I warned in my last article that if we didn’t do something to hold our leaders to account for the role they played in making the coronavirus pandemic more difficult to manage than it needed to be, something similar would surely occur again in the future. This was not melodrama on my part: this was an opinion informed by the fact that similar things have already happened in the recent past, for highly similar reasons, albeit on a much smaller scale. In this article, we’re going to learn a little bit about one of these events, with a strong focus on the eerie similarities that this particular disease outbreak shares with our current one.
The story begins in early December of 2013, when a young boy hailing from a small village in the West African nation of Guinea died of a mysterious illness. Multiple members of his immediate family soon fell ill with similar symptoms, later dying themselves, though not before infecting their fellow villagers. Owing to the location of these cases, the sickness was initially attributed to conditions much more common to the area. As a result, it took several months for local health authorities to recognize the disease for what it was: Ebola. By then, multiple residents of multiple villages in rural Guinea had been infected, with 49 suspected (6 confirmed) cases and 29 deaths registered by the time the World Health Organization recognized the existence of the outbreak on March 23, 2014 (Bell et al., 2016: p. 7).
Ebola is an extremely infectious and deadly disease; so much so that it has acquired something of a memetic quality in the Western consciousness as the go-to, “worst disease you can think of” when prompted to come up with a candidate. The reputation is certainly well-earned: both internal and external bleeding from every possible orifice is a hall-mark of the disease’s terminal stages, and even with the best of modern medical care, Ebola’s case-fatality rate (CFR) can still be as high as 25% — up to 90% with no care at all, as would likely be the case for most of these African villagers. By the time the West African epidemic had been officially declared as “over” by the WHO, in June of 2016, 11,323 of the (reported) 28,646 cases in the region had ended in death, giving it a CFR of 39.5%. 
While Ebola is severe enough in its own right, a number of explanations have been offered with regards to why this recent round had been so ruthless in comparison to those previous. This “perfect storm of factors”, cited by Wenham (2017) in an article regarding the widespread criticism of the WHO’s response to the outbreak, include:
[T]he unprecedented size of the outbreak, the lack of sufficiently trained personnel, limited resources, weak national health systems, the spread of the outbreak to urban settings, a time lag between the initial appearance of the pathogen and the reporting of it to the national and international communities, the highly porous international borders, mis-trust of government and health officials, the virus’ first appearance in West Africa, an exodus of international health providers and a structural failure of global health governance (p. 1).
Now, it is important to note that none of the above factors can be solely attributed to the WHO’s numerous shortcomings. Indeed, as will be discussed, plenty of blame can be shouldered by government officials in Guinea, where the outbreak began, as well as by their counterparts in neighbouring Sierra Leone and Liberia, to where the outbreak soon spread.
Unfortunately, aside from exactly one sentence referencing the “delicate political and economic situations in West Africa” (p. 2) at the time as a possible reason for their delayed declaration of the outbreak as a Public Health Emergency of International Concern (PHEIC), Wenham’s article is unconcerned with the extent to which WHO officials may have been complicit in allowing economic concerns to super-cede public health concerns related to the ongoing spread of Ebola.
In this case, the Guinean government had plenty of reasons to cover-up, or at least downplay, the true extent of the outbreak. The country holds the world’s largest reserves of bauxite, a rock rich in both aluminium and gallium (used in the manufacturing of electronics), and it has been alleged that Guinean officials were rather hesitant to let any blows come to their nation’s primary source of income (Cheng, 2015: para. 41).
With this being the case, the WHO appears to have been quite content to play along with Guinea’s economic imperatives at the expense of trans-national health and safety. Just two days after the WHO put the world on notice regarding the outbreak in Guinea, cases were already being reported in Sierra Leone and Liberia (Cheng, 2015: para. 21). But at the annual World Health Association conference in May, the Guinean Minister for Health seemed highly optimistic that the outbreak would soon be over, dismissing previous concerns that had been raised by NGOs such as Médecins Sans Frontières (MSF, aka Doctors Without Borders) that the outbreak was indeed much larger and much more serious than the Guinean government was willing to admit. While the claims of MSF would later be vindicated by June, the WHO, for its part, made no practical effort to counter the narrative being spun by the Guinean government (Kamradt-Scott, 2018: 202).
