The WHO may not be perfect but it's far better prepared to fight Ebola this time

Two weeks ago a new outbreak of Ebola was confirmed in a rural village in the Democratic Republic of Congo. Last Thursday, the first case was confirmed in Mbandaka – a city of approximately 1.2 million people.

The total number of suspected cases is still relatively low, but for people living in Congo the deadly spectre of the 2014-16 outbreak in west Africa is hard to ignore.

A two-year-old boy in Guinea was the first victim in December 2013 and, over the next two years, 11,000 people died in the worst epidemic of the disease in history.

It took nine months before the global public health system, including the World Health Organization (WHO), woke up, by which time the epidemic was out of control. And this slow response was responsible for many of those 11,000 deaths.

Now, there is the same potential for disaster in Congo. This time it's a similar strain of the virus, and although the epicentre is rural, just along the Congo river from Mbandaka are Kinshasa, Congo’s capital; Brazzaville, capital of the neighbouring Congo Republic; and Bangui, capital of the Central African Republic: three cities with a combined population of 12 million.

This epidemic could explode tomorrow. But even if it does, lessons have been learned. The WHO has changed.

The WHO has traditionally been happier as a bureaucratic assembly than a leader. But it was terribly clear, in the aftermath of the last Ebola epidemic, that things needed to change. And they have. In the past few days the WHO’s response could not be more different.

The latest outbreak was confirmed on the afternoon of May 8. By the next morning, the WHO had sent out a team to Congo to investigate and agreed an action plan, including offering vaccination to communities and healthcare workers. A coordinated response took less than an hour to galvanise and 18 hours to launch.

Within days, Tedros Adhanom Ghebreyesus, the new WHO director general, and his senior team were on the ground in Congo to work with the government which immediately agreed to the use of the new vaccine – which was developed with Wellcome Trust and UK government funding. The first vaccines are now being administered. 

It is nearly a year since Dr Tedros became the WHO's first African director general – and this week he is leading his first World Health Assembly, the decision-making body of the organisation.

He is pushing the WHO out of its comfort zone, as a consensus-seeking follower of its members’ interests, to become a leader. He has brought diversity; 60 per cent of his senior team are women. He has improved the morale of an organisation bruised by its past failure.

His mistakes – for instance the brief appointment of Robert Mugabe as a “goodwill ambassador” – are outweighed by his achievements.

There is still plenty to do, and huge challenges to face. Non-communicable diseases, such as heart disease, cancer and diabetes, are up worldwide; mental illness remains neglected, at enormous cost; and the success story of malaria control is in danger of stalling. The spectre of microbial resistance to drugs will not go away. Nor will the changing climate and its impact on health.

Now the organisation needs to set itself ambitious, measurable targets, to push itself even more. The sign of a confident organisation is that it gives itself goals to achieve, goes about achieving them and then resets for new challenges.

This is a dangerous time. Nationalist agendas threaten to undermine international agencies, including the WHO. That’s frightening. There is no other organisation that can do what the WHO does. We should have high expectations of the WHO and challenge it when it gets things wrong.

But national governments need to acknowledge when the WHO gets things right, trust it, and back that trust with financial support. If they do not, we may face a world without the WHO where the 2014-16 scenario – and worse – becomes far more likely.

Instead, we have the 2018 version. It’s not perfect: there remains much to do. But ask a healthcare worker in Congo who has just been given an Ebola vaccine by the WHO whether it’s better than before.

Dr Jeremy Farrar is director of  the Wellcome Trust

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