Why the World Health Organization responded so differently to Zika and Ebola

Special To The Washington Post

The World Health Organization jumped into action on the Zika virus outbreak in 2016, in sharp contrast with the WHO’s much slower 2014 response to the Ebola outbreak. Research on international organizations and on how health issues are framed can help explain the difference.

The WHO confirmed an Ebola outbreak in March 2014. Five months and nearly 1,000 deaths later, the WHO announced that the West African Ebola outbreak was a “public health emergency of international concern.”

This was only the WHO’s third public health emergency declaration, after the 2009 H1N1 influenza pandemic and polio’s 2014 resurgence. After the Ebola outbreak, donors mobilized financial and military resources, and the United Nations Security Council created the U.N. Mission for Ebola Emergency Response. Public health officials and policymakers found the time lag inexplicable, given the WHO’s scientific knowledge and experience with Ebola.

In contrast, the WHO quickly flagged Zika, which is spread to people primarily through the bite of an infected Aedes species mosquito, as a public health emergency, despite significantly fewer deaths. More precisely, the third Zika-related death in Brazil — the epicenter of the current outbreak — was recorded 10 days after the announcement. It’s estimated that the Zika virus may have already infected more than 1 million people; most have recovered, and an estimated 80 percent do not experience symptoms. WHO officials estimate that 3 million to 4 million cases of Zika are possible in the Americas in a 12-month period.

The WHO’s public health emergency declaration was intended to jump-start scientific research, vaccine and treatment development, and mosquito-control campaigns.

WHO officials blamed the slow Ebola response on budget cuts that hit programs on infectious disease control — as well as on poor communication between Ebola-affected countries and WHO headquarters in Geneva. Despite ongoing budget pressures, in 2016 the WHO said that the need for greater scientific knowledge on Zika drove its announcement. And surely, after being accused of dragging its feet with Ebola, the WHO wanted to act quickly on Zika.

Political scientists would argue that the story is still more complicated. In “Rules for the World,” authors Michael Barnett and Martha Finnemore show that international organizations’ internal workings and technical expertise influence their actions in ways that are sometimes at odds with the goals of countries that set up these organizations to work on their behalf. Three points:

1. The WHO has six autonomous regional offices

The WHO is not a monolith. It does not always behave uniformly across its six regional offices, each of which is autonomous. The organization’s internal dynamics matter when it comes to launching an urgent health initiative. In the Zika case, the Pan-American Health Office, a regional WHO office, had expertise on mosquito-transmitted diseases such as dengue and chikungunya fever, which legitimized its call for more WHO action. PAHO also exhibited the professionalism needed to bump up the Zika response. With its close links with the United States, PAHO could put into place disease-control measures needed to respond to Zika.

In contrast, the WHO’s African Health Office was relatively ineffective against Ebola, in part because of cozy political relationships and inefficiency and because it wasn’t as well-funded or staffed.

2. The WHO cares about its reputation

By acting swiftly on Zika, the WHO may be trying to rebuild its reputation for efficiency and decisiveness that it gained when responding to the severe acute respiratory syndrome, or SARS, pandemic in 2003 — but lost during the Ebola crisis.

The WHO is also influenced by how powerful nations — such as the United States — perceive particular health issues. For those nations, Ebola was a distant threat in the world’s poorest region.

Zika cases, on the other hand, appeared quickly throughout the Western Hemisphere, with Brazil predicted to soon have more than 2,500 microcephaly cases, a birth defect in which a baby's head is smaller than expected. According to the U.S. Centers for Disease Control and Prevention, nationwide there are already 312 cases of travel-associated Zika virus disease cases; the Illinois Department of Public Health reports that there are nine cases statewide. The long-term costs of caring for microcephalic children will be high.

Political scientist Adam Kamradt-Scott shows how the WHO’s autonomy has historically vacillated, depending on nations’ interests. The WHO’s early public health emergency declaration on Zika may reflect pressures from both the United States and Brazil.

Indeed, the WHO seemed to follow the CDC and several other countries’ health ministries when in early March it advised pregnant women to avoid traveling to Zika-affected countries. Brazil and the United States showed the WHO scientific evidence linking microcephaly and Zika, and Brazil and other Latin American countries started calling for more global funding for Zika.

3. The message matters

There’s a final point to understand. Health issues are more likely to become global political priorities when they are conveyed in a way that resonates with both policymakers and citizens. “Framing” may have little to do with how much mortality, morbidity or disability comes from a disease. If it did, cardiovascular diseases and mental illnesses would have much higher health priorities.

Researchers show that framing issues that stress the prevention of bodily harm for vulnerable or innocent groups sway policymakers. Newborns who developed microcephaly from Zika-infected mothers stand for innocence and vulnerability.

Ebola had high mortality rates and infected wide swaths of society, making it harder to frame the need for action around a particular group. What’s more, Ebola aligned with the “outbreak narrative.” That’s the conventional view that poor countries have disease outbreaks, and powerful states only care about those outbreaks when the spread of those diseases threatens those states. A Zika potential outbreak is likely to occur in powerful countries, too..

In deciding how to respond to outbreaks, global organizations and the states that support them should realize that how those diseases are framed matters.

Washington Post

Amy S. Patterson is a professor of politics at the University of the South. This piece appeared in The Monkey Cage, an independent blog anchored by a group of political scientists from universities around the country.

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