Is any of this beginning to sound familiar?
In July, catastrophe was narrowly averted when an infected traveler from the Liberian capital of Monrovia flew into Lagos, Nigeria, the most populous city in Africa with some 21 million inhabitants at the time. Thankfully, a rapid and aggressive response from local health authorities limited the number of Nigerian cases to just 19 (Bell et al., 2016: p. 9). Despite this and other close calls, the WHO did not declare the West African Ebola outbreak as a PHEIC until August of 2014. In this respect, the Associated Press (2015) article cited by Wenham gives us yet another gem from the increasingly-infamous WHO lackey Dr. Bruce Aylward, now world-renowned for responding to a Hong Kong-based journalist’s questions regarding the Taiwanese government’s exceptional response to the coronavirus pandemic by hanging up on her:
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’” (para. 16-17).
Well, yes, genius; we might expect some restricting of travel in affected areas to occur in the event of a known Ebola outbreak, because those people doing the travelling — and I’m just spit-balling, here — might be a tad concerned about, I don’t know, dying from Ebola, as an average of some 50% of patients are known to do. To borrow the analogy used in the AP article, “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” — or, to be specific to the alleged economic concerns, this is like the manager of a Wal-Mart refusing to pull the fire alarm while sparks are flying in the electronics department because customers might not be interested in buying anything as they rush out the doors to safety.
Now, I get the concern about shutting down the economy to mitigate disease outbreak –really, I do. I understand that there is a need to strike some sort of balance between making sure that people don’t get sick (or, at the very least, that not too many people get sick in too short of a time-frame), and making sure that people can still pay their bills. However, and particularly where a disease with a high CFR is concerned, such as Ebola, I am quite tempted to argue that dead people can’t buy anything at all, ever again, so perhaps it’d be a smarter idea just to shoulder the burden of whatever sales hit may come from sounding the alarm — but I’m not a doctor, so don’t quote me on that.
At any rate, Aylward’s comments would seem to suggest that the PHEIC declaration would have resulted in the rest of the world effectively cutting ties with the affected nations and simply leaving them to their fates. As the same article points out, this was certainly not the case:
After WHO declared the international emergency[,] U.S. President Barack Obama ordered up to 3,000 troops to West Africa and promised to build more than a dozen 100-bed field hospitals. Britain and France also pledged to build Ebola clinics; China sent a 59-person lab team and Cuba sent more than 400 health workers (para. 52).
Clearly, the international community did not abandon West Africa: they took the necessary measures to protect their own citizens from harm , then they sent equipment and staff to the region to assist on the ground. This assistance surely saved lives – how many more could have been saved had the PHEIC declaration been made sooner? One has to wonder if the short-term sustenance of the Guinean economy really was worth the permanent loss of those human lives driving that same economy.
The buck doesn’t stop with the Guinean government, of course. By the end of April 2014, the Liberian government had reported just one suspected case of Ebola in Monsterrado County, the nation’s most populous. In defiance of the near-certainty that this was unlikely to be the only case, detected or otherwise, within Liberian territory, the WHO once again failed to challenge the government’s figures, appearing content to take them at face-value, a decision which Kamradt-Scott (2018) aptly describes as “perplexing to say the least” and that “can only be considered a serious error in judgement” (pp. 202-203).
In response to the scathing criticism levied at the WHO over its handling of the situation, it had pledged to establish a Health Emergencies Programme, “explicitly including an operational role for the organization when a state is unable to show the necessary operational leadership and management on their own” (Wenham, 2017: p. 3). But as Kamradt-Scott observes, like similar initiatives that have preceded it, “the [Health Emergencies Programme] is also struggling to gain the necessary financial backing to see the programme fully operationalised” (p. 209).
Of course, Wenham is careful to note that “The success of this initiative will only become apparent when the next global disease concern emerges” (p. 3).
