Why the WHO failed during COVID–19
Lee Jones explains how neo-liberalism undermined the WHO’s COVID-19 response
The World Health Organization (WHO) was one of the first casualties of the COVID–19 pandemic. While initially prominent, once the virus had escaped China, it was quickly marginalized. The 2005 International Health Regulations (IHR) — the cornerstone of global health governance — were ignored as states engaged in uncoordinated, improvised and often mutually harmful responses. Indeed, the miserable failure of these responses only highlighted how badly the WHO had prepared the world for a pandemic. So, what went wrong?
Not enough power?
Many have argued that the problem is that the WHO’s member states never gave it enough authority over them. Consequently, it lacked the clout to enforce the IHR. The answer, therefore, is a new pandemic treaty or revised IHR to give the WHO more power.
This argument assumes that global governance must involve transferring power from states to supranational organizations. But that is not at all how states have behaved in reality — nor is it realistic to expect them to behave this way in the future.
As Shahar Hameiri and I have argued, the WHO and its member states have actually pursued global governance through state transformation (GGST). They have sought to create consensus on international objectives, and then develop detailed policy guidelines, soft law and regulations which states are then meant to implement. The objective is to transform states’ domestic operations so that they serve global agendas — not local ones. Nation states, previously responsive to domestic demands and constituents, are thereby transformed into member states, whose policy direction is set in elite forums and legitimized by technocratic expertise. International organizations like the WHO were never intended to manage issues directly. They instead act as ‘meta-governors’, generating the principles, regulations and policy templates that states should follow, then measuring compliance through technocratic benchmarking exercises.
It is this approach that failed so disastrously during the pandemic.
Pursuing GGST seems very clever, because it deliberately circumvents politics. But as Hameiri and I explain, it has two critical weaknesses, which were exposed during the pandemic.
First, policy-making becomes undemocratic. Policy objectives and implementation are not publicly discussed or ratified; they become technical questions discussed in inter-elite forums. This can cause weak support for policies, and limit their real world effectiveness.
Second, implementation has also been compromised by the hollowing-out of state capacities under neo-liberalism. GGST is itself enabled by the neo-liberal transformation of the state, which has fragmented and dispersed authority, enabling the empowerment of inter-elite technocratic networks. But ultimately, the rules they create must be implemented on the ground. And yet, successive waves of privatization and austerity — often promoted by these same networks — have profoundly weakened states’ capacities to manage health crises. GGST is therefore built on a foundation of sand.
A failed response
Both of these problems were exposed by the COVID–19 pandemic — though they were visible far earlier. As of 2019, the WHO reported that only a third of the IHR’s requirements had actually been implemented by states. When the pandemic hit, even this figure was shown to be a fiction, as the world’s wealthiest countries quickly fell into disarray.
These states’ pandemic preparedness strategies had all faithfully implemented the WHO’s guidelines. But, in line with their undemocratic policy processes and hollowed-out state capacities, they had done so on the cheap. They produced reams of bureaucratic documentation, but failed to invest in material capabilities needed to cope with a pandemic. In fact, their capacities had been run-down, with laboratories shuttered and even equipment stockpiles privatized.
When these problems were revealed, the public understandably panicked. With no public scrutiny of pandemic preparedness, they were unprepared to accept the laissez-faire, ‘business-as-usual’ plans developed according to the IHRs. They demanded lockdowns, and most politicians — themselves panicking and fearful — were powerless to resist.
This was, in part, because the WHO itself effectively endorsed lockdown, despite this not featuring in any of its previous guidance, precisely because it would (as subsequent analyses have confirmed) do more harm than good. This endorsement was itself an ironic effect of the WHO’s transformation in the neo-liberal era.
During the Cold War, UN agencies like the WHO had been swept up by calls from Soviet Union and Global South for a New International Economic Order. The WHO consequently became involved in helping developing countries build their public healthcare systems. But with the turn to neo-liberalism, powerful donor states starved the WHO of its resources, bending it to their will. The WHO dutifully joined the drive for healthcare privatization, issuing bureaucratic guidelines and then telling poor countries to implement them at their own expense. It is hardly surprising that they were ill equipped to fight a pandemic. And so was the WHO, with an emergency operations budget of just $154m in 2018/19.
The donors’ transformation of the WHO into a cash-strapped meta-governor also meant it was predisposed to be highly sycophantic towards China when COVID–19 struck. Where the WHO had been highly critical of China during the SARS outbreak in 2003, by 2020 China was a major donor country, with the potential to contribute much more. Indeed, when President Trump announced a US boycott of the WHO, China became its biggest donor, pledging US$2bn. Coupled with the need to secure Chinese cooperation, this gave the WHO a strong incentive not to alienate Beijing. Officials praised China’s ‘transparent’ conduct as ‘very impressive’, ‘incredible’, ‘beyond words’ and setting ‘a new standard for outbreak response’. The WHO effectively endorsed the CCP’s authoritarian lockdown policy, jettisoning its own guidelines. The rest is history.
The upshot is that we need to worry less about the weaknesses of global governance and more about the weaknesses of the state. Without responsive, democratically accountable and well-resourced states capable of serving the public good, no amount of treaties, international laws, policy templates, regulations and blueprints will save us. To rebuild from the pandemic, we have to start not from the top down, but from the bottom up.
Read more on the WHO’s COVID-19 response here.
Lee Jones is Professor of Political Economy and International Relations at Queen Mary University of London.
His article, ‘Explaining the failure of global health governance during COVID–19’, co-authored with Shahar Hameiri, was published in the November 2022 issue of International Affairs.
All views expressed are individual not institutional.