The WHO Cannot Be Saved
As humans, we commonly consider ourselves, our beliefs, and our work of particular importance. It is not surprising, then, that when we form institutions, those within them seek to promote the institution’s relevance, expand their work, and centralize decision-making within their own ‘particularly important’ group. Few want to divest power and resources, let alone put themselves and their colleagues out of a job. This fatal flaw infects all bureaucracies, from local to national and regional to international.
It is unsurprising, then, that the World Health Organization (WHO), an international health bureaucracy of over 9,000 staff, a quarter of them in Geneva, should suffer the same problems. The WHO was originally intended primarily to transfer capacity to struggling states emerging from colonialism and address their higher burdens of disease but lower administrative and financial capabilities. This prioritized fundamentals like sanitation, good nutrition, and competent health services that had brought long life to people in wealthier countries. Its focus now is more on stocking shelves with manufactured commodities. Its budget, staffing, and remit expand as actual country need and infectious disease mortality decline over the years.
While major gaps in underlying health equality remain, and were recently exacerbated by the WHO’s Covid-19 policies, the world is a very different place from 1948 when it was formed. Rather than acknowledging progress, however, we are told we are simply in an ‘inter-pandemic period,’ and the WHO and its partners should be given ever more responsibility and resources to save us from the next hypothetical outbreak (like Disease-X). Increasingly dependent on ‘specified’ funding from national and private interests heavily invested in profitable biotech fixes rather than the underlying drivers of good health, the WHO looks more and more like other public-private partnerships that channel taxpayer money to the priorities of private industry.
Pandemics happen, but a proven natural one of major impact on life expectancy has not happened since pre-antibiotic era Spanish flu over a hundred years ago. We all understand that better nutrition, sewers, potable water, living conditions, antibiotics, and modern medicines protect us, yet we are told to be ever more fearful of the next outbreak. Covid happened, but it overwhelmingly affected the elderly in Europe and the Americas. Moreover, it looks, as the US government now makes clear, almost certainly a laboratory mistake by the very pandemic industry that is promoting the WHO’s new approach.
Collaborating on health internationally remains popular, as it should be in a heavily interdependent world. It also makes sense to prepare for severe rare events – most of us buy insurance. But we don’t exaggerate flood risk in order to expand the flood insurance industry, as anything we spend is money taken from our other needs.
Public health is no different. If we were designing a new WHO now, no sane model would base its funding and direction primarily on the interests and advice of those who profit from illness. Rather, these would be based on accurate estimates of localized risks of the big killer diseases. The WHO was once independent of private interests, mostly core-funded, and able to set rational priorities. That WHO is gone.
Over the past 80 years, the world has also changed. It makes no sense now to base thousands of health staff in one of the world’s most expensive (and healthiest!) cities, and it makes no sense in a technologically advancing world to keep centralizing control there. The WHO was structured in a time when most mail still went by steamship. It stands increasingly as an anomaly to its mission and to the world in which it works. Would a network of regional bodies tied to their local context not be more responsive and effective than a distant, disconnected, and centralized bureaucracy of thousands?
Amidst the broader turmoil roiling the post-1945 international liberal order, the recent US notice of withdrawal from the WHO presents a unique opportunity to rethink the type of international health institution the world needs, how that should operate, where, for what purpose, and for how long.
What should be the use-by date of an international institution? In the WHO’s case, either health is getting better as countries build capacity and it should be downsizing. Or health is getting worse, in which case the model has failed and we need something more fit for purpose.
https://brownstone.org/articles/the-who-cannot-be-saved/