A GLOBAL HEALTH RISK FRAMEWORK FOR THE FUTURE

The role of the

Christopher Dye

The World Health Organization’s role

• Infectious disease challenges for– governance – finance– health systems– R&D– information– coordination

• Learning from Ebola &c• Global health landscape

– 25-year increase in funding in MDG era, many players– post 2015 development agenda

Ebola update: 7 cases in week 30 (20-26 July)lowest weekly total in >1yr but it’s not over yet

GovernanceChallenges• Capacity: more people than ever need emergency assistance• Mixed cultures: outbreaks, humanitarian emergencies, health security• WHO normative: consensus-building technical work, limited logistics

and little internal surge capacity, ill-equipped for rapid decisions• WHO compartments and levels ─ HQ, regional and country offices

Solutions• WHO in general – reform decision-making, priorities, accountability• WHO in outbreaks and emergencies – all-hazard rapid response,

logistics and operational platform, rapid access to emergency workforce and global technical experts (standby capacity, UN, GOARN, FMT, NGOs)

• Reinforced International Health Regulations• WHO coordination -- Ebola transition from UNMEER (Aug 1)

Scope of a new WHO emergency programme

(under discussion)

All Hazards

PreventionHealth systemVaccination

Some disease programmes

Preparedness, Alertness,Readiness

Responseacute

protractedRecovery

R Brennan WHO

FinanceChallenges• 5-fold increase in $$ for global health since 1990; WHO much less• WHO budget cuts in global financial crisis ─ key staff laid off• WHO $ 4.4 bn budget 2016-17, ¼ from assessed contributions

(subscription), ¾ voluntary • No core funds for emergency response• Discontinuous, patchy donor funding

Solutions• 8% budget increase – though not AC• Preparedness, outbreaks $580M -- but DG may spend more• US$100 million contingency fund for outbreaks • Other initiatives e.g. Pandemic Emergency Facility• Flexible donor funding - not earmarked, continuous, reliable

Health systemsfragile building blocks → poor health outcomes

Health systemsChallenges (in all 6 building blocks)• Delivery: slow diagnosis, little improvement in survival through better care• Delivery: collateral damage (Ebola) – vaccination, malaria, clinics etc• “Delivery”: weak community engagement (anthropology)• Funding: vertical programmes supported by external donors, little national

or international investment in health services, weak donor coordination• Workforce: few motivated, well-trained HCWs (e.g. those unpaid earn

money in unregulated private practices)• Leadership: Ebola exposed many weaknesses but some strengths

Solutions• Universal Health Coverage central to SDGs – strategic, long-term investment• Immediate priorities: early warning and response systems for all health

threats, logistics, field epidemiologists, mobile labs, clinical procedures, IPC training, focus on district-level services, and coordinated international technical assistance with partners.

R&DChallenges

• Inappropriate technology, slow development of new technology• Absent target product profiles (TPPs), R&D roadmaps, review mechanisms,

reference preparations for assays, approved standards of care • Limited data sharing - clinical trials and other research during outbreaks &

emergencies• Inadequate R&D funding models, few $$ to quick-start R&D • Limited stockpiles of effective treatments • Low national participation in R&D efforts to build research capacity• Narrow view of R&D – mostly vaccines, drugs, diagnostics – not operations

Solutions• Ebola diagnostic, drug, vaccine development, trials, licensing compressed to

months• Expand existing collaborations e.g. African Vaccine Regulatory Forum (AVAREF)• Blueprint for Research and Development Procedures in the Context of Global

Public Health Threats (WHA 2016)

Information

sit reps – rapid guidance - data sharing – triggers for outbreak response

WHO Ebola Response

WHO Ebola Response

FAO

ILO

WHOMoH

WB

ADB

KHANA

ClintonHAI

SRCHNI

RHAC

RACHA

MSF

Global Fund to Fight ATM

GAVI

HMN

JICA

CDC

GTZ

AFD

BTC

KfW

DFID

EC

USAID

AusAid

UNDP

UNFPA

UNAIDS

UNICEF UNWFPCARE

URC

HU

AECI

KOICA

Gates

ICRC

International Health Partnership

Catalytic Initiative

UNITAID

PMNCH

RBM

Stop TB

PEPFAR PMI

PSI

SC

Oxfam 100+ health partners

1990-2015: new coordination role40 bilaterals, 26 UN agencies, 20 global funds, >100 global health initiatives…

NGOsOIE

GOARN

IFRC OCHA

Role of WHO in public health 6 core functions

• Providing leadership, engaging in partnerships • Shaping the research agenda• Setting norms and standards• Articulating ethical and evidence-based policies• Providing technical support, catalysing change, building sustainable institutions• Monitoring health situation and trends

Critical aspects of emergency preparedness/response should be linked to core public health functions

“Now is the historic political moment for world leaders to give WHO new relevance and empower it to lead in global health”

Stocking report, July 2015

“I am creating a single new programme for health emergencies, uniting all our outbreak and emergency resources across the three levels of the Organization… designed for speed, flexibility, and rapid impact.”

Margaret Chan, WHA May 2015

Port Loko, Sierra Leone early wet season