Do we Still Need WHO?

The World Health Organization (WHO) has just celebrated its 72nd birthday but this septuagenarian is not aging in grace. The 72nd birthday has been “celebrated” in the midst of a crisis, a crisis which WHO handled in a manner that hardly reflected readiness and responsiveness. A cursory review of WHO’s past shows the organization is not set up to succeed in such a mission anyway and perhaps it is time we asked ourselves how important and relevant it still is.

#1 Little More Than a Bystander

In its own words, WHO aims to:

…address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches

Secondly

…to promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health. 

Everything mentioned above falls in the realm on national/global politics and the relevance and importance attached to them is dependent on the person/party in power. On the international stage, the global powers determine the priorities directly or indirectly. There is little that WHO can do if governments tell it to piss off. It should not surprise us that WHO Director General Tedros was praising China even when the prevailing sentiment is that China may not have been entirely open about COVID-19

We appreciate the seriousness with which China is taking this outbreak, especially the commitment from top leadership, and the transparency they have demonstrated

Tedros Adhanom Ghebreyesus, Director-General, WHO

#2 An Expensive Affair

In 2018, the budget for WHO was USD 4.4 Bn. Between 2019-23, WHO is asking for USD 14.1 Bn.  Despite budget slashes, WHO is a costly outfit which has 8500 employees scattered in 147 countries. It also runs 6 regional offices in Brazzaville, Copenhagen, New Delhi, Cairo, Manila and Washington. The levels of bureaucracy in such a monstrosity do not help much and they invariably result in unnecessary costs.

For example, the amount of money used in travel and related expenses has come into sharp focus in the past. Over USD 200 Mn is spent on travel and this is more than what WHO spends on mental health problems, HIV-AIDS, tuberculosis and malaria combined. Aljazeera reported in 2017 that the then Director General, Margaret Chan spent USD 370,000 on travel – she was fond of traveling first class.

It seems the lack of fiscal discipline was right from the top.

WHO declined to say if it paid for director-general Margaret Chan’s stay earlier this month at the 1,000-dollars-per-night Palm Camayenne hotel in Conakry, Guinea, but noted that host countries sometimes pick up the tab for her hotel stays

WHO vehemently denied, stating that Chan “strictly abided by WHO travel policies and less than half of its travel costs were on its staff”.

#3 Seven Decades Later,World is still Sick

Among the achievements in WHO’s portfolio are eradication of small-pox in 1979 and “near” eradication of polio in recent times. These are no mean feats but one would hope for more – we are talking 7 decades after all. With malaria still killing 400,000 annually and 90% of this is in Africa alone, these achievements pale in significance.

Whilst all the blame cannot be laid at WHO’s doorstep -African governments for example are not investing in public health as much as they should – such deaths are not exactly an indicator of success in global healthcare.

#4 Slow to Mobilize and Slow to Decide

A big organisation, which cannot speak truth to the powers, dependent on voluntary contributions and walking a myriad of tightropes in global politics cannot be nimble. This is the predicament that WHO finds itself in and the bigger it grows, the more rigid it becomes yet the threats it is supposed to address keep increasing in number and in speed.

COVID-19 has shown how slow WHO is. The first COVID-19 case in China was detected around 17 November 2019. Tedros deferred the declaration of COVID-19 as a Public Health Emergency of International Concern (PHEIC) until 30 January, but he stressed that there was no need to “unnecessarily interfere with international travel and trade”.

#5 Slow to Learn and Adapt

Roughly 6 years ago, Jeremy Youde, commenting on the Ebola crisis, wrote:

The current Ebola outbreak in West Africa has caused more illness and death than any previous one, and we all hope that the World Health Organization is able to quickly and effectively coordinate a response to the current Ebola outbreak. We must remember, though, that many of WHO’s shortcomings in responding to this outbreak are the result of limitations placed on the organization. If we want a WHO that can respond more quickly and with more resources, the international community has to be willing to support such an organization

Between then and now, clearly the international community has not seen the need to free and reinvigorate the WHO and neither has WHO learnt how to adapt to the status quo i.e. that it is is not seen as an organization worth being given the reins to drive real improvements in public health. Strongly shackled, WHO is as reactive and as uncertain as ever.

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