The health crisis has certainly rekindled criticism of the role of the WHO, but it has also shown the extraordinary cost of states’ lack of preparation in the face of health risks. What is needed for the WHO? A strengthened authority in emergency contexts, more financial autonomy, an internal reorganization aimed at the efficiency and restoration of the authority of its Director-General, greater inclusion of scientific communities, more active participation of non-profit organizations.
Since the start of the Covid-19 pandemic, the World Health Organisation (WHO) has been blamed for its poor management of the response to the global health crisis. Caught in the turmoil of tensions between China and the United States, it is a case study of the growing difficulty of multilateral institutions in responding to collective risks.
The WHO trial is not new.
It reflects, beyond the perennial question of financing and the internal difficulties encountered by all international organizations, the unwillingness of States to recognize it with sufficient authority and resources to assume its mission in the face of global health risks.
The role of WHO is poorly understood by the general public. However, the Geneva organization assumes essential functions outside of emergency periods are like collecting knowledge from global research, analyzing the evolution of health situations, alerting to major health risks, advising governments, carrying out major international advocacy campaigns, and coordinating health actions on a global scale. Its role is decisive for countries with the most fragile health systems and which have very weak research capacities. The WHO defends universal access to health in a context where trade agreements, particularly relating to intellectual property rights, have a significant impact on access to medicines and health care.
Since 1948, when the WHO was created, the global health landscape has changed a lot, as have international health issues. The recurring criticisms of the UN organization, coming for a long time from the United States, have focused too much attention on questions of management and governance. Rather, the debate should be refocused on the goals of a multilateral entity whose mission is to promote global health. What should be the place of WHO in the international health system? The awareness of the interdependence of health and environmental issues, in particular, changes the framework for reflection and prompts us to question new institutional and political perspectives.
The health crisis has certainly rekindled criticism of the role of the WHO, but it has also shown the extraordinary cost of states’ lack of preparation in the face of health risks. It is not a question here of multiplying the missions of the UN institution, but of strengthening its authority and its legitimacy where it is essential: the production and sharing of knowledge in a universal perspective aimed at promoting health for all.
What is needed for the WHO? A strengthened authority in emergency contexts, more financial autonomy, an internal reorganization aimed at the efficiency and restoration of the authority of its Director-General, greater inclusion of scientific communities, more active participation of non-profit organizations. states to the governance of the agency and, finally, the integration of global health into the challenges of biodiversity and climate.
When a global health crisis strikes, sharing reliable and transparent information is essential. Lack of cooperation from a single state can be disastrous on a large scale. However, within the framework of its powers, WHO still depends on the goodwill of States when it must organize a response to an epidemic threat, with considerable risks for the safety of all. It would benefit from being assigned enhanced skills in order to be able to conduct mandatory inspections in countries and alert the international community when a State fails to meet its obligations in the face of proven health risk of international significance.
Gradually suffocated by the freezing of recurrent contributions paid by its Member States, the WHO now depends mainly on so-called “voluntary” contributions, partly coming from private actors. However, the promotion of major health priorities cannot depend on such resources, fluctuating, unpredictable, and subject to the different requirements of each major donor. Financial reform should help reduce the WHO’s dependence on targeted funding.
A singular case among United Nations organizations, the WHO is divided into six regional directorates each with a regional director, a specific budget, attached staff, and specific priorities. This institutional structure has the effect of fracturing the organization and sometimes reinforcing the rivalries between its components, to the detriment of the coherence and effectiveness of international action. It is now necessary to give back to the Geneva Secretariat, in particular to the Director-General of WHO, the means to restore a clear line of command within the organization.
WHO’s a link to the production of scientific knowledge must be rethought as global health research networks expand, multiply and reorganize. The international experiences conducted in the fields of the fight against climate change (IPCC) and the protection of biodiversity (IPBES) provide interesting perspectives for the evolution of global health governance. The constitution of a “global health IPCC” would make it possible to increase the role of scientific communities in the production of universal knowledge on health risks. It would institute, within the WHO, mechanisms giving scientific expression a stronger place to inform political decision-making in health.
States are no longer the only major players in the field of global health. NGOs, civil society networks, philanthropic organizations, foundations, and private companies have become essential partners in health policies, both internationally and in countries. WHO, as an intergovernmental entity, should thus give a greater place to non-state actors. It is nevertheless essential, at the same time, to continue to strengthen the safeguards to prevent the attempts of industrial actors and certain governments to put undue pressure on the normative activities of the WHO.
The 2020 pandemic has heightened awareness of the impact of environmental degradation on human health. The so-called “ One Health” approach illustrates the need to better take into account the interdependencies between human health, animal health, and environmental health. The protection of biodiversity, agricultural practices, food security, the fight against global warming … all these dimensions, today took care of by different institutions, should now be systematically crossed and addressed by integrated actions to promote population health.
Human health is a common good of humanity. It is by nature “global health”. It cannot be protected or promoted without an international response. In order to develop such a response, WHO must not be marginalized. It must be reinvented.