The following is a guest post by Terrence Mullan, assistant director for international institutions and global governance at the Council on Foreign Relations.
After nearly 1,700 recorded deaths in the Democratic Republic of Congo (DRC), and almost one year since the first Ebola diagnosis of the ongoing epidemic there, World Health Organization (WHO) Director-General Tedros Adnahom Ghebreyesus finally declared the second-deadliest Ebola outbreak in history a public health emergency of international concern (PHEIC).
Despite the deployment of over 160,000 highly-effective vaccines, as well as other measures from the WHO and its partners, Ebola continues to spread, even in areas where it was previously contained. Control of the outbreak is hampered by escalating ethnic violence—which hinders responders’ access to patients and monitoring of the diagnosed—and rampant distrust of local and national authorities—which hamstrings vaccination efforts.
The PHEIC declaration, only the fifth ever, should help drum up international support, including in the form of additional resources. The WHO received a mere $49 million from international donors between February and July—half of what it needed. Supplies to fight the outbreak, including protective gear for health workers and vaccines, are running short. Adding to the difficulties, almost 2,000 Congolese children have also died from measles this year, for many of the same reasons.
The WHO emergency committee, which recommended the director-general’s formal PHEIC declaration, expressed disappointment about delays in “funding which have constrained the response.” Global health expert Laurie Garrett has also highlighted the World Bank’s failure to mobilize funds specifically dedicated to pandemic responses, calling its inaction “appalling.”
The abysmal international response to the crisis is symptomatic of a broader apathy toward global health governance. For three straight years, leading think tank heads have relegated health promotion to the absolute bottom of the global agenda, ranking it as the lowest priority among ten issue areas of global concern in the Council of Councils (CoC) Report Card on International Cooperation.
Efforts in 2018
The CoC Report Card awarded a B– to international efforts to promote global health in 2018, the highest grade out of all ten global challenges the Report Card examined. It is important to note, however, that the Report Card survey was taken between mid-December 2018 and early January 2019, when respondents were mostly satisfied with the WHO’s early response to the DRC Ebola outbreak.
“The year 2018 was one of cautious optimism in global health governance, mainly shaped by the leadership style and communication skills of the new WHO leadership,” wrote Memduh Karakullukçu, vice chairman and president of the Global Relations Forum (Turkey). Yasushi Kudo, president of the Genron NPO (Japan) similarly gave a positive assessment to WHO Director-General Tedros Adhanom Ghebreyesus’s first full year in office, remarking that “his new policies can be praised for establishing” more cooperation among international agencies.
“Strong progress is being made in rolling out vaccines and primary health care,” observed Elizabeth Sidiropoulos, chief executive of the South African Institute of International Affairs. Sadly, 2018 also saw a growing opposition to immunizations, which is leading to increased rates of illness and death from preventable diseases.
In addition to the anti-vaccination sentiments plaguing efforts to promote global health, lack of funding remains a constant thorn for organizations such as the WHO. Despite efforts from the United Nations, which held its first high-level meetings on tuberculosis and third on noncommunicable diseases, new funding pledges failed to materialize. Likewise, the world made slight progress in reducing HIV incidence, but prevention efforts remained underfunded. “The disabling reliance of global institutions, mainly WHO, on soft money and the skepticism of donors about the competence of global institutions continue to shape a fragmented system and pose a structural challenge,” noted Karakullukçu.
Prospects in 2019 and Beyond
CoC think tank leaders ranked global health number one in terms of opportunity for breakthrough for the second straight year. However, their comments were oozing with anxiety over the future of global health, and they cited concerns about inadequate prevention efforts, rampant noncommunicable diseases (NCDs), and other challenges. Bukar Bukarambe, president of the Nigerian Institute of International Affairs, offered an explanation, reasoning that “Health issues tend to involve less politics than issues such as trade or climate change,” so there is more hope for progress. Karakullukçu added that global challenges like “Health and development are processes that require years of work and rely a lot on other factors that underpin peace and prosperity. Unless a pandemic or a famine occurs, it does not seem realistic to mobilize global actors.”
