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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
GovernanceChallenges• 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
PreventionHealth systemVaccination
Some disease programmes
Preparedness, Alertness,Readiness
Responseacute
protractedRecovery
R Brennan WHO
FinanceChallenges• 5-fold increase in $$ for global health since 1990; WHO much less• WHO budget cuts in global financial crisis ─ key staff laid off• WHO $ 4.4 bn budget 2016-17, ¼ from assessed contributions
(subscription), ¾ voluntary • No core funds for emergency response• Discontinuous, patchy donor funding
Solutions• 8% budget increase – though not AC• Preparedness, outbreaks $580M -- but DG may spend more• US$100 million contingency fund for outbreaks • Other initiatives e.g. Pandemic Emergency Facility• Flexible donor funding - not earmarked, continuous, reliable
Health systemsfragile building blocks → poor health outcomes
Health systemsChallenges (in all 6 building blocks)• Delivery: slow diagnosis, little improvement in survival through better care• Delivery: collateral damage (Ebola) – vaccination, malaria, clinics etc• “Delivery”: weak community engagement (anthropology)• Funding: vertical programmes supported by external donors, little national
or international investment in health services, weak donor coordination• Workforce: few motivated, well-trained HCWs (e.g. those unpaid earn
money in unregulated private practices)• Leadership: Ebola exposed many weaknesses but some strengths
Solutions• Universal Health Coverage central to SDGs – strategic, long-term investment• Immediate priorities: early warning and response systems for all health
threats, logistics, field epidemiologists, mobile labs, clinical procedures, IPC training, focus on district-level services, and coordinated international technical assistance with partners.
R&DChallenges
• Inappropriate technology, slow development of new technology• Absent target product profiles (TPPs), R&D roadmaps, review mechanisms,
reference preparations for assays, approved standards of care • Limited data sharing - clinical trials and other research during outbreaks &
emergencies• Inadequate R&D funding models, few $$ 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
FAO
ILO
WHOMoH
WB
ADB
KHANA
ClintonHAI
SRCHNI
RHAC
RACHA
MSF
Global Fund to Fight ATM
GAVI
HMN
JICA
CDC
GTZ
AFD
BTC
KfW
DFID
EC
USAID
AusAid
UNDP
UNFPA
UNAIDS
UNICEF UNWFPCARE
URC
HU
AECI
KOICA
Gates
ICRC
International Health Partnership
Catalytic Initiative
UNITAID
PMNCH
RBM
Stop TB
PEPFAR PMI
PSI
SC
Oxfam 100+ health partners
1990-2015: new coordination role40 bilaterals, 26 UN agencies, 20 global funds, >100 global health initiatives…
NGOsOIE
GOARN
IFRC OCHA
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