The Washington PostDemocracy Dies in Darkness

Why the WHO could not stop the Ebola outbreak

A health worker, right, disinfects the corpse of a man suspected of dying due to the Ebola virus as people, rear, look on in Monrovia, Liberia, on Sept. 4, 2014.  (AP Photo/Abbas Dulleh)

It was last Tuesday when Olivet Buck got the news every doctor dreads. After months treating scores of Ebola-infected patients, the Sierra Leone physician had contracted it too. She had days to live. Local authorities found a hospital in Hamburg, Germany, that would care for Buck — perhaps even save her. But they needed money. So a desperate plea went out to the World Health Organization.

Even Sierra Leone President Ernest Bai Koroma begged in a letter, according to the Associated Press. The German hospital, he said, was in “readiness to receive her.”

But the WHO declined. And on Sunday, Buck died, the fourth Sierra Leone doctor to die of the disease. “I think it showed a callous lack of compassion for a devoted frontline clinician,” her brother told the Guardian. “Especially since there is now awareness of equipped units elsewhere to which other patients have been evacuated and successfully treated.”

It also showed something else. The WHO, which calls itself the “coordinating authority on international health work,” is underfunded and, critics say, ill-equipped to handle an unprecedented Ebola outbreak that has killed more than 2,400 and infected 4,784. The organization’s budget, snipped at by the global economic collapse and austerity measures, has shrunk by 12 percent in the past two years — and in all the wrong places to combat an Ebola outbreak.

One expert described WHO to The Washington Post as a “a shadow of its former self, racing to regain its own credibility in this crisis.” It today has a budget of nearly $4 billion — substantially less than the Centers for Disease Control, which has a $6 billion budget.

Some help is finally on the way. On Tuesday, President Obama will announce plans that would place the U.S. military in a leadership role over the Ebola response, dispatching 3,000 military personnel to West Africa in a plan that could wind up costing as much as $750 million.

It’s the sort of expense that the WHO can’t match.

According to Nature, the 2013 WHO budget “showed a shift away from infectious diseases,” cutting $72 million from that section. The Geneva office, where the organization is headquartered, took a significant hit. One office, which specialized in managing cultural differences in outbreak responses, was dissolved, according to the New York Times. Before the Ebola outbreak struck, there was only one remaining Ebola expert in the unit tasked with pandemic diseases.

“That shaping of the budget did affect the area of responding to big outbreaks and pandemics,” Keiji Fukuda, an assistant director general at the WHO, told The Times. “You have to wonder are we making the right strategic choices? Are we ready for what’s coming down the pike?”

The short answer, critics say, is no.

Its shortcomings were not so apparent during the SARS epidemic of 2003, in part because SARS infected Asian countries that could marshal responses by themselves. WHO was also better-resourced then, with one doctor telling the Times the wealthy were giving the WHO “literally hundreds of millions because their businesses were affected. But as SARS burned out, those guys disappeared.”

They haven’t reappeared during the Ebola epidemic, which has ravaged countries mired in poverty and dysfunction and unable to throw many resources at the outbreak. And following the recent budget cuts, which shrank its crisis and outbreak response fund by 50 percent, the WHO struggled.

“Let’s be clear: WHO has not responded to Ebola as swiftly as it should have,” wrote the University of Minnesota’s Jeremy Youde in the Monkey Cage blog published at “Under the International Health Regulations, any human cases of Ebola must be reported to WHO within 24 hours, which should then trigger a response from the organization,” wrote Youde, who studies global health issues. “This did not happen.”

“I would say … that it wasn’t taken seriously by many partners at the beginning,” Fadela Chaib, a WHO spokesperson told Buzzfeed. “It was a failure of the international response that we weren’t able to work with local communities.”