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October 13, 2015

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

Lessons Learned from the Ebola Crisis

Anna Tordjmann

The Ebola outbreak was one of the most serious epidemics of the 21st century. According to the Ebola Situation Report from the WHO dated 14 October 2015, the Ebola outbreak caused 11,297 deaths out of 28,454 identified cases in Guinea, Liberia and Sierra Leone. The international community harshly criticized the WHO for its handling of the Ebola crisis. The criticisms centered on four main problems: the failure of the WHO to respond quickly to the outbreak; the lack of coordination with local authorities; the confusion of interventions in the affected countries; and the fear generated by a lack of information disclosed to the populations. To those critics, Director-General Margaret Chan humbly admitted that the WHO did not effectively respond to the Ebola tragedy and acknowledged that the organization learned precise lessons from that episode.

First, Dr. Chan argued that the WHO failed to respond quickly to the Ebola outbreak in part because the detection of the first symptoms of Ebola took time to occur. Many individuals infected by Ebola neglected to go to the hospital because they thought they had a regular flu. Among those who were worried that the disease would be more than a regular flu, some decided not to go to the hospital because they did not have health coverage and others did not find adequate medical facilities. Then came the butterfly effect: one individual’s lack of disclosure of his symptoms caused a worldwide outbreak. As a consequence, several months passed, the virus spread, and no medical facility, no state administration, no international body was aware of the disease. To quote Dr. Chan: “no regime of global governance can manage the invisible. You cannot manage what you cannot measure. And you cannot manage what you cannot see.” From now on, Dr. Chan insists that WHO will provide a higher level of vigilance and surveillance. Data will be collected more effectively and detection of infectious diseases will occur quickly.

Second, Dr. Chan acknowledged that WHO did not coordinate effectively with local authorities. However, she explained that WHO could not compensate for the absence of strong, functional and resilient health systems. Local authorities also had their share of responsibility.

Third, Dr. Chan understood that there was confusion between interventions in affected countries. She recommended that international interventions, for instance action of Medecins Sans Frontières (MSF), be coordinated with local medical professionals.

Finally, Dr. Chan deplored the fear and suspicion from local communities that spread quickly during the Ebola outbreak. She said: “During a crisis, you have confusion. Trust is not there.” Local inhabitants were indeed very suspicious and many families tried to hide their sick relatives in their homes. They were reluctant to disclose the symptoms of Ebola and were not encouraged to go to hospitals, especially if the facilities were not adequate and if medical staff were overwhelmed.

Beyond the failures of global action, the Ebola outbreak was first and foremost a human tragedy. The virus affected some of the poorest countries in the world with very weak health systems and very few medical professionals. As we think about global governance and global health policies, Doctor Chan invited us to “remember the people."

In conclusion, we must view Ebola as a tragedy but also as a wake-up call. WHO was severely criticized but it certainly learned its lesson. We can only hope that the world will be more prepared for the next infectious disease so it can be quickly measured, detected and effectively handled. 

Anna Tordjmann (L'16) is a Global Health Law LL.M Candidate.

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