WHO’s politically appointed country heads in Africa dropped the Ebola ball

Dr Louis Sambo

Dr Louis Sambo, WHO Regional Director Africa

Why are the WHO’s Regional Directors (for Africa, Dr. Luis Sambo) not answerable to the head of the WHO in Geneva?

The first indications that the Ebola ourbreak was getting out of control were raised in April by Medecins Sans Frontieres (MSF).

BBC: Medical charity Medecins Sans Frontieres (MSF) warned in April that the outbreak was out of control – something disputed by the WHO at the time.

…… In the worst affected countries – Liberia, Guinea and Sierra Leone – the Ebola virus has now killed 4,546 people with cases of infection numbering 9,191, according to the latest WHO figures.

AP carries a damning story of the complacency of the African WHO representatives who seem to have been unwilling to even acknowledge that there was a problem on their turfs. That the country heads of the WHO are mainly political appointments is not perhaps so surprising, but even all the Regional Directors around the world are apparently not responsible or accountable to the WHO head in Geneva.  That does not seem to be an organisation very conducive to taking actions on medical reasons alone. Presumably the African Regional Director is himself a political appointee (from Angola in this case) and  was elected to his position in 2005. It would seem that the position of Regional Director primarily reflects some political balance rather than just competence for the job to be done.

The outbreak began at least in January and by April had already killed 69 just in Guinea (around 70% fatalities of those infected).

AP:

In a draft document, the World Health Organization has acknowledged that it botched attempts to stop the now-spiraling Ebola outbreak in West Africa, blaming factors including incompetent staff and a lack of information.

In the document obtained by The Associated Press, the agency wrote that experts should have realized that traditional infectious disease containment methods wouldn’t work in a region with porous borders and broken health systems.

“Nearly everyone involved in the outbreak response failed to see some fairly plain writing on the wall,” WHO said in the document. “A perfect storm was brewing, ready to burst open in full force.”

The U.N. health agency acknowledged that, at times, even its own bureaucracy was a problem. It noted that the heads of WHO country offices in Africa are “politically motivated appointments” made by the WHO regional director for Africa, Dr. Luis Sambo, who does not answer to the agency’s chief in Geneva, Dr. Margaret Chan.

 ….. The document — a timeline on the Ebola outbreak — was not issued publicly but the AP was told the health agency would be releasing it earlier this week. However, WHO officials said in an email Friday that the timeline would now probably not be released publicly. No official at the agency would comment Friday on the draft report.

Dr. Peter Piot, the co-discoverer of the Ebola virus, agreed in an interview Friday that WHO acted far too slowly, largely because of its Africa office.

“It’s the regional office in Africa that’s the front line,” he said at his office in London. “And they didn’t do anything. That office is really not competent.” 

WHO’s other regional directors — the Americas, Southeast Asia, Europe, Eastern Mediterranean and the Western Pacific — are also not accountable to Geneva and are all elected by their regions.

Piot, director of the London School of Hygiene and Tropical Medicine, also questioned why it took WHO five months and 1,000 deaths before the agency declared Ebola an international health emergency in August.

“I called for a state of emergency to be declared in July and for military operations to be deployed,” Piot said. But he said WHO might have been scarred by its experience during the 2009 swine flu pandemic, when it was slammed for hyping the situation.

In late April, during a teleconference on Ebola among infectious disease experts that included WHO officials, Doctors Without Borders and the U.S. Centers for Disease Control and Prevention, questions were raised about the performance of WHO experts, as not all of them bothered to send Ebola reports to WHO headquarters, according to the draft document.

In the timeline, WHO said it was “particularly alarming” that the head of its Guinea office refused to help get visas for an expert Ebola team to come in and that $500,000 in aid was being blocked by administrative hurdles. ….

In fact the outbreak dates back at least to the beginning of this year. In Guinea, 69 people had already died between January and April 21st of Ebola:

MedicalDaily: Apr 21, 2014

Sixty-nine people have died since January of Ebola in the West African country of Guinea with 109 cases now confirmed by the World Health Organization (WHO). … WHO’s Dr. Rene Zitsamele-Coddy said in a press release. “As soon as the outbreak was confirmed on March 21, we started to work with [Guinea officials] and other partners to implement necessary measures,” she said. ”It is the first time the country is facing an Ebola outbreak, so WHO expertise in the area is valuable.”

 

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