‘WHO Is Not Just Seeking To Be A Firefighter’ – Peter Salama On Reform And Emergency Response At The UN Health Agency 26/10/2016 by William New, Intellectual Property Watch Leave a Comment Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window)Under its new health emergencies program, the World Health Organization is setting up an improved structure for global health emergencies like the Ebola outbreak. But the UN agency is also opening itself up to a role as partnership broker to ensure the world has what it needs when the emergencies arise. And in doing so, WHO is trying to ensure that it remains the central player in global policy discussions and is not just an emergency response unit. “WHO is not just seeking to be a firefighter,” Peter Salama, executive director, Health Emergencies Program at WHO, told a recent conference. “We are seeking to really leverage partnerships around the response. WHO should play the leadership role.” Peter Salama Salama, who joined WHO over the summer after a long career at UNICEF, spoke at the 11 October Annual Health Care Summit held in Geneva, sponsored by Politico and Le Temps. He took over responsibilities of Bruce Aylward, but Salama has a different mandate and has been given more authority as a deputy director general where Aylward was an assistant director general. In building its new program, Salama said WHO is “on track” on workforce, mapping out its staff in the headquarters and completing the design, with approvals for new structures and “putting the foundation in place across all levels of the organisation. “This program is a first for WHO in that the workforce is the same workforce – headquarters, regional, and country level,” he said. But Salama cautioned not to set expectations unreasonably high given the number of health challenges worldwide. He gave a “quick snapshot” of the week’s issues: There were the ongoing Zika and yellow fever outbreaks, a new outbreak of another fever on border of Niger and Mali – one of most insecure parts of the world today, which is “causing havoc” in that region and WHO staff had to be evacuated, he said. Colleagues in Aleppo were working with the Syrian opposition and teams to medically evacuate staff as soon as there is a humanitarian pause in the fighting. They had to respond to an air strike in the capital of Yemen. And they were responding to Hurricane Matthew in Haiti. So even as they are putting the foundation of the new program in place, they are having to respond to any number of crises, he noted. ‘No One Organisation Can Do This Alone’ Meeting such demands effectively is going to require “tremendous support” from partners, not just donors, but also technical operation partners, said Salama. “No one organisation can do this alone,” he said, adding that WHO needs to be a partner because of its “convening power,” he said, but it also needs to be the centre of activity in order to be successful. One of the premises of the new program is that it is one program, bringing together WHO’s six regional offices, headquarters in Geneva, and around 147 country offices, he said. The structure making it all one program will ease communication and coordination. The design is inherently a common framework of results, indicators, systems and processes that every person working on the program needs to abide by, Salama said, noting, “We now have very clear time protocols in place.” So when a detection event such as a fever identified, they will have team on the ground in 72 hours to assess it. They must immediately gauge the severity of an event, which triggers a series of management consequences, including a new system of incident management, and dedicated staff in place. “So now whenever we have an emergency, that process is triggered,” he said. Equally important to WHO’s response to emergencies – “and this will be of interest to some of the partners in the room,” Salama said – will be what they uncover in terms of vulnerabilities of the global health system in each one of these emergency responses. For example, Ebola uncovered that there was a dearth of medical tools, whether diagnostics, therapeutics or vaccines. Similarly, when there was a major yellow fever outbreak in the Democratic Republic of the Congo this year, WHO realized they did not have enough yellow fever vaccine to go around, “there isn’t enough to meet the demand of the world,” he said. “So it triggers a whole set of partnerships and discussions,” said Salama. Each emergency is helping them to find a medium to longer term strategy to address these global problems. Thinking Strategically Equally, beyond the product vulnerability, they are “understanding very clearly” that it is no coincidence that they saw Ebola outbreaks in certain countries in West Africa, and no coincidence that the last holdouts of polio are in northern Nigeria, Afghanistan and Pakistan. “These are countries that by any measure of the imagination can be defined as fragile states, countries with fragile health systems,” he said. So WHO is working on that, helping countries build up their core capacity such as surveillance networks, their global health workforce, so they can start to think more strategically about why these countries have these problems and address them not just in emergencies but more systematically,” he said. Salama said to get national