Ineffective WHO must get back to basics
As the biggest African member of the World Health Organisation (WHO), holding its annual assembly in Geneva this week, SA has a pivotal role in setting the global health agenda.
The WHO’s work has never been more important to address serious and evolving international health threats. It is only a matter of time before there is another global influenza pandemic to match the devastating outbreak of 1918, and, as recent outbreaks of Ebola and Zika have shown, new and deadly diseases can emerge at any time.
As a UN organisation to which almost every country in the world belongs, the WHO should make strengthening national health systems and coordinating defences against transnational disease its priority. But it’s often hard to know if the organisation has any priority.
Superficial involvement in a ballooning number of health areas has made it a directionless, ineffective and inward-looking player in an increasingly crowded global health scene.
The WHO’s tendency to do a lot poorly has seen it fail in its core business of leading international action on transnational disease outbreaks.
Take the organisation’s response to the West African Ebola crisis of 2014. An expert panel convened by Harvard Global Health Institute and the London School of Tropical Medicine criticised the WHO for its “catastrophic” delay in declaring a public health emergency. The worry is that the WHO will fail to handle the next inevitable global pandemic.
Funding is part of the problem: the WHO spent just 5.7% of its 2014-15 budget on disease outbreaks, a 50% drop on the previous two years. Its core budget, paid by member governments, fell from $579m in 1990 to a feeble $465m in 2018. To put this in context, this is less money than India receives each year in foreign aid from the UK alone.
The WHO has topped up its budget with project-based donations from countries and big charities, which now constitute 80% of its overall income. That has cost the WHO its strategic independence. Alongside global health staples like tropical diseases and immunisation, the WHO now publishes recommendations on subjects from adolescent health and headaches to traffic safety.
Jeremy Farrar, director of the UK-based global health research charity the Wellcome Trust, argues the WHO is being undermined by its inability to focus on a few core issues.
This lack of focus and mission creep will be on full display at this week’s World Health Assembly.
Bizarrely, large parts of the agenda are dedicated to discussion of how to dilute the intellectual property (IP) protections that drive discovery of new health technologies.
Given the scale of global health challenges, it’s not clear how repeating a tired debate about IP and access to medicines will help. The vast majority of treatments prescribed in developing and developed countries are offpatent and therefore unaffected by IP rules, yet far too many still do not have reliable access to them.
A narrow and divisive focus by the WHO on IP may tick political boxes, but it does nothing to improve health and will lead to more unproductive debate. It looks like a power grab by WHO staff to intervene in areas that are best left to national governments.
This week’s World Health Assembly is the first under the leadership of former Ethiopian foreign minister Tedros Adhanom. SA and other member states need to help steady the ship. To maintain its relevance, WHO must get back to basics and do a few things well, not many things poorly. It must unite nations around practical solutions, not divide them in pointless debates.
THE TENDENCY TO DO A LOT POORLY HAS SEEN IT FAIL IN ITS CORE BUSINESS