The World Health Organization (WHO) has come under severe fire for a visible lack of institutional integrity during the unfolding of the Covid-19 pandemic. Instead of leading from the front, the WHO has instead become a Cheshire Cat that has only attempted to placate a country which foresees itself as the next global superpower. This brazen partisanship displayed by the WHO has been easily discerned by the Global community who have become vociferous advocates of the WHO undergoing reform. The critics argue that the organization has failed to discharge its central duty of saving lives by making transparent communication subject to a veto by a rising China. This critics argue does not befit the institution and underscores the need for the institution to undergo reform or risk losing relevance. An equal amount of attention also needs to be directed in understanding how the WTO & the Chinese Government came together in an unholy matrimony.
The founding members of the United Nations (UN) and a handful of other countries signed the constitution of the WHO in July 1946. WHO’s constitution came into force in April 1948, when a majority of the UN member states ratified the constitution. It adopted a grand global aim - “the attainment by all people of the highest possible levels of health”. It achieved its first success, the eradication of smallpox in 1979. This was driven by a risk management strategy that paid attention not only to functional capabilities and immunization research, but also vital diplomatic and organizational roles.
The lessons learnt while combating small pox were deployed again in 2003 during the SARS outbreak. The WHO in that crisis was ably led by its then Director-General Dr Gro Harlem Brundtland. Her bold steps and comprehensive approach of relying on her own diplomats and ground workers in addition to the governments of states for information, was successful in controlling the spread of SARS from China. China even during the SARS outbreak made valiant attempts at concealing information. Brundtland on the other hand had other ideas. She took aggressive steps which included dispatching her team for an audit, which cajoled China to divulge crucial data. This coupled with a series of reasoned steps ensured that the WHO led by Brundtland could restrict the number of deaths to 1000 people worldwide.
In this backdrop, the current response of the WHO, with Dr Tedros at the helm has been woefully inadequate and is likely to have a long lasting impact on the international legitimacy it commands. The WHO during the earlier stages of the pandemic seemed more keen on using its press releases to rid the Chinese of their guilt rather than warn the world of the imminent.
President Trump, a staunch critic of the WHO’s current response, has made his annoyance known by withdrawing his country from the WHO, alleging that the organization “stood behind China’s ‘disinformation’ about COVID-19”. The USA’s departure from the organization is significant because it contributes a fourth of WHO’s statutory contributions and a seventh of its voluntary contributions. Withdrawal of US support at this juncture when the organization is at the abyss in terms of its credibility is a cause of worry for those that believe in the need for an international healthcare system. The USA's decision has understandably drawn ire from global leaders.
China’s contributions, when compared with the contributions of the US, are paltry at 8% of the statutory contributions and 0.21% of the voluntary contributions. China’s voluntary contributions (0.21%) are lower than even Pakistan’s (0.36%). Despite its low contributions to the budget, China’s disproportionate influence over the WHO raises further eyebrows and compels one to explore the political dimensions of the issue. Experts argue that either the incompetence of Dr Tedros or worse still his alleged complicity with the Chinese government needs to be looked into as it has bruised the credibility that the organization commands. A section of scholars point out that during his time as Ethiopia’s foreign minister, Dr Tedros had forged close relations with the Chinese leadership. In a visible display of quid pro quo the Chinese played a crucial diplomatic role in vouching for his candidature through their international missions, and pushing him to the top role at the WHO.
The professionalism of Dr Tedros has also been called into question. Experts point out that his track record in managing pandemics has been below average as seen during his attempted cover-ups of the cholera outbreaks in Ethiopia. Human rights activist Kassahun Adefris, expressed reservations about Dr Tedros’s appointment. To quote Kassahun, “When he was the Minister of Health in Ethiopia, many people lost their lives because he covered up cholera epidemics” and it is “highly questionable to nominate someone for a position like this when they have made such grave mistakes”. Human Rights Watch criticised the nomination of Tedros as a WHO Director General for his association with “an authoritarian regime that persecuted members of the opposition and journalists in Ethiopia”. A circumspect leader, covered neck deep in allegations of lack of morality as Ethiopia’s health minister, would in the normal circumstances guarantee disbarment of a candidate from the top job at the WTO. The appointment of Tedros points to structural deficiencies plaguing the WTO.
