We reflect on why we need the World Health Organization now more than ever.
A crowd-sourced list of global health ‘epic failures’ on the Nature Research Microbiology Community site that is being coordinated by Dr Madhukar Pai, Canada Research Chair in Epidemiology and Global Health at McGill University, Canada, recently caught our attention 1 . There are several mentions of the World Health Organization (WHO), ranging from criticism over their slow response to the emergent Ebola disease in West Africa, the chronic problem of underfunding by member states, the failure of China to share crucial coronavirus data with the organization and, most recently, the announcement of the United States withdrawing their funding. The hope expressed by Pai is that each ‘failure’ will be analysed to provide lessons that could underpin more successful attempts to achieve future global health goals.
One lesson seems obvious: we can only improve health for the entire human population if we have a properly funded, independent and global health-coordinating body. Whether or not the WHO has made mistakes, it must be supported and enabled to succeed in a way that reduces or removes interference from geopolitics.
The stated goal of the WHO is “to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and well-being.” At its inception in 1946, the Constitution of the WHO specified that the two main functions of the organization were technical assistance to countries and cooperation with governments to strengthen national health services. Initially the WHO lacked sufficient funds to be effective, but in 1948, cooperation between UNICEF and the WHO changed this 2 , and the remit of the WHO has grown ever since, making it clear that funding is key.
The WHO has many achievements under its belt. Perhaps the most famous of these is the eradication of smallpox, which was declared to be complete on 9 December 1979 after a long campaign. This was no easy feat, as vaccination campaigns need coordinated action to reach as many people as possible. Nowadays, for example, the Expanded Programme on Immunization vaccinates children against six preventable diseases (diphtheria, pertussis, tetanus, measles, poliomyelitis and tuberculosis), but despite continuing efforts to improve delivery, 1 in 5 children still do not receive these vaccines 1 . Millions of preventable deaths have been averted using vaccinations, but much more work remains to be done.
The success of vaccination campaigns and the delivery of therapeutics may be reliant on relationships and trust built up over many years between the WHO, healthcare professionals and community leaders in different regions. Given the experience of the WHO in delivering vaccination programs, it seems clear that the organization will form an essential part of the global response to SARS-CoV-2 infection once one or more vaccines become available.
The main Sustainable Development Goal (SDG) associated with the WHO, SDG3, aims to “ensure healthy lives and promote well-being for all at all ages” by 2030. The pandemic crisis that is gripping the world is one of many problems that will need to be overcome to achieve this. Other goals include reducing deaths caused by road traffic collisions, by drug abuse or chemical poisoning, by the unavailability of essential medicines and by human immunodeficiency virus/AIDS, tuberculosis and malaria. The WHO must respond to COVID-19 while also managing all of these other campaigns. All of this requires money — and more of it, not less.
A reduction in funding for the WHO by the United States at the point where more money than ever is needed is astonishing. Once scientists develop effective vaccines for SARS-CoV-2, we will need a global effort to control outbreaks, not least in those countries that lack the resources or healthcare systems capable of delivering robust vaccination programmes. The WHO has proven expertise in global vaccination campaigns and must not be crippled by financial insecurity going forward.
The world is already facing enormous challenges to global health: climate change, COVID-19 and antimicrobial resistance (to name just three). The performance of the WHO must be scrutinized, reviewed and audited, not least because the WHO is accountable to the countries that fund it. With regards to COVID-19, an independent evaluation with Helen Clark and Ellen Sirleaf as chairs has now been announced 3 .
Pulling funding from the WHO during a pandemic, whatever the concerns over its performance, is only likely to stifle the global response to COVID-19 and will make achieving SDG3 impossible. After all, which other agency would take its place if we did not have the WHO?
We hope that the worth of the WHO will be recognized with an equitable system of funding that enables those who work for a healthier world for all to continue to do so.