The WHO we want
Authors: Olivier Nay, Marie-Paule Kieny, Lelio Marmora, Michel Kazatchkine
Journal: The Lancet (2020)

The 73rd World Health Assembly convened virtually in May, 2020, in a climate of international dissent. Caught in the midst of tensions between the USA and China, WHO has been the target of US President Trump's attacks and of multiple grievances.1The EconomistAmerica and China take their rivalry to the World Health Organization.The Economist. May 17, 2020; Google Scholar, 2Gramer R Lynch C Detsch J Trump cuts US ties with World Health Organization amid pandemic.Foreign Policy. May 29, 2020; Google Scholar In recent years, WHO has often been criticised for what it should have done or did not oversee, and for the political approach3Collins M The WHO and China: dereliction of duty. Council on Foreign Relations, Feb 27, 2020https://www.cfr.org/blog/who-and-china-dereliction-dutyDate accessed: June 3, 2020Google Scholar to the agency's management by its Director-General Tedros Adhanom Ghebreyesus. WHO is not perfect. No one would deny its limitations, dysfunctions, and bureaucratic processes.4Kamradt-Scott A WHO's to blame? The World Health Organization and the 2014 Ebola outbreak in west Africa.Third World Quart. 2016; 37: 401-418Crossref Scopus (101) Google Scholar However, we believe that WHO should be supported in its full mandate and its coordinating role in international health crises should be reaffirmed. The global community also needs to clarify what we can expect from this UN agency. Never has the need for multilateralism been greater. Never have health challenges been more global.5Frenk J Moon S Governance challenges in global health.N Engl J Med. 2013; 368: 936-942Crossref PubMed Scopus (245) Google Scholar The response to the COVID-19 pandemic calls for unprecedented global solidarity.6West-Oram PGN Buyx A Global health solidarity.Public Health Ethics. 2017; 10: 212-224PubMed Google Scholar No nation can address this crisis in isolation, even if some governments retain the illusion they can. In the past 20 years, multilateral cooperation helped in responding effectively to HIV/AIDS, tuberculosis, and malaria.7Oberth G Torres MA Mumba O O'Connor M A quarter for prevention? Global Fund investments in HIV prevention interventions in generalized African epidemics.Univers J Public Health. 2017; 5: 231-241Crossref Google Scholar Multilateral cooperation also paved the way for large-scale vaccination campaigns in fragile settings.8Zerhouni E GAVI, the Vaccine Alliance.Cell. 2019; 179: 13-17Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar Many low-income and middle-income countries have been supported by multilateralism to develop sustainable, resilient, country-owned health strategies.9Velasquez G The right to health and medicines: the case of recent multilateral negotiations on public health, innovation and intellectual property.Bioethics. 2014; 14: 67-74Google Scholar We call on UN member states to recognise their roles and responsibilities in the governance of WHO. We call on nations to restore multilateral cooperation on global health. Such cooperation will require funding, collective thinking, political leadership, and technical rigour. We also need active intellectual and strategic investment; support, not empty criticism; and commitment, not abandonment. The global community must reflect on which WHO we want in leading the response to COVID-19. In the wake of the outbreak of severe acute respiratory syndrome, WHO member states ratified the International Health Regulations (2005) (IHR)10Wilson K Tigerstrom B McDougall C Protecting global health security through the International Health Regulations: requirements and challenges.CMAJ. 2008; 1794448Crossref Scopus (52) Google Scholar as a legally binding international treaty. In doing so, member states committed to report to WHO and to prepare for and respond to any disease outbreaks that could become global public health threats.11Suthar AB Allen LG Cifuentes S Dye C Nagata JM Lessons learnt from implementation of the International Health Regulations: a systematic review.Bull World Health Organ. 2018; 96 (21E): 110Crossref PubMed Scopus (32) Google Scholar Created in 2016 after the outbreak of Ebola virus disease in west Africa, the WHO Health Emergencies Programme12WHOWHO's role in emergencies.https://www.who.int/news-room/q-a-detail/who-s-role-in-emergenciesDate: 2019Date accessed: June 3, 2020Google Scholar has been effective in responding to outbreaks of yellow fever, polio, smallpox, and Zika virus disease, as well as Ebola virus disease in the Democratic Republic of the Congo,13WHO Regional Office for AfricaWHO Health Emergencies Programme in the African Region: annual report 2016. World Health Organization, Geneva2017Google Scholar despite scarce funding and operative challenges. However, COVID-19 has exposed how inadequate the