World Health Organization Seeking to Overcome Psychological Obstacles

With sharply increasing numbers of babies born with microcephaly, especially in Brazil which is to host the Olympics next summer, the World Health Organization (WHO) is once again back on center stage. The WHO was the focus of widespread criticism for its handling of the Ebola outbreak in 2014, and appears to have learned some important lessons from that experience. My new book Behavioral Risk Management discusses the underlying psychological issues associated with the WHO's slow response to the Ebola outbreak. In this regard, the behavioral approach provides an important backdrop to compare the Ebola case to the outbreak of microcephaly, which appears to be coincident with the spread of the Zika virus.

The most important difference between the two cases is that in the current outbreak, the WHO is not actively underreacting to events, as it did with the Ebola outbreak. A New York Times article by Sabrina Tavernise reports that the agency's current reaction involves the convening of a special meeting whose purpose is to decide whether or not to declare a public health emergency. This is a marked contrast to the WHO having downplayed the potential seriousness of Ebola in the first few months of 2014, at a time when Médecins sans Frontières (MSF), also known as Doctors without Borders, was sounding alarms from its activities on the ground in Africa. While the MSF warned that the spread of Ebola would create an epidemic which would be "unprecedented," the WHO suggested that MSF was engaged in overstating the problem and generating unnecessary hype.

Some of the psychological issues that plagued the WHO's behavior in the case of Ebola are self-evident. The WHO was excessively optimistic in its initial assessment that the 2014 outbreak was minor and presented no threat of becoming a major epidemic. They were overconfident in their opinion, by which I mean too sure of themselves. In addition, they downplayed information provided by MSF, thereby exhibiting confirmation bias, the tendency to underweight or ignore information that does not confirm their prior views, and overweight confirming information.

There is also a more subtle psychological issue, which relates to the WHO's chief Margaret Chan. Before she became head of WHO, Chan was a public health administrator in Hong Kong. Notably when severe acute respiratory syndrome (SARS) broke out in China in 2003, Chan acted boldly. However, her attempts to limit the spread of the disease were heavily criticized as an overreaction. Psychologically, someone in her position might have suffered from regret, the pain associated with second guessing oneself in hindsight. People with regret aversion, and that includes most of us, exhibit behavior consistent with "once burned, twice shy."

The WHO is headquartered in Geneva but operates through regional offices spread across the globe. The WHO's regional office responsible for the area affected by Zika and microcephaly is The Pan American Health Organization (PAHO). They have been tracking cases since last May. Is the WHO being shy? Tavernise's article notes that some experts have for months been calling for earlier action by Geneva.

To be sure, the WHO is not structured along the lines of an emergency team. It is a large bureaucratic organization with a broad mission for developing health policy and systems around the world. It is also budget constrained, and its budget had been shrinking before the Ebola outbreak. It does not maintain an army of epidemiologists on reserve, waiting for an emergency to spring into action. However, it can set the tone for global discussion, and draw attention to serious issues as they arise. In psychological terms, they can fight availability bias, the syndrome in which "out of sight is out of mind."

The WHO appears to be setting the tone now, describing the situation as cause for concern, but not alarm. To be sure, it is dealing with a situation in which there is no known causal link between microcephaly and the Zika virus. All the evidence is circumstantial. At present, there is no vaccine to prevent infection from the virus or even a rapid diagnostic test for determining whether a person has become infected. Many people contract the virus, but do not display symptoms. The Zika virus is largely spread by mosquitoes, and so mosquito control is a key factor.

With tragic consequences for many newborn babies afflicted with microcephaly, a looming Olympics, and memories of Ebola still fresh, psychological issues will loom large in the way that the associated risks are managed. The more people understand about how psychological factors impede sensible decision making, the more likely it is that we can prevent psychological pitfalls from infecting our collective response to the current outbreak.