The World Health Organization can be reformed

Although it suffers from lack of independence, it should be fixed rather than scrapped

JENNIFER PRAH RUGER May 6, 2020

The writer is the Amartya Sen professor of health equity, economics and policy at the University of Pennsylvania

Untold suffering, loss of life and economic disruption. In health crises, the world usually looks to the World Health Organization for authoritative guidance. But the WHO today is a compromised institution.

US president Donald Trump has called it “China-centric” and suspended funding. Years before Covid-19 struck, former WHO director-general Margaret Chan suggested that others might “do a better job” in dealing with global health threats. The WHO certainly needs to change. But it should not be defunded now, amid a global pandemic. Rather, it needs to reform in four key areas.

For one, it lacks independence from its member countries, and not just China. In the early 1990s, Japan allegedly pressured small nations with trade actions, while also offering them aid, to win support for a second term for its director-general candidate. Historically, unwritten rules also required that five of the WHO’s six assistant directors come from the US, UK, France, the Soviet Union and China.

Global health challenges require that the WHO rise above such parochial interests. Moreover, an independent and objective international institution can best serve national interests too. Here the WHO can take a page from the IMF, which was taken to task in an internal report for its role in the eurozone debt crisis and urged to separate finance from politics, and to focus on its role as a “global financial truth-teller”.

The WHO also needs to be more accountable, transparent and fair. In 2009, its opaque management of H1N1, commonly known as swine flu, led to charges of undue influence. The emergency committee set up by Dr Chan during her leadership did not deliberate publicly. This undermined its subsequent declaration of H1N1 as a global pandemic, a decision that critics called scientifically unjustified. There were also widespread allegations that WHO advisers had ties to pharmaceutical companies. Estimated sales from vaccines reached several billion dollars in 2009.

Geopolitical interests have also shaped WHO actions. In 1955, it was roped into the west’s ideological struggle against the Soviet Union when the World Health Assembly, the WHO’s decision-making body, voted for a malaria eradication programme promoted by the US and its allies. Powerful commercial interests sometimes trump science too. In 1985, the US withheld WHO funding after big pharmaceutical companies objected to its “essential drugs programme” for priority needs.

Third, WHO funding needs to become bigger and more sustainable. Currently, powerful countries and organisations influence its actions via extrabudgetary funding tied to specific purposes. These are often associated more with donor interests than global health needs; misaligned with the WHO’s own programmes; and not evenly spread across programme areas. Currently, 80 per cent of the WHO’s budget is from voluntary contributions. This undermines the WHO’s institutional integrity, and opens a chasm between its stated objectives and performance. It requires reforms such as multiyear funding agreements.

Finally, the WHO must reclaim its scientific credibility to better protect global public health. One way to do that is to uncouple science from politics. It should separate its technical and implementation functions from the political functions while using the WHA to maintain representative democracy among the WHO’s 194 member nations. It can be done.

Gro Harlem Brundtland, often seen as the WHO’s best director-general, led the successful 2003 containment of SARS. Stopping the disease in its tracks required science-based decisions that always placed public health first. The world needs such a WHO, that puts science before politics. Our lives literally depend on it.

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