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October 15, 2015

Responding To: WHO Director-General Continues Georgetown's Conversation on Global Governance

Global Health Governance: The Indispensable Role of National Health Systems

Margaret Chan

Excerpted from a lecture by Dr. Margaret Chan at Georgetown University on September 30, 2015.

The Ebola outbreak is not yet over, but we are very close. We are in a phase where we can track each and every chain of transmission and break them. To get to that phase, WHO deployed more than one thousand staff to 68 field sites in the three countries, ten times our normal capacity.

The world is on the verge of having a safe and effective Ebola vaccine. The ongoing WHO clinical trial in Guinea was recently extended to Sierra Leone at the request of the government. Being able to vaccinate close contacts of confirmed cases gives us another ring of protection. WHO, working with partners and in the industry, has pre-qualified for rapid point of care diagnostic tests. These tests are important, especially when health systems begin to recover. Being able to rapidly screen new admissions and test whether they are infected with Ebola virus, especially in high-risk settings, like the maternity and the surgical wards, builds confidence and trust in the health system for patients and for the staff alike. 

As a contribution to preparedness, we are developing a blueprint for generic clinical trial protocols and arrangements for fast track regulatory approval to expedite the development of new medical products during the next emergency. This was not done in the past, yet all this preparedness has to be done in advance of a crisis. This is a big lesson for all of us. During a crisis, you have confusion. Systems don’t work. Coordination is difficult. Trust is not there. So, the lesson we learnt is advanced preparation, we call it preparedness, to respond to working with partners, working with governments, bringing together the search capacity that the world could bring to bear on the next threat is extremely important.

Do you think the international community can compensate for the absence of strong health systems, with surveillance and laboratory capacity in any given country? Can an international agency like WHO do this? Not entirely. Managing the global regime for coordinating the international spread of disease is the central and historical responsibility of WHO. But no regime of global governance can manage the invisible. You cannot manage what you cannot measure. And you cannot manage what you cannot see. This opinion is shared by other friends and colleagues in global health.

In the most dramatic and tragic way possible, the Ebola outbreak focused international attention on the need for building strong, functional, and resilient health systems, especially in fragile states. In fact, some analysts argue that universal health coverage is the best defense against the infectious disease threat, nationally and internationally. Having good data on normal disease patterns is important, especially at the community level. That helps you to distinguish and recognize an unusual disease event, like Ebola. The attention that the world has given to the importance of health systems is most welcome. That message was very strong a few days ago in New York as heads of governments and heads of states endorsed the sustainable development goals for the next 15 years.

The global health initiatives, like Global Fund and GAVI, brought such spectacular results in the last fifteen years by delivering commodities, bed nets, vaccines, and cocktails of medicine. Confronted with weak health systems, these global health initiatives often built their own parallel systems for procurement, for delivery, as well as financial management and reporting. This is not needed. This caused duplication, fragmentation, and we don't have enough resources to continue in that manner. Fortunately, as I said, from the debate and the discussion in New York, many development partners now recognize that virtually all health goals under goal number three need a strong functioning health system. And not just the health goal alone, health is related to nutrition. Health is linked to environment. Health is also linked to water and sanitation. So, we need to think of a comprehensive, integrated approach to address the complex, multiple challenges the world is giving us.

Ladies and gentlemen, the world is dangerously ill prepared to cope with a severe new disease, and we haven't seen the worst case scenario yet. The worst case scenario would be a disease spread by the airborne route by a very contagious and severe pathogen that is difficult to recognize the signs of illness during the incubation period. We have not seen that yet. Thank goodness. And we don't want to see it. But it is in our collective interest that we get the world better prepared, and learn all the lessons from Ebola, so that the people of this world can be better protected.

As the Pope says, "Remember the people." This is what we are here for.

Dr. Margaret Chan is director-general of the World Health Organization.

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