“International cooperation on pandemics remains insufficient,” lamented Kudo, adding that the “outbreaks of Ebola in the Democratic Republic of Congo and Cholera in Yemen highlighted the difficulty of handling containment in conflict zones.” “The world is no closer to having a global prevention and response system for an outbreak like Ebola in 2014 and 2015; there will always be a next time,” warned Rohinton Medhora, president of the Centre for International Governance Innovation (Canada).
Sunjoy Joshi and Samir Saran, respectively the chairman and president of the Observer Research Foundation (India), called on policymakers to make fighting NCDs a global priority. Medhora added that “the incidence of noncommunicable diseases (diseases associated with people becoming richer) continued to rise globally, driven by trends in developing countries. There might not be much scope for international cooperation in the latter, but the lack of progress in strengthening the World Health Organization–centered global health system is a failure of will to act multilaterally.” Kudo cautioned that the threat posed by NCDs goes beyond rich countries, noting that fragile health-care systems and income and geographic disparities will make progress on NCDs challenging.
Newer issues in global health are also salient. Xue Lei, assistant research fellow at the Shanghai Institutes for International Studies worried about progress on the opioid crisis in the United States and the health of aging populations in China and beyond. Michael Fullilove, executive director of the Lowy Institute (Australia) cautioned that “climate change will exacerbate existing health challenges,” making progress even more arduous.
While much needs to be done to improve international cooperation on global health challenges, CoC respondents offered broad and detailed recommendations.
“Strengthening the capacity of the World Health Organization” should be at the top of any policy options going forward, suggested Riccardo Alcaro, research coordinator at the Institute of International Affairs (Italy). Fullilove advised that the WHO should be provided “with more core funding to enable the organization to respond to crises more effectively and undertake preventative work.” Volker Perthes, executive chairman and director of the German Institute for International and Security Affairs, recommended reforming both the United Nations and WHO to align the Sustainable Development Goals and the Global Action Plan, which “could create major shifts in global health governance as well as mandate changes and denominations of international health organizations and funds.”
Creating more effective policies to combat NCDs was also a common recommendation. Richard Haass, president of the Council on Foreign Relations, called for the WHO and major health donors to “shift more of their attention and resources to combating the surging threat of NCDs (including lifestyle-related conditions such as heart disease, lung cancer, and obesity) in the developing world.”
Other CoC respondents emphasized the importance of battling antimicrobial resistance (AMR). AMR “is a fast-evolving, critical threat to global health. There should be sustained focus on and search for mechanisms to involve the private sector in the fight against it,” wrote Karakullukcu. Sidiropoulos suggested “integration of countries’ responses to antimicrobial resistance across relevant regulatory bodies and sectors, using the United Nations’ convening power.”
With the rise of nongovernmental organizations and the private sector in health promotion, respondents also recommended more public-private partnerships. Ong Keng Yong, executive deputy chairman of the S. Rajaratnam School of International Studies (Singapore) went as far as calling for pharmaceutical companies to contribute to the WHO’s regular budget.
For now, it appears that in a world awash in troubles, nothing less than catastrophe will spur policymakers to forceful action on global health. Unfortunately, with countless health crises already simmering, concerted action could come too late to prevent local crises from becoming global emergencies.
About the CoC Report Card
The Council of Councils (CoC) Report Card on International Cooperation evaluates multilateral efforts to address ten of the world’s most pressing global challenges, from countering transnational terrorism to advancing global health. No country can confront these issues better on its own; on the contrary, combating the threats, managing the risks, and exploiting the opportunities presented by globalization all require international cooperation. To help policymakers around the world prioritize among these challenges, the CoC Report Card on International Cooperation surveyed the Council of Councils, a network of twenty-eight foreign policy institutes around the world between December 2018 and January 2019.
View the full CoC Report Card on International Cooperation to see how global think tank leaders graded the world’s performance and prospects for 2019 on ten global challenges.
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