1. A GLOBAL HEALTH RISK FRAMEWORK FOR THE FUTURE The role of the Christopher Dye

2. The World Health Organization’s role Infectious disease challenges for – governance – finance – health systems – R&D – information – coordination Learning from Ebola &c Global health landscape – 25-year increase in funding in MDG era, many players – post 2015 development agenda

3. Ebola update: 7 cases in week 30 (20-26 July) lowest weekly total in >1yr but it’s not over yet

4. Governance Challenges Capacity: more people than ever need emergency assistance Mixed cultures: outbreaks, humanitarian emergencies, health security WHO normative: consensus-building technical work, limited logistics and little internal surge capacity, ill-equipped for rapid decisions WHO compartments and levels ─ HQ, regional and country offices Solutions WHO in general – reform decision-making, priorities, accountability WHO in outbreaks and emergencies – all-hazard rapid response, logistics and operational platform, rapid access to emergency workforce and global technical experts (standby capacity, UN, GOARN, FMT, NGOs) Reinforced International Health Regulations WHO coordination -- Ebola transition from UNMEER (Aug 1)

5. Scope of a new WHO emergency programme (under discussion) All Hazards Prevention Health system Vaccination Some disease programmes Preparedness, Alertness, Readiness Response acute protracted Recovery R Brennan WHO

6. Finance Challenges 5-fold increase in $$ for global health since 1990; WHO much less WHO budget cuts in global financial crisis ─ key staff laid off WHO $ 4.4 bn budget 2016-17, ¼ from assessed contributions (subscription), ¾ voluntary No core funds for emergency response Discontinuous, patchy donor funding Solutions 8% budget increase – though not AC Preparedness, outbreaks $580M -- but DG may spend more US$100 million contingency fund for outbreaks Other initiatives e.g. Pandemic Emergency Facility Flexible donor funding - not earmarked, continuous, reliable

7. Health systems fragile building blocks → poor health outcomes

8. Health systems Challenges (in all 6 building blocks) Delivery: slow diagnosis, little improvement in survival through better care Delivery: collateral damage (Ebola) – vaccination, malaria, clinics etc “Delivery”: weak community engagement (anthropology) Funding: vertical programmes supported by external donors, little national or international investment in health services, weak donor coordination Workforce: few motivated, well-trained HCWs (e.g. those unpaid earn money in unregulated private practices) Leadership: Ebola exposed many weaknesses but some strengths Solutions Universal Health Coverage central to SDGs – strategic, long-term investment Immediate priorities: early warning and response systems for all health threats, logistics, field epidemiologists, mobile labs, clinical procedures, IPC training, focus on district-level services, and coordinated international technical assistance with partners.

9. R&D Challenges Inappropriate technology, slow development of new technology Absent target product profiles (TPPs), R&D roadmaps, review mechanisms, reference preparations for assays, approved standards of care Limited data sharing - clinical trials and other research during outbreaks & emergencies Inadequate R&D funding models, few $$ to quick-start R&D Limited stockpiles of effective treatments Low national participation in R&D efforts to build research capacity Narrow view of R&D – mostly vaccines, drugs, diagnostics – not operations Solutions Ebola diagnostic, drug, vaccine development, trials, licensing compressed to months Expand existing collaborations e.g. African Vaccine Regulatory Forum (AVAREF) Blueprint for Research and Development Procedures in the Context of Global Public Health Threats (WHA 2016)

10. Information sit reps – rapid guidance - data sharing – triggers for outbreak response

11. WHO Ebola Response

13. FAO ILO WHO MoH WB ADB KHANA Clinton HAI SRC HNI RHAC RACHA MSF Global Fund to Fight ATM GAVI HMN JICA CDC GTZ AFD BTC KfW DFID EC USAID AusAid UNDP UNFPA UNAIDS UNICEF UN WFP CARE URC HU AECI KOICA Gates ICRC International Health Partnership Catalytic Initiative UNITAID PMNCH RBM Stop TB PEPFAR PMI PSI SC Oxfam 100+ health partners 1990-2015: new coordination role 40 bilaterals, 26 UN agencies, 20 global funds, >100 global health initiatives… NGOs OIE GOARN IFRC OCHA

14. Role of WHO in public health 6 core functions Providing leadership, engaging in partnerships Shaping the research agenda Setting norms and standards Articulating ethical and evidence-based policies Providing technical support, catalysing change, building sustainable institutions Monitoring health situation and trends Critical aspects of emergency preparedness/response should be linked to core public health functions

15. “Now is the historic political moment for world leaders to give WHO new relevance and empower it to lead in global health” Stocking report, July 2015 “I am creating a single new programme for health emergencies, uniting all our outbreak and emergency resources across the three levels of the Organization… designed for speed, flexibility, and rapid impact.” Margaret Chan, WHA May 2015

16. Port Loko, Sierra Leone early wet season