A Canberra infectious diseases expert is calling on the World Health Organisation not to remain "a toothless tiger" after its orders were ignored during the Ebola outbreak.
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Associate Professor Sanjaya Senanayake from the Australian National University says the United Nations body should adopt punitive measures against member states that fail to comply with its instructions, "especially in the setting of an acute epidemic where time is of the essence and protracted debate is impractical".
"Sanction is one possible strategy that the WHO could use on such occasions - it is important for the WHO not to remain a toothless tiger," he says.
Professor Senanayake gives his prescription for WHO's future in the Medical Journal of Australia, published on Monday.
It has been almost two years since the world first became aware of the Ebola epidemic in West Africa that has caused more than 11,000 deaths.
Such a ferocious outbreak with pandemic potential should have been a showpiece of the WHO's skills in managing public health emergencies but instead highlighted deficiencies within the organisation.
"Criticism of the WHO, both by external voices and from within, has loomed large in the background throughout the outbreak, bringing into question both its purpose and pre-eminence in guiding global health," Professor Senanayake says.
"A major criticism of the WHO has been its failure to declare a public health emergency of international concern (PHEIC) when the outbreak was in its infancy.
"It is believed that such a declaration at that time could have resulted in far fewer casualties."
During last year's World Health Assembly, WHO announced changes including developing a global health emergency workforce.
Fundamental problems with WHO's structure have not been addressed, Professor Senanayake says.
"This final point is part of a larger debate about how to make the WHO relevant in 2016; after all, it is not easy being the leader in global health security," he says.
The criticism of the WHO's inadequate response to Ebola comes not long after the organisation underwent examination for its handling of the 2009 H1N1 influenza pandemic.
"It can be difficult for any large organisation to adapt to change and, since it was founded in 1948, the WHO has had to confront a rapidly changing world," Professor Senanayake says.
"The emergence of new international health institutions such as Médecins Sans Frontières, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Bill and Melinda Gates Foundation and the GAVI Alliance also cannot be ignored.
"These non-governmental organisations operate, proselytise and criticise in a manner often not possible for the WHO, whose member states are usually the very stakeholders at the centre of such humanitarian operations. The WHO must tread carefully."
During the Ebola outbreak, WHO's director-general was apparently put under political pressure not to declare a PHEIC.
"Trade and quarantine enforcement and travel bans were instituted, despite the director-general's recommendations not to do so," Professor Senanayake says.
"Only 64 of 196 states have developed core health system capacities, even though it is mandated under the international health regulations.
"Thus, the WHO should incorporate punitive elements into its constitution for member states that fail to comply with its instructions, especially in the setting of an acute epidemic, where time is of the essence and protracted debate is impractical."
