The firestorm that was the Zika outbreak in Brazil has largely passed since last year, but the mosquito-borne virus remains a stubborn global health threat.
Cases have been popping up in a number of Southeast Asian countries for years – Thailand has reported nine cases in the past five years – but health officials in Vietnam are worried they could soon be dealing with a Zika pandemic.
By January, Ho Chi Minh City had over 200 cases on its hands.
Even if the Vietnamese public health system had taken steps forward over the past few years, it is still ill-prepared to handle an outbreak. Vietnam’s structural healthcare issues make trying to handle any kind of potential pandemic a frightening prospect.
The Vietnamese government spends 7.2 percent of its GDP on healthcare, surpassing its neighbours, but the country still has far too few doctors and hospital beds to meet the high (and growing) demand.
And even though Communist Vietnam has traditionally seen healthcare as a basic pillar of its relationship with the public, lacking facilities and “maddeningly opaque bureaucracies” still come standard.
Like in China, Vietnam’s move from a strictly Communist to a more commercialised healthcare system from the 1980s created a two-tiered system.
The percentage of people insured might be rising and out-of-pocket costs are falling, but many poor Vietnamese remain uninsured and still have to choose between unbearable expenses or not seeking treatment at all.
What makes the decision even harder for rural Vietnamese is that the doctors in their areas have flocked to the cities, even when urban hospitals are severely overcrowded.
The ratio of health workers and hospital beds to people stands at 7-8 healthcare workers and 25 beds for every 10,000 Vietnamese. The global average, by comparison, is 15 healthcare workers and 30 beds per 10,000 people.
The gap between the current healthcare capacity and what Vietnam would need to handle a crisis means the country, like many other developing nations, will have to rely on the World Health Organisation (WHO), which offers support to national health authorities as one of its primary missions — for help.
Unfortunately, the organisation’s most recent attempts to combat crises do not inspire much confidence.
In 2015, an expert panel brought together by the Harvard Global Health Institute and the London School of Hygiene and Tropical Medicine did not mince their words in condemning the WHO’s response to the Ebola crisis.
The panel called the response an “egregious failure“ and pointed out fatal delays, such as realising in March 2014 the Ebola outbreak was out of control, but waiting until August to declare an emergency.
Again, when the link between Zika and microcephaly became apparent in Brazil, public health experts called out the WHO for inexplicably “sitting back on Zika“.
Compounding the WHO’s technical shortcomings is its dwindling funding.
To support its cumbersome and costly setup, with a head office in Geneva and six semi-autonomous regional offices (Vietnam’s is in Manila), the WHO relies on the overwhelming support from voluntary contributions by countries that are increasingly frustrated with its performance.
— WorldPoliticsReview (@WPReview) September 19, 2016
The largest of those countries is the United States, and the Trump administration has signalled its scepticism in funding the United Nations and other international organisations.
The WHO’s sub-agencies are not helping its cause either: a U.S. congressional committee led by Jason Chaffetz, one of the leading Republicans in the House of Representatives, is currently locking horns with the International Agency for Research on Cancer (IARC).
Over the past several months, Chaffetz and other Congress members have investigated U.S. federal government funding to an agency under scrutiny after declaring things like coffee and red meat carcinogenic.
The IARC’s less-than-transparent approach to dealing with partners and critics has not helped matters, but transparency is an issue for the WHO as a whole.
Behind the scenes, major personnel and policy decisions still involve backroom deals and secret ballots. Even with changes to how it elects its top leadership, the WHO is, in many ways, still the product of bickering among its parts.
Quite a few outside observers are questioning whether the organisation should have a future at all.
Oxfam UK former chief executive Barbara Stocking, who chaired the expert panel reviewing the Ebola response, pointed out responding to outbreaks should be the organisation’s “absolute essence.” She asked: “If it doesn’t deal with health emergencies across the world, then what is it there for?”
That’s a question Vietnamese health officials could be asking in the next few months, as the Zika virus continues to spread throughout the southern provinces.
To fix its internal dysfunction and provide the critical support developing countries need to deal with health crises, the WHO needs fixing fast.
Three candidates, who are vying to take over as director-general this summer, are promising to do just that.
Ethiopia’s Tedros Adhanom has taken on funding challenges by saying the organisation needs to expand the donor base rather than “put all [its] eggs in one basket,” while Pakistan’s Sania Nishtar argues the WHO needs to “demonstrate value for money” and “become more result-orientated and more resilient.”
UK’s David Nabarro says he understands the importance of making sure the “organisation is working for impact in the most effective, efficient and transparent way.”
It is imperative whoever ends up winning follow through on their promises to reform the agency.
Unless the WHO gets fixed, countries like Vietnam, which have limited resources to deal with health crises, would not be getting the strategic and material support they need.