Structural deficiencies have been further exacerbated because of the circumspect efforts of the leadership in cajoling information out of China. However, the warning signs were there earlier as well. WHO’s structural deficiency was apparent during the ebola outbreak in Africa. International Health Regulations (IHR), adopted in 2005, grants the authority to WHO to take actions that can challenge the way governments exercise their sovereignty when it comes to global pandemics. IHR inter alia grants power to WHO Director-General to “declare a public health emergency of international concern” despite objections from a concerned state. However, during the Ebola outbreak in West Africa, WHO failed to act decisively upon the information it received from non-governmental sources. The WHO did not challenge the governments that wanted to hush up the ebola outbreak. It did not declare Ebola as a public health emergency of international concern until it already became a crisis. The poor implementation of IHR displayed deficiency during this epidemic. UN Secretary General Ban Ki-moon had to create an ad-hoc emergency response to offset the damage done by the WHO’s weak response. WHO became the subject of criticisms on its performance during Ebola, its incompetence in exercising political leadership under IHR and its capabilities to respond to serious disease events. Six years down the line, WHO has repeated its mistakes from Ebola on a much larger scale during the unfolding of the COVID-19 pandemic.
The WHO’s behaviour in the past decade reveals, that unlike its behavior while combating small pox and the SARS, it has chosen not to exercise its authority to challenge erring governments. On the other hand, the WHO has been predisposed towards deploying its bureaucratic machinery solely for demonstrating its technical capabilities. This non-confrontational approach has put WHO in a tough spot in managing emergencies like the COVID-19 pandemic or the Ebola outbreak. It is a tragedy that the WHO continued to tow the Chinese line for the fear of losing Chinese cooperation.
COVID19 pandemic should therefore become a turning point for WHO reforms. What could these reforms be? First, there is an urgent need to diversify the funding structure of the organization in a manner commensurate with the goals of the WHO. It is, at present, overly dependent on a few donors like the US, the Bill and Melinda Gates Foundation, etc. The aim of the organization is often inconsistent with the objectives of the donors and that leads to a fluctuation in funding.
Second, WHO should devote more resources on research, identification and contingency planning for tackling future pandemics. Resource allocation for maintaining a rigid bureaucratic structure that lacks agility because of uncoordinated information dissemination from the regional offices to the headquarters needs to be reviewed. The WHO spends less than 20% of its budget for pandemic identification and mitigation. Third, strengthening the IHR is a prerequisite for soliciting compliance from erring countries and avoiding situations like COVID-19. While reforming IHR to make its implementation stricter, the WHO can consider imposing costs on countries that do not comply with the prescribed standards. The prescribed standards and minimum adherence standards of countries vis-à-vis IHR can itself be fine-tuned to allow for relevant data reporting regularly and allowing WHO technical teams to study complex situations at the site of occurrence. Fourth, coordination between regional offices and the headquarters must be fine-tuned by creating a command structure that allows for smooth passing of information between individual regional offices and between the regional offices and the headquarters in Geneva.
Finally, reforms need to push forward emergency response teams that function independently of the WHO bureaucracy, have dedicated funding of their own, and are responsible directly to the WHO’s executive board. There are many more significant reforms like improving the manuals for declaring an international emergency that member countries need to push forward, but the above five should be of utmost priority.
Prime Minister Modi has already called for a coordinated global effort towards the pandemic and hinted towards a need to reform the WHO in a virtual meeting of the G20 leaders. The structural safeguard that run a global organization like the WHO will have to be cognizant of the changing geopolitics. WHO needs to command legitimacy to maintain its stature in the world. Scholars acknowledge the significance of public trust in public health and medicine. Trust is at the core of legitimacy of healthcare institutions. Structural reforms resulting in strengthened support for operational capacities of WHO would re-institute its diminished yet the most valuable asset - trust. Until WHO reforms are pursued with vigour, the snake coiling the Rod of Asclepius will continue to envenomate the organization’s global legitimacy.