Should the USA have cancelled funding to WHO?
WHO is the UN agency charged with spearheading international public health efforts — but does it do a good job?
WHO is a large organisation with a Head Office in Europe, a Global Service Center in Malaysia, six regional offices all over the world and country offices in nearly 200 countries. It employs more than 7000 people from more than 150 countries. It is one of the major UN organizations, and was established in 1948, three years after the UN was established.
The bureaucracy
Have you ever tried to get planning permission from a local council? What about trying to get information from a state government? Even worse, how about getting help from the federal government? Well, WHO has 194 member states, each with a vote, which is a bit like herding nearly 200 cats! It is a major bureaucratic organization and therefore has all of the foibles and difficulties that a bureaucracy has, with the added complication of having six official languages — Arabic, Chinese, English, French, Russian and Spanish.
Added to this highly complex bureaucratic structure, key leadership positions including that of the Director General, are political appointments rather than based on public health expertise. However, under these leadership positions, WHO has some of the best public health experts in the world.
WHO’s major successes
Over its 70-year history, WHO has had some outstanding successes. These include campaigns against malaria, yaws, and tuberculosis, culminating in the eradication of smallpox in 1977. There is no doubt that these have saved millions of lives.
In the 1970s while I worked at WHO, it was at the forefront of primary health care, organizing the Alma-Ata Declaration of 1978, which was a major milestone of the twentieth century in the field of public health. The declaration stated “An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world’s resources, a considerable part of which is now spent on armaments and military conflicts”. Well we haven’t quite reached health for all even in 2020, but the sentiment still rings true.
Unsung technical role
Although most people have heard of WHO’s response to epidemics such as Ebola virus, SARS, MERS and of course now COVID-19, WHO does an enormous amount of work in other areas. It convenes expert groups on all major health areas. Its encouragement of breast feeding and its campaign to immunise children in developing nations against diphtheria, tetanus, whooping cough, poliomyelitis, measles and TB stand as proud achievements.
WHO also assists less-developed countries establish decent health services and it has established a list of essential medicines, helps countries develop services for people with dementia — and the list goes on.
Importantly, WHO publishes the Annual World Health Statistics report, provides technical support to countries to help them collect accurate health statistics, and maintains the International Classification of Diseases (ICD), used by every country in the world.
The failures
WHO like every major organization has had its scandals (sexual, financial etc) over the years. And sometimes it has failed in its public health response; like its management of the 2009 H1N1 pandemic and of the 2014 outbreak of Ebola Virus Disease (EVD) in West Africa which was pretty much a fiasco. President Trump’s criticism of WHO’s response to the COVID-19 pandemic is probably valid. WHO is subject to enormous political influence from countries like China, and as I pointed out earlier, the leadership are political appointments. It is well known that China supported the current Director General Dr Tedros Adhanom Ghebreyesu’s appointment to the position.
President Trump is also justified in his criticism of the UN. It is a toothless, bureaucratic monolith, hamstrung by vetoes in the General Assembly. Many of its specialized Agencies are even worse —for example, the UN Human Rights Commission, whose member states contain some of the World’s worst abusers of human rights.
However, WHO is one of the few UN Agencies that actually does a lot of good — it is more like what the UN should have been all about. Notably, WHO is a UN Technical Agency, not a political one.
Despite this, its senior executives are political appointments, which probably has a lot to do with its current poor handling of the COVID-19 pandemic. The people of Lebanon were recently on the streets crying out for its government of corrupt politicians to be replaced with technocrats. Perhaps this major deadly pandemic might be a good wake up call for the countries of the world to appoint leading public health experts to the top positions in WHO, rather than the current system based on color, race, gender, nationality, and political alignment.
Is WHO perfect? — absolutely not. Does it need some major changes at the top? — yes. However, it is the best we have out there, by and large does a brilliant job, and certainly does not deserve to have its funding reduced.
I do hope you enjoyed this article. I have written several other about COVID-19. Here are the links:
COVID-19 — facts and fiction
Infectious diseases and their impact on civilisation
Epidemiology and infectious diseases
Are the statistics we see in articles about the Coronavirus accurate?
A fascinating history of clinical trials from their beginnings in Babylon
Should the USA have cancelled funding to the WHO?
