An underfunded WHO can't fight Ebola

Volunteers in protective suits burying the body of a person who died from Ebola in Waterloo, Freetown.
Volunteers in protective suits burying the body of a person who died from Ebola in Waterloo, Freetown. PHOTO: AFP

Now that Ebola has reached the United States and Spain, it is time to reveal the dirty little secret that helps explain how things got this bad.

The World Health Organisation (WHO), the only agency with the legitimacy and mandate to curb global pandemics, has consistently and over several decades been weakened and undermined by policy failures and budget cuts.

The proof for this claim?

In 1970-71, the WHO received 62 per cent of its budget from regular budget funds (RBFs) and 18 per cent from extra budgetary funds (EBFs).

RBFs are compulsory contributions from WHO member states, while EBFs are additional voluntary contributions by donor governments and non-governmental organisations.

RBFs are vital, because they fund long-term programmes that develop the organisation's capacity to fight pandemics like Ebola.

By 2012-13, RBFs had fallen to less than a quarter of the overall budget, with EBFs - which are often used for donors' pet projects - making up three-quarters.

World Bank president Jim Yong Kim should have pointed this out when he criticised the international community for its failure in responding to the Ebola virus. He was right to say: "We should have done so many things. Health-care systems should have been built. There should have been monitoring when the first cases were reported. There should have been an organised response."

But he should have noted that the lack of response was the result of a long-term, Western-led policy of underfunding the WHO that has weakened it substantially, a point that has been well-documented.

As Dr Kelley Lee pointed out in her book profiling the organisation, "for the WHO, it has meant a substantial bypassing of its role as the lead UN health agency".

In 2011, the agency cut 300 jobs in response to what director-general Margaret Chan described as "a new and enduring era of economic austerity".

The impact of a prolonged period of WHO budget cuts has been disastrous, leading to many deaths.

One of the first respondents to reach the remote forests of Guinea where Ebola was initially detected in March was Mr Mariano Lugli, an Italian nurse from the medical charity Medecins Sans Frontieres.

He noted: "In all the meetings I attended, even in Conakry, I never saw a representative of the WHO. The coordination role that the WHO should be playing, we just didn't see it. I didn't see it the first three weeks and we didn't see it afterwards."

The WHO was not in Guinea because its capacity to deploy medical professionals has been steadily undermined over the decades.

Global health law professor Lawrence Gostin of Georgetown University told Reuters: "The WHO's budget and capacity to respond are in tatters, and it has become mostly a technical organisation."

Fortunately in all this bad news, there is built-in good news.

Once we have diagnosed the problem facing the WHO, we can also prescribe a clear solution: instead of starving the patient, the time has come to feed it.

The policy of scrimping on the WHO's budget must be abandoned and Western countries must ramp up their contributions to RBFs. The rest of the world will be happy to work with the West if it decides to reverse course on the international health organisation.

Let me stress that there is a paltry amount of money involved. The WHO's annual budget is about US$4 billion (S$5 billion). A decision to increase the organisation's RBFs from 25 per cent to 75 per cent would mean an increase of only US$2 billion from the global community.

The funding might not even need to increase this much; as well as money from individuals and private foundations like the Bill & Melinda Gates Foundation, much of the "voluntary funding" is from individual countries.

This government money could be converted into compulsory funding.

But the solution does not end here. The West must engage in deeper reflection to ascertain whether the starving and weakening of several critical multilateral organisations - such as the WHO and the International Atomic Energy Agency - is wise.

In my book, The Great Convergence, I explain how this tragic policy emerged and why it is unwise to continue weakening multilateral institutions.

Ebola's quick spread has confirmed a new reality: we live in an ever-shrinking global village. All villagers know instinctively that the medical conditions of their fellow inhabitants will affect them directly. Hence, they strive to achieve a well-run village with better conditions for all.

We should apply this well-known village wisdom to the world we have created.

Instead of weakening "global village councils" like the United Nations family of institutions, we should work towards strengthening them.

If Ebola succeeds in convincing humanity to adopt this long-term policy, it will have had at least one positive implication, and demonstrate the wisdom in the Chinese character for crisis: a combination of "danger" and "opportunity".

Let us seize this opportunity to learn this important lesson: we live in one, small, interdependent, global village.

Let us strengthen our councils.

The writer is dean of the Lee Kuan Yew School of Public Policy at the National University of Singapore. His latest book is

The Great Convergence: Asia, The West And The Logic Of One World. This article first appeared in the A-List blog of the Financial Times.