Why the WHO is failing and how to fix it

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The maligned World Health Organization (WHO) faces its biggest crisis since its inception in 1948. Critical questions about whether China reported the novel coronavirus to the WHO promptly expose a sustained governance flow which the global health security regime builds upon—where national sovereignty has always trumped mutual responsibility. While the nation-state is primarily responsible for the health of its population, building a global health regime based on national sovereignty has proven disastrous.

Countries have turned inward despite the pandemic requiring a global concerted effort. The United States has reasserted its nationalistic position; China has launched a propaganda campaign to reshape the narrative on the coronavirus through savvy use of social media. The social fabrics of liberal democracies are further under assault: Russia is accused of using disinformation to destabilise democracies. The WHO, established as a specialised health agency within the United Nations system, is under intensified scrutiny, undermining the organisation’s ability to lead.

Global health and politics

While global health is, has been and always will be, political, that does not mean geopolitics should be the dominant global health discourse. But it is. Part of the reason lies with the International Health Regulations (IHR) specifically and the WHO governance structure more broadly. The IHR, while a legally binding instrument, is only as effective as member states are willing for it to be. To that end, so is the WHO. This is, in part, because of the concept of sovereignty. The WHO is overseen by 194 member states with varying power of influence. Yet, as a member-states driven organisation, the WHO is only as effective as countries that participate in the regime. This has seen the WHO shuffle between positioning itself as a normative and a technocratic agency throughout its existence.

While scientific cooperation has intensified across borders with the emergence of COVID-19, the WHO’s institutional credibility has taken a notable plunge. The 2005 IHR was designed to foster global solidarity above national sovereignty. The power to declare a public health emergency of international concern was envisaged to empower the WHO director-general to shape the political context during an outbreak; Articles 9 and 10 of the IHR further authorise the WHO to collect disease event information from non-governmental sources and seek verification from the member state. It remains unclear if the WHO did so with China: the WHO has no enforcement power to compel China to verify the information. The IHR builds on liberalist assumptions of compliance through transparency and openness. Yet in the absence of strong enforcement mechanisms, countries have little incentives to cooperate.

National sovereignty is a double-edged sword

Constructing an international infectious disease regime based on sovereignty is a double-edged sword. As the regime is intended to encourage international cooperation, it is deliberately designed without a “naming and shaming” component. As such, while member states are required to report their implementation progress of the IHR through electronic submission to the WHO beginning in 2018, reporting does not necessarily mean member states have taken the necessary steps to improve their pandemic preparedness.

This is chiefly because the IHR relies on state parties to conduct self-assessment on their pandemic preparedness, which has seen state parties presenting themselves in the best light possible. The voluntary evaluation process on pandemic preparedness entails dialogues between the WHO and government officials, which often excludes consultations with civil society organisations (CSOs) and non-government organisations (NGOs). Without governance mechanisms to engage with non-state actors and non-members, there is limited external accountability for both the WHO and member states. For instance, the WHO has pointed out in a 2016 report that the United States’ decentralised public health system brings challenges to a coordinated federal to state to local response, which in retrospect, was a chilling warning that failed to sound the alert.

The need for inclusive participation

The diminishing space for CSOs as well as the lack of engagement with WHO non-members is concerning.

Civil society organisations are deeply engaged in caring for communities and monitoring governments for human rights violations. Past success in containing the AIDS pandemic is illustrative. Likewise, in the international human rights regime, CSOs have helped raise awareness on existing social inequalities and to hold states accountable through shadow reports. While the WHO’s engagement with CSOs in general has improved with the adoption of the Framework of engagement with non-state actors, engagement remains limited with those in “official relations” with WHO.

Likewise, the exclusion of Taiwan from the annual World Health Assembly (WHA)—the WHO decision-making body—due to political pressure from China also highlights the dilemma. Widely applauded for its COVID-19 response, Taiwan’s success so far further underscores the island-nation’s visible invisibility in the WHO, where China claims Taiwan as part of its territory (which is disputed by Taiwan). This has seen the WHO muddling uncomfortably in an unfamiliar territory of geopolitics.

Similarly, a global COVID-19 response involves more than just the governments. Increasingly, the WHO is relying on technology giants such as Google, Facebook, YouTube, and Twitter to combat harmful information during the COVID-19 pandemic collaboratively. While these social media companies are acting responsibly, the alarming spread of misinformation (where the content is believed to be true and is shared with the intention of being helpful), and disinformation (where the content is intentionally false with the intention for private gains) is concerning. The proliferation of this type of information – termed as “infodemic” by the WHO – around the world undermines and dangerously endangers public safety. While many countries have resorted to use emergency decrees to mitigate “infodemic”, the use of emergency powers also carries the risks of curtailing the freedom of expression, as legitimate journalism is also affected. Insofar as the freedom of expression is a fundamental human right, the responsibility to protect lies with national government. Yet, as a global health agency, the WHO also plays a complementary role, for instance, encouraging evidence-based information sharing, ethical conduct within journalism and for internet communication companies. As the governance structure of the WHO remains state-centric, the arrangement is ill-equipped to reflect the changing global health landscape. In the post-pandemic world, there needs to be a critical assessment of how the WHO can support and protect the freedom of expression and meaningful realisation of UN Sustainable Development Goal (SDG) 16 (public access to information) and SDG 3 (good health and well-being for all).

Committee C

With the world in an unprecedented lockdown—affecting individuals in authoritarian states and liberal democracies alike—in a post-COVID-19 world, the international infectious disease control regime must move beyond the construct of states. To be sure, national sovereignty remains important in the international disease control regime, but a post-COVID reform must include governance mechanisms to improve trust and inclusive participation. These governance weaknesses mentioned above are not limited to the IHR but reflects the institutional weakness of the WHO more broadly. Elements of good governance— inclusiveness, transparency, and accountability—are currently lacking in the operations of the WHO.

A little over a decade ago, Gaudenz Siberschmidt, Don Matheson, and Ilona Kickbusch proposed the addition of a committee to the WHA, which aims to improve transparency and accountability of the WHO. Accordingly, “Committee C” is envisaged to facilitate constructive debate on major global health initiatives, allow diverse global health actors to present and share their achievements in the global health arena, and address coordination challenges in global health.

The establishment of a Committee C will not be a panacea to the ills of the international infectious disease regime, but by broadening participation at the WHO, it would move the discourse by recognising individuals, not states, for which the WHO ultimately serves and from which it draws its moral legitimacy.  

 

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