The WHO. A once in a lifetime rock and roll band combining punching chords with fizzy melodies and tub-thumping lyrics. Songs arguably befitting to this ongoing and punitive pandemic: I Can’t Explain (the world as it could become); Substitute (to a new normal please); Pictures of Lilly (if only); and My Generation (the consequences now but to the future too). This is before sampling undoubtedly most people’s overarching emotion: Had Enough! Alas, this article is not designed to regale the genius of Daltrey, Townshend, Entwistle and Moon. Yet rather on the namesake: The World Health Organization aka The WHO.
It has become axiomatic, or at should it be, that the world has changed, continues to change, and will continue to change. Many searching questions remain on the future and when this pandemic world will cease to be, whilst reflection must continue on the critical lessons learnt and how future infectious disease threats should be handled. It should be unequivocal that vaccination is the only way the world gets through and out of this pandemic yet one crucial area of international policy that remains less clear is the role and purpose of The WHO.
Formed in 1948, the WHO’s defined primary role, as a special agency of the United Nations, is to coordinate international health and lead on global health responses. Yet definition and reality are two very different things. The WHO’s effectiveness and leadership have been placed under significant scrutiny.
Although the Biden administration’s immediate executive order to reinstate the US as a member of The WHO is welcome – and reverses the egregiously polemical and deeply absurd decision of the Trump Presidency whose modus operandi was always to irresponsibly shift the blame – there is no escaping the bigger questions around The WHO’s performance strategically, organisationally and politically.
Just as it is clear that infectious diseases never respect borders and are antithetical to geography, meaning the need for international coordination is always key, the “return of the Americans” should not mask the need for urgent reform. Trump was wrong on the ultimate decision as were his solipsistic finger pointing motives, but that does not mean The WHO can credibly be described as a beacon of brilliance and apotheosis of excellence.
Strategically, the WHO has been struggling to cement, communicate and understand its own role during this pandemic. Many developed countries have essentially “gone it alone” following their own evidence, data and strategy when it comes to virus control, lockdown and counter virus measures, and the procurement of vaccines. Despite regular postulations, the WHO has failed to cut through and the world has gone off in different directions. Although some differences from country to country should be expected due to contrasting demographics, population health profiles and geography - never mind cultural norms and social acceptability - The WHO has largely been consigned to the stands as a spectator whilst nations have battled the virus on the pitch. Even as the world has entered a perpetual extra time and penalties with repeat lockdowns and stringent transmission measures, few have looked over to The WHO to strip down and come off the bench as a much needed substitute.
There is also the fundamental strategic question of focus. A critical concern must be middle-income countries who perversely are arguably highest risk of ongoing COVID and pandemic meltdown given their limited healthcare systems and structural capabilities to roll out mass vaccination programmes, whilst simultaneously dealing with a rampant R and strain mutations with the grim consequences for hospitals and society. Developed countries in the main are well equipped to handle these imperatives, despite differences of success on the overall scorecard, and hold the infrastructure and public reach to deliver fulsome pandemic responses. Vaccination programmes are complex realities demanding experience, high expertise and delivery capacity. Lower income countries, despite their intrinsic challenges with poverty and deprivation, are well aided by powerful organisations such as the UN, UNICEF, GAVI and The Gates Foundation. Although their challenges should never be underestimated, such countries benefit from holistic support and are therefore in a better place to succeed. The WHO should be filling the gap with middle income countries, but strategically and practically it is not really at the races. This prompts question of organisation and organisational presence.
Organisationally, many have questioned The WHO’s budget, global locations and structure. Many have criticised “lavish budgets” and “big staffing levels”. It is not the purpose of this article to debate the merits or demerits of this important topic, but to rather question whether The WHO is structurally set up to succeed and moreover focusing in on the right problems.
The lack of presence in middle income countries is concerning yet also the overly academic feel to an organisation which, although must always be scientific and factual at its core, must place greater emphasis on its practice and what its offers countries in times of crisis but also how it shapes the policy debate to encourage and motivate greater prevention across the global policy spectrum. It is difficult to rank highly The WHO’s achievements in this regard with a par score at best.
And then there is the business of politics. The WHO, as seen by wayward US politics, is not immune and this points to a wider issue of communications. If the art of communication is not just what you say but also how you say it, The WHO has struggled with this imperative. The need for a clear narrative on its own role and value offering has lacked a political astuteness to match the scientific pedigree and pedagogic expertise. The fact a bile throwing Donald Trump was able to gratuitously position his argument and galvanise some support says it all. Like a boxer beaten to the punch, The WHO has bounced off the political ropes with no clear political strategy and often been caught complaining to the referee.
For all its scientific raison d’etre,The WHO is ultimately funded by politicians via governments and so there must be a political antenna to its way of being. This demands a political strategy and enhanced “public affairs”. To avoid doing so is a recipe for ongoing isolation.
The recent act of political thuggery from a peevish EU embodied in effectively the illegal threat of enacting Article 16 – thankfully reversed following a day of dawning, some serious Irish pushback, and all coming from the real politique of impending German, Dutch and Italian elections where the incumbents face public roastings from angry voters – also has sadly highlighted the missing link of The WHO. These sorts of international disputes demand international leadership and it was missing. For now, The WHO despite its need to lead, coordinate and sprinkle the world with its scientific capabilities is in danger of becoming a toothless tiger. And it is from that premise the time has come to “get the band back together” and deliver a strategic, organisational and political vision to its global public. So less of The WHO and more focus on the what, how and when. Without it, everyone loses and the threat of infectious diseases only grows. As Pete Townshend once wrote, you better you bet.
All views expressed are my own and do not represent the opinions of any entity.
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