Cómo mejorar la gobernanza ante las emergencias de salud global

Improving the Governance of Global Health Emergencies

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That diseases spread without respect for borders is something we have always known since the dawn of humanity; and, incidentally, bacteria, viruses and parasites have all played decisive roles in the development of our species. What is new is the speed with which diseases can spread today and their increased impact on the population due to unstoppable demographic growth and the ever greater concentration of the world’s population in large urban centres. The situation is further exacerbated by the fact that news now travels even faster than disease, heightening the sensation of proximity in space and time and our individual and collective perception of uncertainty and risk.

The Ebola epidemic is an opportunity to encourage countries and the leading international actors to agree to relinquish a small part of their sovereignty to allow them fit in with the demands of the combined effort, promoting international cooperationWe need effective global health governance mechanisms to deal with this situation—mechanisms capable of coordinating the actions of multiple public and private actors in their response to the diseases and health risks that require efficient cross-border action. In this category we find the many diseases which, because of their distribution, day after day have a powerful but silent impact on social and geographical inequalities in health; they include malaria, AIDs and tuberculosis, as well as neglected tropical diseases, such as Chagas disease, dengue and leishmaniasis. But global health governance is also put to the test in other circumstances, such as pandemics, epidemics, and outbreaks of diseases that require a rapid response—the “wildfires” of global health. Moreover, these outbreaks often affect areas characterised by fragile social structures and health systems, limited resources and high levels of uncertainty, as is the case of the current Ebola epidemic in West Africa.

The delays in the organisation of an effective response to the Ebola crisis and the lack of coordination between most of the international stakeholders, such as the World Health Organisation (WHO), national governments, the World Bank, and private organisations (with the exception of a few NGOs), has shown that we have to rethink how to mount an adequate and timely response to such emergencies, a response that articulates leadership, interdiscipinary knowledge, and intervention on multiple levels. A number of interesting proposals have been made, including the following:

  • 1. To recognise the leadership role—and not just technical, but also political—of the WHO in global health emergency situations, a role only partially contemplated in the current Emergency Response Framework
  • 2. To organise and train a permanent international “white coat” corps composed of civilian health professionals and technical support staff. This proposal was put forward two months ago by the UN Secretary General and appears to have generated very little response. Such a corps would count on the effective support of the governments of all countries and would work together with the existing organisations working in the field.
  • 3. To establish a permanent fund to finance the world’s response to global health emergencies, not only focused on the short-term response but also encompassing the reconstruction and strengthening of the affected country’s health systems after the acute phase of the emergency is over, as suggested in a statement made by the president of the World Bank a month ago.
  • 4. To promote the commitment of the major public and private institutions and agencies funding research and innovation—in basic and clinical science as well as public health—to include preparedness for global health emergencies among their top priorities.

Although strengthening our global capacity to “put out fires” should not detract from the priority need to build effective, sustainable and equitable health systems, the Ebola epidemic is an opportunity to encourage countries and the leading international actors to agree to relinquish a small part of their sovereignty to allow them fit in with the demands of the combined effort, promoting international cooperation instead of the more short-sighted action driven by internal politics. The WHO itself also needs to improve the agility and capacity of its response and reduce unnecessary and counterproductive bureaucracy. Finally, it is the responsibility of civil society, and particularly those of us who live in the world’s wealthier countries, to mobilise and push for the changes needed in global health governance, working together to improve the equity, development and safety of our world.