Ebola Smackdown: World Bank Takes On the WHO

Could the World Bank have handled the Ebola outbreak in West Africa better?

Let's begin 2015 with an important and hard-hitting brand of analysis the IPE Zone is known for by now. The outbreak of Ebola in the countries of Liberia, Sierra Leone and Guinea has raised several questions about how the international system responds to pandemics with potentially global consequences. We hear it all the time nowadays: if the international system understood the potential extent of the problem, would early action have helped reduce thousands of needless deaths cause by the outbreak in West Africa? In particular, the United Nations' World Health Organization (WHO) has come under fire for its belated response and early skepticism about the outbreak. TIME's "Persons of the Year" feature on Ebola fighters is representative of the criticism that has been leveled at the WTO:

One skeptic—perhaps the most influential and thus the most disastrous—was WHO, the health arm of the U.N. Underfunded and overly bureaucratic, WHO is, in the eyes of its many critics, woefully inadequate in dealing with rapidly emerging threats like Ebola. Worse perhaps, the agency’s local representatives are notoriously jealous of their turf and prerogatives. At this same critical moment, WHO offices in West Africa turned away a team of experts from the CDC working in Guinea, insisting that their help was not needed, says CDC director Dr. Thomas Frieden. The CDC, a large and very well-regarded public-health agency, is unsurpassed in its capacity for action, maintaining some 2,000 field workers in 60 countries around the world. Those workers in turn can often summon resources from the U.S. to smother epidemics in their infancy abroad.

Now, an unlikely critic of the WTO during the continuing crisis has been the World Bank. Students of international organizations often forget that the World Bank and IMF are actually part of the United Nations system. See here and the following:

The International Monetary Fund (IMF) and the World Bank are institutions in the United Nations system. They share the same goal of raising living standards in their member countries. Their approaches to this goal are complementary, with the IMF focusing on macroeconomic issues and the World Bank concentrating on long-term economic development and poverty reduction.

Given his background in epidemics, current World Bank President, Korean-American Jim Yong Kim is refloating the idea of creating a rapid response of outbreak specialists. Since the idea was shot down earlier by the WHO, it is interesting that it's being taken up again at the World Bank. After all, this is similar to Kim's previous international experience handling HIV/AIDS at the WHO (which he now criticizes):

The World Bank, headed for the first time by a [medical] doctor, wants to create a cadre of outbreak specialists who could be sent anywhere to end deadly epidemics. A similar idea, floated by a World Health Organization panel three years ago in the wake of the swine flu pandemic, didn’t get enough support. The WHO says the idea might not be practical and countries should ideally have the capacity to respond themselves..

Kim, who previously headed the WHO’s HIV/AIDS department, has voiced publicly his opinions on Ebola more than a dozen times in op-eds, speeches, statements, media briefings and in webcasts detailing the World Bank’s response and what needs to be done. He’s also been critical of the initial global response, describing it as “late, inadequate and slow.” 

The worry is that internecine warfare among ostensible UN sister agencies will further damage the WHO's ability to respond:

“There is a genuine risk that governments will use the Ebola outbreak as a basis for further undermining the WHO’s authority, which would simply be disastrous,” Kamradt-Scott said. The health agency had been subjected to “extensive budget cuts” as part of a reform process, he said. “While this doesn’t entirely explain why the organization was slow to respond to the outbreak, it has certainly had an impact on the WHO’s operational response. Rather than erode the organization’s capacity further, Ebola should be a wakeup call that we can’t have global health security without appropriate investment.”

A letter co-authored by Kamradt-Scott backing WHO and endorsed by almost 100 public health workers, academics and researchers in international relations is slated for publication in the Lancet medical journal on Jan. 10, he said.

There are two things I wish to point out here that place me more with the University of Sydney's Adam Kamradt-Scott on the dangers of further damaging the WHO. First, the World Bank has already been criticized a lot for "mission creep." From long-term development it has moved into areas such as emergency lending (a la the IMF)...and now emergency response to global pandemics? This is a longstanding worry. From the September/October 2001 issue of Foreign Affairs:

By now, its mission has become so complex that it strains credulity to portray the bank as a manageable organization. The bank takes on challenges that lie far beyond any institution's operational capabilities. The calls for greater focus through reform seem to produce little beyond conferences and consternation, since every program has a dedicated constituency resisting change. To counter these problems, the countries that own the bank -- its shareholders -- need to elaborate a worthwhile and suitably modest agenda. The views of emerging-market countries, which have shared in the bank's successes as well as its failures, should count a great deal; they are the ones who have lived the lessons of the past decades. Policymakers should consider a broad array of options, including devolving some of the bank's functions to new institutions or redistributing them to existing ones. But whatever the remedy, it is time to redefine the bank's unwieldy mission.

Second, and perhaps more importantly from an operational standpoint, the World Bank is already undergoing a tumultuous process of reform to "rationalize" its operations. Staffers have already (sort of) gone on strike. Since the downsizing effort was begun at Kim's request, it will doubtlessly strike many at the World Bank as unfair that Kim is seeking to defund their World Bank projects to fund one of his pet projects--the rapid response team.

Bottom line: the idea of a disease outbreak rapid response team may make good sense, but housing it at the World Bank risks not only further "mission creep" but also goes against the very spirit of reform that it is undergoing to focus on core missions. Just because something is happening in "developing" countries does not make the World Bank the UN's authoritative body on everything that happens there. The WHO needs to be helped--not further harmed by friendly fire--at the point in time.