The world needs a better World Health Organisation

The world needs a better World Health Organisation

The WHO has done well against covid-19. But it needs more muscle and more money

According to the Economist, the WHO has done well against covid-19. But it needs more muscle and more money

THE GLASS and metal headquarters of the World Health Organisation (WHO), the UN’s health agency, contrast starkly with their bucolic surroundings in the hills around Geneva. The only dabs of colour are the flags of its 194 member-states. For now the American flag still flutters beside the rest. But if President Donald Trump has his way, by July 2021 it will be gone. America is the WHO’s biggest donor. A tenth of its staff are American. Its influence runs through the agency, right down to the peanut-butter cups in the staff vending machine.

It is an odd time to cut ties with the world’s foremost public-health body. There is a pandemic going on. Mara Pillinger, a health-policy researcher at Georgetown University in Washington, DC, says the WHO has done a “pretty remarkable job” of coping with covid-19, given the constraints built into the way it works. Nonetheless, the twin threats of Trumpism and coronavirus have illuminated both the agency’s strengths and its weaknesses, and raised questions about its future.

The WHO’s emergency work is governed by a legal framework known as the International Health Regulations, the current version of which has been in force since 2005. They spell out how public-health emergencies should be handled. They set the rules for how nations should behave. And they constrain the WHO. Member-states are bound to report outbreaks of diseases as soon as they can, but if they fail to do so, or delay as China did with covid-19, the organisation has no way of compelling them.

Before 2005 the rules were different. Gro Harlem Brundtland, a former Norwegian prime minister who led the WHO from 1998 to 2003, slammed China for failing to report an outbreak of SARS promptly in 2003. Those days are gone, she says; member-states have now limited what the head of the WHO can do and say. Tedros Adhanom, the current director-general, has not openly criticised China. But nor has he lambasted America, points out Jeremy Hunt, a former British health secretary. Such tact is crucial. UN bodies work by consensus, he says: “That is the price you pay for getting all the countries in the world around the table.”

Ordinarily the job of the WHO is to identify the best public-health measures, share that information and offer technical support to members that need it. It is the main forum where countries co-operate on matters of health. The practical work of public health is not its job. However, when others fail it will step in. It has provided mental-health services in Syria and airlifted ambulances into Iraq. It failed in its response to an outbreak of Ebola in West Africa in 2014 which killed more than 11,000 people. But when the disease struck the eastern Democratic Republic of Congo in 2018 it played a leading role in bringing it under control. When others thought it too dangerous to send staff into the field, the WHOstayed. Two staff were killed by rebels, who often attacked clinics. Dr Tedros visited Congo 14 times, showing unusual pluck for someone in his position.

WHO are you

The WHO was central in the eradication of smallpox, a disease that killed almost 300m people in the 20th century. It has helped almost wipe out polio, which in the 1980s paralysed 350,000 people in 125 countries each year. The disease is now found in only three countries. The WHO receives information from countries on outbreaks, organises vaccination programmes and often acts as a kind of vaccine-approval agency.

One problem for the WHO, argues Dr Pillinger, is that much of its work is invisible. It co-operates closely with governments and lets them take credit for its efforts. When things go wrong, of course, it makes a convenient scapegoat, as Mr Trump has realised.

Its response to covid-19 has come under intense scrutiny, as it should. Dr Brundtland thinks the WHO declared the outbreak a public-health emergency far too late. That could be because China, once again, withheld information about a novel outbreak. It was, she says, “concealing and waiting and shouldn’t have done, according to International Health Regulations”.

Some say the WHO was too slow to issue guidance on the use of dexamethasone, a drug that can treat some of the sickest patients. Others have blasted it for dragging its feet before promoting the wearing of fabric masks on buses and in shops. Initially it did not have the evidence on which to base such guidance, explains Maria Van Kerkhove, a WHO epidemiologist. It needed to know whether masks would be available and what the science said about the efficacy of the widespread use of the fabric kind. It asked researchers at Stanford University to investigate. On the basis of their research in June it changed its advice to say that such masks should be worn in public where physical distancing is impossible.

But overall the organisation has responded to covid-19 swiftly. At the start of the outbreak officials worked with technology and social-media companies to encourage them to promote accurate information. It coined the phrase “infodemic” to describe the rapid spread of misinformation about the new virus.

It has helped co-ordinate global efforts to find treatments and vaccines. It is working with drug firms to safeguard the supply of medicines. It is now a key player in COVAX, a plan to distribute 2bn doses of a covid-19 vaccine in 2021. The WHO has rushed to digest research produced at high speed and explain what it means. Behind the scenes member-states are regularly told where the WHO thinks their measures are not aggressive or comprehensive enough. Click here for the complete article

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