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What’s next for the WHO?
As the World Health Organization celebrates its 75th anniversary on April 7, it is preparing to put the COVID-19 pandemic behind it by declaring an end to the public health emergency sometime later this year. Yet it won’t be easy for the UN agency to rehabilitate its reputation after the criticism received for its handling of the world’s worst health crisis in 100 years.
We asked Eurasia Group public health expert Laura Yasaitis to provide some perspective on the WHO’s long history and where it goes after COVID.
As it turns 75, what are the WHO's main accomplishments?
Probably the most outstanding was the complete eradication of smallpox, a remarkable example of international coordination to achieve a public health goal. WHO officials worked with countries to encourage widespread vaccination, as well as donations of the vaccine, and the US and the Soviet Union were both major donors. WHO consultants were dispatched around the world to identify and respond to outbreaks quickly, even in war-torn and poverty-stricken locations such as Somalia, which saw the last natural case in 1977.
The WHO’s efforts to improve childhood vaccination around the globe have also brought about the near eradication of polio, while efforts to prevent and treat malaria have helped dramatically reduce the range of the disease and improve outcomes for those infected.
And failures?
As the organization has grown and taken on an expanded mission, it has become overstretched and overly bureaucratic. These shortcomings were blamed for the slow response to the Ebola outbreak that began in West Africa in 2014 and lasted until 2016.
Yet many of the organization’s perceived failures can be traced to the constraints within which it operates. Only 16% of its budget comes in the form of dues. The rest comes from large donors and is earmarked for specific causes, which means the WHO is limited in pursuing its own priorities. Furthermore, it relies on the goodwill of countries to follow its recommendations; even the legally binding International Health Regulations, which require reporting of specific diseases and public health events, are essentially unenforceable.
What did the WHO do well during the pandemic?
The WHO helped coordinate data sharing among countries, providing invaluable information that helped experts to track and better understand the novel virus. Without a central source of trusted scientific information, it may have taken the world far longer to understand what it was up against. The WHO also co-led COVAX, which aimed to equitably distribute COVID vaccines to all countries, rich or poor. While the group fell far short of this goal – largely because wealthy nations hoarded the initial production of most vaccines – the framework it established may provide a model for future pandemics.
What did it not do so well?
The WHO has been faulted – including by an independent committee it established to review its response – for waiting an extra week before declaring a Public Health Emergency of International Concern, the highest level of emergency. Much of the delay was attributed to its regulations on reporting of public health incidents, which forced slow consideration of the data. These regulations also recommend against declarations that could hurt a country’s economic activity. Furthermore, the organization’s messaging – it does not officially define the term “pandemic” and didn’t use the term until two months after a PHEIC was declared – was faulted for its lack of urgency. That may have contributed to inconsistent and ineffective responses at the national level.
What about its relationship with China?
The WHO was accused of unwarranted deference to China early in the pandemic, both in delaying its PHEIC declaration, and in the public praise lavished on the country for its initial response. The most prominent criticism came from Donald Trump, who in July 2020 declared that the US would withdraw from the organization (though US President Joe Biden reversed the decision when he took office). The WHO-China relationship soured somewhat after the first phase of an investigation into the virus’s origins, which included the lab leak theory, even if “extremely unlikely”; China vehemently opposed any mention of the possibility. Then, earlier this year, China refused to release data revealing the scale of a massive outbreak, despite its legally binding commitments to do so. Yet WHO officials praised the limited releases of data, and largely avoided criticizing the country despite what international experts asserted were highly inaccurate official infection and mortality rates.
Will we ever know where the virus came from?
At this point, it’s unlikely, at least with enough certainty to convince the vast majority of skeptics given that the science has become highly politicized. China has stonewalled further WHO-led investigations after the lab-leak theory was included in the phase one report, forcing the WHO to quietly abandon plans for additional study. Other independent research continues; for example, data released last month supported animal-human transmission as the original source. However, given the length of time that has passed, and the many people who have made up their minds on both sides, it’s far more likely that the issue will continue to be a political football.
In light of all this, how is the WHO reforming itself?
There have been many calls for reforming the WHO and its powers to grant it more authority to investigate and respond to disease outbreaks. However, given the importance of assuring member states’ sovereignty, and the political and economic implications of being named the source of a major disease outbreak, establishing an independent, powerful, WHO remains an uphill battle. Nonetheless, some reforms are being pursued that will allow increased independence. It was recently announced that sources of the organization’s funding would shift over time to be at least 50% comprised of membership dues by 2030-2031.
What is the WHO doing to ensure it's better prepared for the next pandemic?
The WHO is trying to learn from the mistakes of the past few years. The most ambitious effort may come in the form of a new legally binding pandemic prevention, preparedness, and response treaty. A draft presented in February lays out a framework to ensure equitable distribution of vaccines and treatments and provide incentives for poor countries to participate in the data sharing that is needed. However, a big question is whether the provisions will be backed by adequate enforcement mechanisms. The WHO’s authority and credibility has been badly damaged by the pandemic, a situation that will need to be rectified if it is to lead a global health response to the next pandemic.
Edited by Jonathan House, Senior Editor, Eurasia Group.