governments to change, WHO needs to “look at all the levers that we have.” For instance, WHO and the UN still have a “lot of authority and legitimacy,” and for WHO, the International Health Regulations are an “extremely important lever of change.” “These are treaties that all of the world’s governments have signed on to and they take very seriously,” he said. ‘We Cannot All Feel Safe Any Longer’ Salama discussed what WHO can do when governments don’t acknowledge the occurrence of a major outbreak. He said his discussions have showed him that most governments want to be “extremely honest and transparent,” in part because they want to be able to leverage the resources from around the world to be able to respond. But what stops them often, he said, is “the real concern that other member states are going to slap on trade and travel restrictions to their countries if they acknowledge that there’s an outbreak.” So WHO is trying to promote “global solidarity,” he said, with the idea that because of travel an outbreak in one remote part of Angola today becomes an outbreak in China tomorrow. “We cannot all feel safe any longer,” said Salama. “We are part of the global infectious disease and health system now whether we like to acknowledge it or not.” WHO is “at the core of partnership” that involves UN, civil society, member states, private sector, he concluded. “That will be the power of what we do.” Financing for Emergencies Asked about innovative financing for Ebola and other outbreaks with public-private financing, Salama said WHO now has new contingency financing for emergencies. That has been “tremendously important” in responses to an outbreak this year, to polio in Nigeria, displaced populations, and Ethiopia and Libya. But it is a small amount of money, he said. They have asked for US$100 million, and so far have over $30 million. “But it has allowed WHO to immediately, within 24-48 hours, to be operational on ground,” he said. While that fund is purely for WHO to be able to respond on the ground, the question was about a pandemic financing facility, which WHO is working on with the World Bank. This comes in after the initial response, if it looks like another “Ebola in the making.” When there is a critical time limit, just a few cases in a rural area like Ebola was a few years ago. It triggers a new response mechanism, will kick in to fund WHO and all partners to respond to types of viruses. He said the hope is that it will be operational by early next year, as it involves “a lot of conversations with insurance companies and pharmaceutical sector as well.” 200-300 Detections Per Year, Mostly Informal There are several elements to how to measure effectiveness of WHO’s response going forward, said Salama. There are about 200-300 events that WHO is detecting every year. There are formal channels, such as WHO staff reporting from country to regional level, but most detections are informal, from media, rumours, or communities. So, he said, the ability to detect quickly is extremely important, and we have very clear timeframes associated with that. And second, the ability to respond robustly, they have clear timeframes and indicators to respond. Much of WHO’s response is actually by activating partnerships, said Salama. An example is the Global Outbreak Response Network (GORN), which has 200 institutions associated with it, and WHO acts as the secretariat. This year more than 150 people from GORN have been deployed under the WHO umbrella. Another example is the Emergency Medical Team initiative, which the Europeans are very involved in. It uses national assets to respond to emergencies around world. They now have eight teams from Europe going through the verification and prequalification process to be part of what we anticipate will be more than 200 teams, he said. And an equally important measure for success, he said, is the issue of prevention and preparedness, addressing the underlying vulnerabilities. Now if they identify that they lack enough yellow fever vaccine as was identified in the outbreaks in Angola and the DRC this year, they are adding an evaluation framework, with measures around the world in the next one to two years. They are working with organisations such as GAVI, and with the manufacturing and pharmaceutical sectors, so they will be in different situation next time they have a major urban outbreak of yellow fever in terms of the ability to respond, “because we’ll have more vaccine and won’t have to make the difficult decision we had to make this year to stop [routing] yellow fever or suspend it for some time because we didn’t have enough to respond to an outbreak,” he said. “We shouldn’t have to make those sort of calls,” he said. “There should be enough of those critical medical [products] to be able to respond.” The final area Salama mentioned that WHO is working on is supporting country capacities including for surveillance under the International Health Regulations, and formulating clear measurement capacities for success. Image Credits: UNICEF Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Related William New may be reached at wnew@ip-watch.ch."‘WHO Is Not Just Seeking To Be A Firefighter’ – Peter Salama On Reform And Emergency Response At The UN Health Agency" by Intellectual Property Watch is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.