In a delay that some say may have cost lives, the World Health Organization resisted calling the Ebola outbreak in West Africa a public health emergency until last summer, two months after staff raised the possibility and long after a senior manager called for a drastic change in strategy, The Associated Press has learned. Among the reasons the United Nations agency cited in internal deliberations: worries that declaring such an emergency akin to an international SOS could anger the African countries involved, hurt their economies or interfere with the Muslim pilgrimage to Mecca. Those arguments struck critics, experts and several former WHO staff as wrong-headed. "That's like saying you don't want to call the fire department because you're afraid the fire trucks will create a disturbance in the neighborhood," said Michael Osterholm, a prominent infectious diseases expert at the University of Minnesota.
In public comments, WHO Director-General Dr. Margaret Chan has repeatedly said the epidemic caught the world by surprise. "The disease was unexpected and unfamiliar to everyone, from (doctors) and laboratory staff to governments and their citizens," she said in January. Last week, she told an audience in London that the first sign that West Africa's Ebola crisis might become a global emergency came in late July, when a consultant fatally ill with the disease flew from Liberia to a Nigerian airport.
But internal documents obtained by AP show that senior directors at the health agency's headquarters in Geneva were informed of how dire the situation was early on and held off on declaring a global emergency. Such an alert is meant to trigger a surge in outside help, or, as a WHO document put it, "ramps up political pressure in the countries affected" and "mobilizes foreign aid and action." When WHO experts discussed the possibility of an emergency declaration in early June, one director viewed it as a "last resort." The delay in declaring an emergency was one of many critical problems that hobbled the agency's ability to contain the epidemic. When aid agency Doctors Without Borders warned Ebola was spiraling out of control, WHO contradicted it, even as WHO's own scientists called for backup. When WHO did send staffers to Africa, they were of mixed caliber. Fellow responders said many lacked Ebola experience; one WHO consultant who got infected with Ebola broke his own agency's protocol, putting others at risk and getting WHO kicked out of a hotel, the AP found.
In an email Thursday, WHO said: "People often confuse the declaration of a Public Health Emergency of International Concern with our operational response. It is very different. WHO mounted a strong operational response a year ago when we were notified the outbreak was Ebola." WHO is the only agency with the authority to lead a global response to health crises, by providing medical, laboratory and other support when there are outbreaks of unusual or new diseases. Its handling of the Ebola epidemic has been roundly criticized and led to a new call for reforms. The vacuum of leadership at WHO was so damaging the U.N. created the Mission for Ebola Emergency Response to take over the overall fight against the disease. Dr. Sylvie Briand, head of the pandemic and epidemic diseases department at WHO, acknowledged that her agency made wrong decisions but said postponing the alert made sense at the time because it could have had catastrophic economic consequences.
As Ebola continued to spread in the summer, the situation on the ground grew increasingly desperate, with only a fraction of the needed treatment beds available in Liberia and Sierra Leone. Some regions didn't even have enough soap and water; patients were literally dying outside the gates of Ebola clinics as foreign mine workers evacuated and neighboring countries restricted travel. By the time WHO declared an international emergency, nearly 1,000 people were already dead. Overall, more than 10,000 are thought to have died in the year since the outbreak was announced.
Chan, the WHO leader, declined interview requests with AP for this story. But Dr. Bruce Aylward, WHO's top Ebola official, said labeling the Ebola outbreak a global emergency would have been no magic bullet. "What you would expect is the whole world wakes up and goes, ‘Oh my gosh, this is a terrible problem, we have to deploy additional people and send money,'" he said. "Instead what happened is people thought, ‘Oh my goodness, there's something really dangerous happening there and we need to restrict travel and the movement of people.'"