Keynote address to the Regional Committee for the Western Pacific, Sixty-fifth session
13 October 2014
Dr Margaret Chan
Director-General of the World Health Organization
(delivered in her absence by Ian Smith, Executive Director of the Director-General’s Office)
Mr Chairman, Excellencies, honourable ministers, distinguished delegates, Dr Shin, ladies and gentlemen,
The Director-General sends you her best wishes for a productive session. She is fully occupied with coordinating the international response to what is unquestionably the most severe acute public health emergency in modern times.
I am delivering her messages to you, in the words she wanted to use.
I begin here.
These days, people from WHO are expected to say something about the Ebola outbreak that is ravaging parts of West Africa. I will do so as well.
In my long career in public health, which includes managing the H5N1 and SARS outbreaks in Hong Kong, and managing the 2009 H1N1 influenza pandemic at WHO, I have never before seen a health event attract such a high level of international media coverage, day after day after day. I have never seen a health event strike such fear and terror, well beyond the affected countries.
I have never seen a health event threaten the very survival of societies and governments in already very poor countries. I have never seen an infectious disease contribute so strongly to potential state failure.
All of this was confirmed on 18 September when the UN Security Council convened an unprecedented emergency session to address what has moved from a public health crisis to threaten international peace and security.
I will not give you the latest figures for cases and deaths, as the number of new cases is now rising exponentially in the three hardest-hit countries, Guinea, Liberia, and Sierra Leone.
But I will use the outbreak to show how some messages, some key arguments that WHO has been making for decades, are now falling on receptive ears.
First, the outbreak spotlights the dangers of the world’s growing social and economic inequalities. The rich get the best care. The poor are left to die.
Second, rumours and panic are spreading faster than the virus. And this costs money.
Ebola sparks nearly universal fear. Fear vastly amplifies social disruption and economic losses well beyond the outbreak zones.
The World Bank estimates that 90% of economic losses during any outbreak arise from the uncoordinated and irrational efforts of the public to avoid infection.
Third, when a deadly and dreaded virus hits the destitute and spirals out of control, the whole world is put at risk.
Our 21st century societies are interconnected, interdependent, and electronically wired together as never before.
Fourth, decades of neglect of fundamental health systems and services mean that a shock, like an extreme weather event in a changing climate, armed conflict, or a disease run wild, can bring a fragile country to its knees.
In the simplest terms, this outbreak shows how one of the deadliest pathogens on earth can exploit any weakness in the health infrastructure, be it inadequate numbers of health care staff or the virtual absence of isolation wards and intensive care facilities throughout much of sub-Saharan Africa.
You cannot build these systems up during a crisis. Instead, they collapse.
A dysfunctional health system means greatly reduced population resilience to the range of shocks that our world is delivering, with ever greater frequency and force.
We know that higher numbers of deaths from other causes are occurring, whether from malaria and other infectious diseases, or limited capacity for safe childbirth.
Here is one of the few things WHO is glad to see.
When presidents and prime ministers in non-affected countries make statements about Ebola, they rightly attribute the outbreak’s unprecedented spread and severity to the “failure to put basic public health infrastructures in place.”
Fifth, Ebola emerged nearly 40 years ago. Why are clinicians still empty-handed, with no vaccines and no cure? Because Ebola has been, historically, geographically confined to poor African nations.
The R&D incentive is virtually non-existent. A profit-driven industry does not invest in products for markets that cannot pay.
We have been trying to make this issue visible for many years, most recently through the deliberations of the Consultative Expert Working Group on Research and Development: Financing and Coordination.
Finally, the world is ill-prepared to respond to any severe, sustained, and threatening public health emergency.
This statement may sound familiar to some of you, as it was one of the main conclusions of the IHR Review Committee convened to assess the response to the 2009 influenza pandemic.
The Ebola outbreak proves, beyond any shadow of a doubt, that this conclusion was spot on.
So what does all this tell us? Fundamentally, we have the priorities right, and these priorities finally have high visibility and high-level political support.
They underscore how right WHO and its Regional Offices have been in arguing for the strengthening of basic public health infrastructures, aiming for universal health coverage, and recognizing the urgent need to strengthen IHR core capacities.
We must continue along these appropriate, and now widely embraced paths to better health and stronger resilience for all.