cases in week 30 (20-26 July)
lowest weekly total in >1yr but it’s not over yet
Governance
Challenges
• Capacity: more people than ever need emergency assistance
• Mixed cultures: outbreaks, humanitarian emergencies, health security
• WHO normative: consensus-building technical work, limited logistics
and little internal surge capacity, ill-equipped for rapid decisions
• WHO compartments and levels ─ HQ, regional and country offices
Solutions
• WHO in general – reform decision-making, priorities, accountability
• WHO in outbreaks and emergencies – all-hazard rapid response,
logistics and operational platform, rapid access to emergency
workforce and global technical experts (standby capacity, UN, GOARN,
FMT, NGOs)
• Reinforced International Health Regulations
• WHO coordination -- Ebola transition from UNMEER (Aug 1)
Scope of a new
WHO emergency programme
(under discussion)
All Hazards
Prevention
Health system
Vaccination
Some disease programmes
R Brennan WHO
Preparedness,
Alertness,
Readiness
Response
acute
protracted
Recovery
Finance
Challenges
• 5-fold increase in $$ for global health since 1990; WHO much less
• WHO budget cuts in global financial crisis ─ key staff laid off
• WHO $ 4.4 bn budget 2016-17, ¼ from assessed contributions
(subscription), ¾ voluntary
• No core funds for emergency response
• Discontinuous, patchy donor funding
Solutions
•
•
•
•
•
8% budget increase – though not AC
Preparedness, outbreaks $580M -- but DG may spend more
US$100 million contingency fund for outbreaks
Other initiatives e.g. Pandemic Emergency Facility
Flexible donor funding - not earmarked, continuous, reliable
Health systems
fragile building blocks → poor health outcomes
Health systems
Challenges (in all 6 building blocks)
•
•
•
•
Delivery: slow diagnosis, little improvement in survival through better care
Delivery: collateral damage (Ebola) – vaccination, malaria, clinics etc
“Delivery”: weak community engagement (anthropology)
Funding: vertical programmes supported by external donors, little national
or international investment in health services, weak donor coordination
• Workforce: few motivated, well-trained HCWs (e.g. those unpaid earn
money in unregulated private practices)
• Leadership: Ebola exposed many weaknesses but some strengths
Solutions
• Universal Health Coverage central to SDGs – strategic, long-term investment
• Immediate priorities: early warning and response systems for all health
threats, logistics, field epidemiologists, mobile labs, clinical procedures, IPC
training, focus on district-level services, and coordinated international
technical assistance with partners.
R&D
Challenges
• Inappropriate technology, slow development of new technology
• Absent target product profiles (TPPs), R&D roadmaps, review mechanisms,
reference preparations for assays, approved standards of care
• Limited data sharing - clinical trials and other research during outbreaks &
emergencies
• Inadequate R&D funding models, few $$ to quick-start R&D
• Limited stockpiles of effective treatments
• Low national participation in R&D efforts to build research capacity
• Narrow view of R&D – mostly vaccines, drugs, diagnostics – not operations
Solutions
• Ebola diagnostic, drug, vaccine development, trials, licensing compressed to
months
• Expand existing collaborations e.g. African Vaccine Regulatory Forum
(AVAREF)
• Blueprint for Research and Development Procedures in the Context of Global
Public Health Threats (WHA 2016)
Information
sit reps – rapid guidance - data sharing – triggers for outbreak response
WHO Ebola Response
WHO Ebola Response
1990-2015: new coordination role
40 bilaterals, 26 UN agencies, 20 global funds, >100 global health initiatives…
HMN
KfW
AusAid
EC
GTZ
AECI
MSF
SC
USAID
Clinton
HAI
RACHA
KHANA
HNI
IFRC
SRC
RHAC
ICRC
HU
URC
Stop TB
WB
RBM
Gates
ADB
UNFPA
OCHA
UNDP
PSI
Oxfam
Catalytic
Initiative
PMNCH
WHO
MoH
OIE
NGOs
CARE
Global Fund
to Fight ATM
GAVI
GOARN
AFD
CDC
KOICA
DFID
JICA
BTC
PMI
PEPFAR
UNITAID
International Health
Partnership
UNICEF
FAO
UNAIDS
WFP
ILO
UN
100+ health partners
Role of WHO in public health
6 core functions
• Providing leadership, engaging in partnerships
• Shaping the research agenda
• Setting norms and standards
• Articulating ethical and evidence-based policies
• Providing technical support, catalysing change,
building sustainable institutions
• Monitoring health situation and trends
Critical aspects of emergency preparedness/response should
be linked to core public health functions
“Now is the historic political moment for world
leaders to give WHO new relevance and empower it
to lead in global health”
Stocking report, July 2015
“I am creating a single new programme for health
emergencies, uniting all our outbreak and emergency
resources across the three levels of the Organization…
designed for speed, flexibility, and rapid impact.”
Margaret Chan, WHA May 2015
Port Loko, Sierra Leone
early wet season