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Budget Cuts Hobble The World Health Organization's Ebola Response


"In retrospect, I really wish that we had jumped much higher, much earlier." That appraisal of the medical response to Ebola, from a doctor in charge of health security at the World Health Organization, quoted in today's New York Times. The WHO is the global health agency within the United Nations, and budget cuts at the WHO have severely hobbled the agency's ability to respond to the Ebola epidemic. New York Times correspondent Sheri Fink wrote the lengthy story about that and joins me now. Sheri, welcome to the program.

SHERI FINK: It's good to be here.

BLOCK: And how big are the cuts that you're writing about?

FINK: These were cuts that happened during the global financial crisis. And the WHO's proposed two-year budget, a billion dollars had to be knocked off. And it ended up at around 4 billion being the two-year budget. And comparing that with the CDC here, we have about 6 billion just in a single year. But it was not just the budget cuts. It was also the prioritization. So I think it was 16 percent of staff were cut across the organization. About 35 percent were cut in the departments that deal with outbreak preparedness and response.

BLOCK: Yeah, and you mentioned that there were veterans, outbreak pioneers, people who really, really had spent years in this field, who were gone - who were no longer with WHO.

FINK: Yes. And I think maybe some of that had to do with the budget cuts and the shifting priorities. But it's also the fact that people retire over time. And then, if you don't keep that infrastructure in place and you're not able to fund that so well, then you're not going to perpetuate that. One of the people I interviewed who was one of those folks said, you know, you can only keep something going for so long with passion. You have to marry that with the resources.

BLOCK: Why don't we explain a bit about how WHO is funded? - because I was really surprised, in reading your article, to see what the breakdown is.

FINK: To break it down really simply, 20 percent of the WHO's budget comes from these assessed dues to its member nations. And then 80 percent are a matter of voluntary contributions. I was amazed to learn the Bill and Melinda Gates foundation has given more - I think it was 2013, the last year that I could find data for - more than any single country that gave money to the WHO. And they get to choose the priorities, you know, as long as it fits within the WHO's mandates. So you get a lot of what some of the people at the WHO call pet projects.

BLOCK: Yeah, so this money would be earmarked, in another words, for specific health issues or concerns and not fungible - in other words, wouldn't be immediately shift-able into, say, an Ebola outbreak, if it came up.

FINK: For the most part, no. And of course, now they're fundraising for Ebola. And they pointed out that as they're responding, they're also having to fundraise. It really hobbles the ability to go out full force immediately.

BLOCK: You do point out, Sheri, in your article, a really interesting contrast. When the SARS epidemic broke out, about 10 years ago in Asia, you say there were millions and millions of dollars, private money, pouring into WHO because it was affecting really, really wealthy businesses in the countries where SARS was spreading.

FINK: And I think it's just something we see over and over again with disasters. It's the money that flows after something happens - after Hurricane Sandy, or Katrina or, in this case, SARS. Preparedness is a constant battle. It's not like you can just make an investment and walk away. It's something that needs to be kept up. And quickly, once the crisis passes and the headlines aren't there anymore, that money dries up.

BLOCK: I was really struck by what a doctor told you. This is an Ebola outbreak veteran, Dr. Daniel Bausch, who was in Guinea in May with WHO, went back in July to Sierra Leone, you know, a few months later and said, where is everybody? - meaning the health workers. He would have thought, I guess, that a couple months later, they would have beefed up.

FINK: It was just the opposite. The model now is that people are sent for a short period of time, like he was. And then they come home. And the WHO had cut back on their staffing. They had fewer logisticians, which are people - it all relies on logistics in the field - getting the supplies where they need to go, keeping tabs of things. And there was only one WHO logistician in the entire country of Sierra Leone. So he went alone to Kanema, part of Sierra Leone, and had to deal with all the logistical details himself.

BLOCK: Sheri Fink, thanks so much for talking with us.

FINK: Thank you.

BLOCK: Sheri Fink is a correspondent with The New York Times. Transcript provided by NPR, Copyright NPR.