Monday, 22 September 2014


When Margaret Chan was elected to lead the World Health Organization, she said the agency’s priority was to improve the health of people in Africa.
A Muslim faithful on pilgrimage to Mecca undergoes health
checks for the ebola virus at the Hajj Camp, Murtala
Mohammed International Airport in Lagos
Eight years later, the 67-year-old Chan is under attack for letting an Ebola outbreak there spiral beyond control, and this week her group found itself eclipsed as the leader of humanitarian efforts to control the epidemic.
The United Nations said it would create a separate Health Mission to coordinate care in West Africa, and the U.S. announced it would send 3,000 troops to build hospitals there. Those plans come after Chan delayed designating the outbreak as a global emergency until thousands were infected in three countries, and in the wake of complaints her agency had done too little to manage the response. Now, the WHO is in the awkward spot of being little more than a voice in the crowd, critics suggest, and Chan is seen by some as being partly to blame.
It is “so sad to see the WHO so much on the sidelines of a global heath crisis,” said Lawrence Gostin, a professor of health law at Georgetown University in Washington.
The delayed decision to recognize the outbreak as an international emergency, a declaration designed to signal to the world at large that immediate action is needed, was the WHO’s “Katrina moment,” said J. Stephen Morrison, at the Center for Strategic and International Studies in Washington. The reference is to the U.S. government’s slow response to the hurricane that flooded much of New Orleans nine years ago.

Right Timing

Chan sees it differently.
 “You pull out the tool when it’s the right time to do so,” she said of the declaration during a telephone interview. “You can’t abuse it or under use it. Over or under use would compromise the credibility of the organization.”
On May 1, she met with the leader of Guinea, where the outbreak originated, and warned the government needed to take strong action, according to Chan.
“I insisted he not drop the ball,” she said.
When the disease moved into neighboring countries at the end of June, she met with those leaders as well, she said, after mobilizing WHO experts and setting up a sub-regional hub in Conakry to coordinate the response. She turned to the global emergency declaration only after these early efforts failed.

Judgment Issue

“The judgment issue is important,” Chan said. “It’s easy for people who have the benefit of hindsight to say whatever they’re saying. When you’re in the position of being the director-general of the WHO, you need to look at the evolution of the outbreak. We have taken country-level action, we have taken regional level-action and then I said to my colleagues, if these actions are still not sufficient to bring the outbreak under control, I’m going to sound an alert.”
South African health minister Aaron Motsoaledi, who has worked with her closely, said it’s unfair to criticize Chan’s response to the outbreak. The first cases appeared in December and Chan wasn’t fully informed of the extent of the disease until March, he said.
 “She responded in a way that a normal person would,” Motsoaledi said in an interview at Bloomberg News in New York. “It would be wrong to judge her on Ebola.”
Still, in an earlier interview, Chan admitted the agency “underestimated the magnitude, the complexity and the challenges. Can all of us do better? The answer is yes,” she said during an interview in Washington a week ago. “But this is too big for any organization.”

Rising Cases

Since the start of the outbreak, the virus has infected 5,357 people, killing 2,630, according to a Sept. 18 WHO report. Now, the U.S. Centers for Disease Control and Prevention is estimating the virus could spread to hundreds of thousands more by the end of January, with a worst-case scenario of 550,000 or more infections.
The CDC report, scheduled to be released next week, isn’t yet complete and the figures may change. It assumes no additional aid or intervention by governments and relief agencies, which are now mobilizing to contain the Ebola outbreak before it spins further out of control.
Chan, meanwhile, has said she will continue to push governments to contribute to the effort.
A petite woman whose mother tongue is Cantonese, Chan is a consensus builder who tends to take her lead from the WHO’s member states rather than impose her own agenda on the agency, according to Georgetown’s Gostin. In contrast, Gro Harlem Brundtland, an earlier director who led the 7,000-person UN agency through the lethal SARS outbreak, had a more direct style that was suited to getting things done in times of crisis, he said. 

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