Yeah… about that.
From our present perspective, finding ourselves in the midst of exactly that “global disease concern” that many of the above-cited authors had warned us about just four years ago, it is both disconcerting and, frankly, aggravating to be forced to conclude that neither the WHO nor its member states seem to have learned much of anything at all from their experience with the world’s largest Ebola outbreak on record. On the one hand, these institutions and their leadership push for ever greater inter-dependency and connectivity between nations, economies, and peoples – on the other, precisely when one might reasonably expect the oft-lauded notion of ‘global solidarity’ to be needed the most, time and time again these same institutions have demonstrated that are simply not fit for the roles they have set out to fill.
Anyone familiar with my views on the subject will know that I am by no means in favour of increased, let alone continued globalization of any sort. But for the sake of argument, let’s assume for a moment that globalization is indeed inevitable, and that there really is no means of backing down from it now:
Is this the kind of leadership that we want at the helm? The kind that will gladly pander to selective national interests, even when those interests pose an international risk? If we’re really meant to be “all in this together”, as they like to say, why did the governments of three small countries in West Africa get to call the shots on whether or not several other countries around the globe were exposed to a deadly virus?
Why was the WHO allowed to get away with this? If 11,000 deaths (that we know of) from Ebola was not enough to convince them, let alone their clientele, that something had to change about the way they deal with such things, how sure can we be that 170,000 deaths (at the time of writing) from COVID-19 will be any more convincing?
And as for our leaders — why, oh why do they continue to blindly trust the WHO? This is an especially important question for countries such as Canada, where public health officials are seemingly content to take little other initiative aside from relaying the latest memo received from WHO headquarters to the masses. I must stress that the WHO does not exist because it was somehow determined to be “the best” organization for the task; it exists simply because there was no other organization performing these tasks prior to its creation . Having no natural competition to speak of – like most, if not all other UN agencies – there is no reason for it to undergo sufficient and enduring reform if it is not effectively forced to do so.
Wenham, sadly, like many others, argues that the WHO cannot adequately accomplish its own mandates because it does not have the money or resources to do so. Curious how, despite such failures, the proposed solution to lasting inefficiency seems almost always to be that we should give them even more money than the billions that they already receive. I would argue quite the opposite: if they cannot manage their present operations with the resources on hand, they should scale down those operations to a much more manageable level. And believe me: anyone even vaguely familiar with the organization’s non-pandemic-related controversies, including (but not limited to) spending close to $192 million dollars on travel expenses in just one year, understands that there is a fair bit of fat to be trimmed.
Similar conclusions have been reached by the Harvard-London School Independent Panel on the Global Response to Ebola, stating, among other things, that “all countries need a minimum level of core capacity to detect, report, and respond rapidly to outbreaks” — rather than relying solely on the WHO to shoulder the burden for them. Additionally, the panel observes that “when preventive measures do not succeed, outbreaks can cross borders and surpass national capacities. Ebola exposed WHO as unable to meet its responsibility for responding to such situations and alerting the global community” (Moon et al., 2015: 2204). They, too, recommend the creation of a “dedicated centre for outbreak response with strong technical capacity” (Ibid.), further noting that “decisive, timebound governance reforms will be needed to rebuild trust in WHO in view of its failings during the Ebola epidemic” (Ibid., p. 2205).
Lastly, the panel would appear to agree with my own observation that the WHO clearly has far too much on its plate as is, and, as I have written many, many times in the past, that throwing more money at a problem need not always be the solution:
With respect to outbreak response, WHO should focus on four core functions: supporting national capacity building through technical advice; rapid early response and assessment of outbreaks (including potential emergency declarations); establishing technical norms, standards, and guidance; and convening the global community to set goals, mobilise resources, and negotiate rules. Beyond outbreaks, WHO should maintain its broad definition of health but substantially scale back its expansive range of activities to focus on core functions (Ibid.). [emphasis mine]
The Harvard-London panel was just one of four that Kamradt-Scott describes as being “of particular note.” “Disturbingly,” however, he elaborates that “very many of the recommendations produced by these commissions echoed the practical steps for enhancing global health security advanced by the various H1N1 [“swine flu”] review panels four years earlier” (p. 206).
