Why do we need the World Health Organization?
‘Lapses’ in controlling the Covid-19 outbreak has raised many questions on the World Health Organization. However, it is important to have a comprehensive overview about the responsibilities as well as capacity of the WHO before we conclude. The critical determinants in the success of any independent organization are usually the participatory members/collaborators, underlying regulatory framework and supporting networks that evolve over time. But where did the WHO go wrong?
Origin
Prior to the existence of international integration and cooperation in handling an infectious disease, each country fended for itself following a classical regime, an old international framework of 1851. This framework mainly highlighted two obligations on its member states:
1. Transparency in reporting outbreaks
2. Limiting the disease prevention measures that restrict international trade and travel.
After the Spanish Flu pandemic and World War II, countries realized that international cooperation would be more efficient with an overarching central independent organization with regards to surveillance of information amongst the member states in the Conventions. This led to WHO’s creation in 1948 and the evolution of the ‘classical regime’ began. WHO Constitutions’ preamble, in 1966, proclaimed a change in the international human rights law leading to the adoption of “Right to Health’’ as a Fundamental Right.
The World Health Organization has evolved over the span of 72 years, and some important aspects of this evolution have made a huge impact today, during the Covid-19 pandemic. Going back a few years could probably help us understand these aspects better.
A Timeline to the Past
In January, WHO informed GOARN partners about the unknown pneumonia clusters in China and immediately activated its Incident Management Support Team (IMST). Since then,
· WHO has been leading the landscape of at least 25 vaccine candidates in clinical evaluation and 139 pre-clinical evaluation. It has carefully led global integration and cooperation in response to the pandemic, which has increased the likelihood of having a safe vaccine distributed across the world by 2021.
· It has provided major recommendations based of scientific evidences that have helped compliant countries save many lives. The organization is also utilizing all its machinery to identify the origin/source of SARS-Cov-2 in China. With intensive efforts, WHO continues to respond to the outbreak in all its capacity.
Reporting from another side, here are some headlines:
In the recent times, media is flooded with articles highlighting a ‘Cover-up’ by China as well as the WHO for a delay in reporting the Covid-19 outbreak and an inability in taking actions to control the same. I have tried to highlight some key determinants that could have led to these speculations:
1. Obligations to Act
In the 1960s, although the vision of WHO was clear, its execution framework was not integrated well with the Member States or even with the old International Health Regulations (IHR).
IHR member states regularly flouted agreements to notify WHO of outbreaks of diseases and misused the outbreak control measures for harming the source countries trade and travel. Bound by the old IHR, WHO did not have the authority to act on the surveillance information it gathered about various outbreaks emerging in member states unless the information came directly from the state in question. The routine failure of WHO Member States to report outbreaks of notifiable diseases not only crippled the surveillance system but also handicapped WHOs outbreak response mechanism. WHO ‘‘may take into account reports from sources other than notifications or consultations’’ from or with States Parties, however, the Organization has to try and obtain verification of such information from the member states concerned before taking action and states must participate in the verification effort.
Unfortunately, it is common to witness countries’ inability to be transparent and report an outbreak promptly. Even after the long-drawn struggle, there is still a strong need of amendments in the International Health Regulations to prevent future pandemics.
2. Non-cooperation and Rebuke for Non-Compliance
The organization has laid down a structured framework for its member states to respond to an outbreak. It developed what it called a ‘‘decision tree’’ to guide its Member States in determining whether a public health risk was of urgent international concern. But many constraints as well as non-cooperation decreased its capacity to enhance global health systems.
With these factors in mind, however, an international independent organization cannot ideally reprimand any member state for non-compliance.
In the early 2000’s, the organization struggled to get strict voluntary compliance to regulations in place, as the WHO informal consultation put it, ‘‘in this age of wide media coverage, nothing can be hidden’’. To overcome the problem of non-cooperation, the Organization extensively utilized technology to build its vast network that could alert the world of a budding outbreak.
3. GOARN — WHOs Proof of Concept
A revelation here would be the fact that working through a handicapped system, the WHO, continued to use technology to expose any cover-ups by the member states. It employed a system called the Global Outbreak Alert Response Network (GOARN) without a formal legal consent through the revised IHR. The WHO went out of the regulatory framework to support Global Health Security, identifying and investigating more than 500 outbreaks in 132 countries from 1998 to 2002. The large network encompassed many non-governmental Organizations and Authorities that helped in surveillance and reporting of an unknown infectious disease by the extensive use of Technology. This indirectly helped in reporting outbreaks early because member states were conscious of their image on a global platform.
In the Covid-19 Era, effectiveness of the GOARN System remains to be a matter of debate and a question of research. It can be anticipated that some major changes await after the Covid-19 pandemic and surely, they could be leading us to a stronger structure of Global Health Security.
We cannot say if the World Health Organization mishandled outbreaks, neither can we deny any politicization, however, the fact cannot be rejected that many countries have been lax in preparation, contribution to global health security and cooperation with the organization with regards to public health measures. We still have a long way to go, so we must prepare ourselves well and prioritize safeguarding humanity over boosting political development of economies. Eventually, it will all come down to a ‘healthy life’ for every individual.
Relevant Resources:
https://www.who.int/bulletin/volumes/85/6/07-100607/en/
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline/
Fidler, David P., “From International Sanitary Conventions to Global Health Security: The New International Health Regulations” (2005). (https://www.repository.law.indiana.edu/facpub/397)
https://www.who.int/ihr/revised_annex2_guidance.pdf
About the Author:
I am a graduate in B.Pharm (Hons.) from BITS Pilani with research experience in healthcare innovation, biomedicine and immunology from Imperial College London as well as the Indian Institute of Sciences, Bangalore and am currently working remotely with the Healthcare Innovation and Technology Lab based out of the Columbia University Medical Center.