preparedness for a pandemic has been, including in those countries with strong health systems.14Friedman S COVID-19 has blown away the myth about "First" and "Third" world competence.The Conversation. May 13, 2020; https://theconversation.com/covid-19-has-blown-away-the-myth-about-first-and-third-world-competence-138464Date accessed: June 3, 2020Google Scholar Clearly, the IHR need to be comprehensively strengthened. In relation to the COVID-19 pandemic, we call on WHO to focus on and be held accountable for the following areas of work. First, provide regularly updated recommendations from independent expert committees on preventive strategies and potential treatments for COVID-19. Second, propose universal and standardised ways of collecting and reporting epidemiological data from countries. Third, accelerate the evaluation, selection, and prequalification of diagnostic tests. Fourth, consolidate information on COVID-19 vaccine research progress and work upstream with partners to ensure equitable access and affordability of therapeutics and vaccines as they become available. Fifth, facilitate logistical coordination and supply of reagents, personal protective equipment, and potential treatments. Finally, support countries with fragile health systems to maintain continuity of routine health care, particularly for chronic diseases, and primary health care. Which WHO do we want after the COVID-19 pandemic? WHO must evolve to become more results-oriented and responsive. Such an evolution requires more than a functional review: it calls for a thorough transformation that overcomes political divisions and empowers WHO with the ability to question and constructively criticise national health strategies.15Lei Ravelo J Battered with criticism, what's next for WHO?.Devex. May 18, 2020; Google Scholar We call for a WHO whose technical authority is fully recognised by member states and is free of political considerations, and whose funding does not depend on unreliable voluntary contributions; a WHO that gives a fair role to civil society and other non-governmental actors in its governance; and a WHO that primarily focuses on the mandate of a technical agency in health, as set by its founders in 1948.16Brown TM Cueto M The World Health Organization and the world of global health.in: Parker R Sommer M Routledge handbook of global public health. Routledge, Abingdon2010: 18-30Google Scholar We call for a WHO with full legitimacy as the world's leading institution in global health, with enhanced authority to enforce its norms and standards and to coordinate global action. WHO needs the resources to publicly warn and potentially call for sanctions against member states that do not comply with global health imperatives. Health is a global political matter17Gill S Benatar S Global health governance and global power: a critical commentary on the Lancet–University of Oslo Commission report.Int J Health Serv. 2016; 46: 346-365Crossref PubMed Scopus (39) Google Scholar and a public good for humanity.18Smith RD MacKellar L Global public goods and the global health agenda: problems, priorities and potential.Glob Health. 2007; 3: 9Crossref PubMed Scopus (45) Google Scholar The prevention of illness and promotion of health entail programmes that sometimes conflict with economic priorities.19Moon S Røttingen J Frenk J Global public goods for health: weaknesses and opportunities in the global health system.Health Econ Policy Law. 2017; 12: 195-205Crossref PubMed Scopus (38) Google Scholar WHO should thus be able to recommend scientific and evidence-based solutions, such as decisions aimed at reducing consumption of tobacco, alcohol, and sugar-sweetened beverages or reducing environmental risks, such as those associated with air pollution.20Landrigan PJ Fuller R Acosta NJR et al.The Lancet Commission on pollution and health.Lancet. 2017; 391: 462-512Summary Full Text Full Text PDF PubMed Scopus (2618) Google Scholar WHO should be granted the full authority to coordinate global health emergencies. The agency should be empowered to compel health-related data transparency by sending independent observers to countries. WHO will evolve only if national governments give priority to a global collective approach to global health issues. However, this move is not enough. The new health governance should give appropriate space to emerging economies and to low-income countries. WHO will not recover its full authority if member states do not waive some of their national prerogatives for the benefit of global public health. M-PK is a former Assistant-Director General of WHO. LM is a former Executive Director of Unitaid and is a member of the board of directors of Orasure Technologies, Inc. MK is a former Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. We are all members of the Santé mondiale 2030 think tank. We declare no other competing interests.