When all of this coronavirus business is said and done, can we expect further review panels to make recommendations for reform that will, ultimately, be left almost entirely by the wayside? Call me crazy, but I’m personally unwilling to wait for the next pandemic to see whether or not this current crisis has inspired any feelings of change at the WHO. Even though the Canadian government is now talking about the “critical need” for a review of the WHO’s response to the coronavirus outbreak, I believe that I have made the point well enough that a mere review is simply not enough.
Enough with the reviews, and enough with the panels, unless those reviews and panels will be centred near-exclusively on how much funding we are prepared to withdraw from the WHO until the day comes where they finally get their act together – if such a thing is possible. And if it isn’t, it may just be the right time to bid abolish the organization once and for all.
As for whether or not the WHO could be, or indeed should be replaced by some form of successor, well… I’ll leave that one up to the ‘experts’ to decide.
 The ‘true’ CFR for the 2013-2016 outbreak is difficult to determine and may indeed be much higher, as an unknown number of cases (perhaps as high as 70%) were not reported to local health authorities. In addition, the survival outcomes for some 44% of “confirmed, probable, and suspected cases” in the WHO Ebola Response Team’s dataset have not been reported. See: Fourna, A., Nouvellet, P., Dorigatti, I., Donnelly, C. A. (2019). Case Fatality Ratio Estimates for the 2013–2016 West African Ebola Epidemic: Application of Boosted Regression Trees for Imputation. Clinical Infectious Diseases, ciz678. https://doi.org/10.1093/cid/ciz678
 For instance, following a confirmed, fatal case of Ebola in a man whom had flown from Liberia to Texas in September 2014, the American Center for Disease Control (CDC) quickly set about developing and deploying Ebola Response Teams and evaluating local healthcare facilities for preparedness, in addition to implementing stringent screening and monitoring protocols for travelers arriving from affected countries. See: Bell et al., 2016: p. 10
 If we’re being pedantic, the WHO was technically preceded by the International Sanitary Conferences (1851-1938; intended to standardize quarantine regulations against the spread of cholera, plague, and yellow fever) and the Health Organization of the League of Nations. However, both bodies were absorbed by the WHO on it’s creation after World War II, and neither of them dealt with public health issues at the same breadth and scale as the WHO does currently.
Bell, B. P., Damon, I. K., Jernigan, D. B., Kenyon, T. A., Nichol, S. T., O’Connor, J. P., & Tappero, J. W. (2016). Overview, Control Strategies, and Lessons Learned in the CDC Response to the 2014–2016 Ebola Epidemic. Morbidity and Mortality Weekly Report, 65(3): 4-11.
Cheng, M. (2015, March). Emails: UN health agency resisted declaring Ebola emergency. Associated Press. http://archive.vn/veQNb
Kamradt-Scott, A. (2018). What Went Wrong? The World Health Organization from Swine Flu to Ebola. In Kruck, A., Oppermann, K., & Spencer, A. (Eds.), Political Mistakes and Policy Failures in International Relations (pp. 193-215). Palgrave Macmillan. https://doi.org/10.1007/978-3-319-68173-3_9
Moon, S., Sridhar, D., Pate, M. A., Jha, A. K., Clinton, C., Delaunay, S., Edwin, V., Fallah, M., Fidler, D. P., Garrett, L., Goosby, E., Gostin, L. O., Heymann, D. L., Lee, K., Leung, G. M., Morrison, S. J., Saavedra, J., Tanner, M., Leigh, J. A., . . . Piot, P. (2015). Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola. The Lancet, 386: 2204-2221. http://dx.doi.org/10.1016/S0140-6736(15)00946-0
Wenham, C. (2017). What we have learnt about the World Health Organization from the Ebola outbreak. Philosophical Transactions B., Royal Society, 372(1721): 1-5. http://dx.doi.org/10.1098/rstb.2016.0307