(Yicai) June 2 -- The Ebola outbreak in the Democratic Republic of the Congo and Uganda has highlighted that a World Health Organization with sufficient funds, a well-structured governance system, and representative offices that meet needs of respective countries, is not a luxury but a must, but the agency requires organizational restructuring to adapt to the new situation of global public health services, according to a public health expert.

The challenges faced by the WHO are structural and cannot be resolved through minor adjustments in the context of significant cuts in  funding, the United States' withdrawal, and a dramatic change in the global health landscape, Tang Shenglan, co-director of Duke Kunshan University's Global Health Research Center, said in a recent interview with Yicai. 

The WHO declared the Ebola outbreak in the DRC and Uganda a Public Health Emergency of International Concern on May 17. The director of the Africa Centers for Disease Control and Prevention said on May 28 that the outbreak is the most severe public health challenge since the Ebola outbreak in West Africa in 2013.

Against the backdrop that the US has withdrawn from the WHO and global health governance has fallen into chaos, the responsive capacity to the Ebola epidemic has been significantly weakened, noted Tang, who was a senior program officer at the WHO representative office in China and a Coordinator of the WHO Special Program for Research and Training in Tropical Diseases in Geneva. Hopefully, this will serve as a warning to the member states of WHO and the international community, he stressed.

The Ebola epidemic is also a "stress test" for the efficiency and effectiveness of the WHO's performance, he pointed out. Because no single country or single institution can independently deal with it, this is precisely the moment when the agency should play its irreplaceable role, functioning as the global coordination center, formulating technical norms, and serving as the emergency response engine. 

The number of WHO employees has grown too rapidly from 2017 to 2024, but this did not lead to an improvement in its operational efficiency, Tang said. On the contrary, multiple crises such as the Covid-19 pandemic and the Ebola outbreak in West Africa exposed its long-standing structural weaknesses, including slow decision-making, decentralized responsibilities, and inconsistent guidelines, he added.

These problems cannot be solved simply by increasing the budget or hiring more workers, because they are deeply rooted in the organizational structure, Tang noted. 

The reform of the WHO could start with its representative offices in different countries, he said. Upper-middle-income countries possess strong technical capabilities, well-developed public health systems, and sufficient professional talents, so the role of the representative offices in those countries in improving public health capabilities is limited, he pointed out.

On the other hand, the WHO's offices in many fragile and low-income nations often have extremely heavy tasks with far from enough competent employees and necessary operating funds, making it difficult for them to have a substantive impact on local public health management, Tang stressed.

The WHO does not need to complete all reforms overnight, but instead, it could first experiment with forming different types of representative offices in different countries based on their actual situations, or it could start by strengthening the accountability mechanism between its headquarters and regional institutions to gradually carry out the structural adjustment of the organizational structure, he said.

Tang and Michael Merson from New York University's School of Global Public Health recently jointly published the commentary article Transforming WHO: Incremental Reform Is No Longer Sufficient in The Lancet, calling for the agency to undergo organizational restructuring. 

Only by restructuring can the WHO truly achieve the transformation from a "loose alliance" to a "unified authority" and regain its core position in the increasingly fragmented global health landscape, they said.

Editors: Tang Shihua, Martin Kadiev