REFORMING THE WORLD HEALTH ORGANIZATION
The spread and scale of the coronavirus disease (Covid19) have seen calls for strengthening international cooperation in the area of public health, both at the regional level and multilaterally. The Group of Twenty (G20) video summit on March 26 decided on better data-sharing and enhanced cooperation.
Prime Minister Narendra Modi led the call for cooperation on Covid19 within the South Asian Association for Regional Cooperation, and urged the G20 about the need for reforms at the World Health Organization (WHO). This is critical as WHO is the lead global and United Nations (UN) agency on public health. Its institutional arrangements must be able to strongly push global cooperation in public health and support developing countries in real-time.
The last major global crisis was the 2008 financial meltdown. At that time, the most important economies came together in the G20. The response then required the largest players to take concerted action. Global public health emergencies involve people across the world. Voices from developing countries must be part of the decision-making process.
As an intergovernmental body, WHO is not immune to global powerplay as is being witnessed by reports of the director-general having shied away from naming the virus after the country where it originated — China — and delaying the declaration of a pandemic. Moreover, only a quarter of its budget comes from contributions from UN member-states, and the real money to power its work is from voluntary funding by countries and organisations.
WHO, as a global convener, plays a key role in standard-setting in public health. This is a matter of much importance to the “haves” of the global economy, especially those with a vibrant pharmaceutical industry. The United States is the largest contributor, but the Chinese have also recognised WHO’s importance, and the previous director-general was their nominee.
The main decision-making body at WHO is the annual World Health Assembly (WHA), attended by all member-states. Then, there is the Executive Board (EB) comprising technically qualified persons from 34 countries, elected based on geographic representation from across the globe. With demands for a better, real-time response from WHO, the EB should be made a standing body with the elected countries having Geneva-based permanent representatives on it. The EB should meet when required and direct action by WHO.
The EB also needs to go beyond only geographic representation and ensure that major stakeholders such as the largest economies and those with the largest populations are always on it. At the UN, there is a precedent for this in the composition of the board of UN Women which, apart from representation from different regions, also has representation from the largest donors.
And, then there are the issues revolving around drugs and medical science. This is a huge and lucrative industry where Intellectual Property Rights (IPRs) count above all, and there is little willingness, for collaborative research even in times of crisis. Neither WHO nor any multilateral organisation is involved in drugs research. They must be involved in rolling out new drugs in developed countries.
Affordability will be a key, and the past record is not exemplary. WHO, along with others such as the World Trade Organization, must find ways to make affordable access to such key drugs in critical times possible.
It is time to use the crisis to launch much-needed, long-due reforms and overhaul WHO.