Health isolationism: how it affects us all

What is the WHO and what does it do?

The WHO, established in 1948 as a United Nations agency, acts as a coordinating authority on international health issues. It was founded on the heels of the Second World War and the creation of the United Nations, driven by the sentiment expressed by then US President Harry Truman:

‘We all have to recognise – no matter how great our strength – that we must deny ourselves the licence to do always as we please.’

The stated mission of the WHO is to ‘connect nations, partners and people to promote health, keep the world safe and serve the vulnerable – so everyone, everywhere can attain the highest level of health.’ Although the organisation is mostly known for helping to address pandemics and disease outbreaks in lower-resourced countries, its role is much broader:

• It provides guidance and sets standards to help countries develop health strategies. An early example is Child Growth Standards, which are used by many governments to establish nutrition targets and monitor child growth to prevent malnutrition in young children.
• It helps steer national governments on which health issues and conditions to prioritise, and sets normative guidelines that offer a blueprint for countries to drive traction on common health goals – for example, in areas such as non-communicable diseases, breast cancer, digital health, antimicrobial resistance and many others.
• It promotes standardisation in nomenclature to facilitate research and data-sharing. A prominent example is the International Classification of Diseases (ICD), which ensures consistency in the naming of diagnoses, allowing international comparisons and databases to be collated using the same nomenclature. The most recent version, ICD-11, also includes tools to strengthen cause-of-death information, allowing countries to track mortality patterns and improve health planning.
• It serves as a global convener, initiating and facilitating multi-stakeholder and multinational discussions, and often providing a powerful steer on how to strengthen health systems and tackle public health challenges. One such example is the Alma-Ata Declaration on primary health care (1978), which spearheaded recognition of the critical role of primary care investment to achieve accessible and equitable healthcare.

The WHO’s record on public health: mixed reviews

There is no doubt that the leadership of the WHO has enabled transformative changes in several areas of global health. Over the years, the organisation has eradicated many infectious diseases – most notably smallpox in 1980. Significant gains have also been made in polio – cases of which have been reduced by 99% globally since 1988 – as well as malaria, yellow fever and dengue fever.

The WHO has also played a key role in advancing childhood immunisation. In 1974, it published the Essential Programme on Immunization (previously the Expanded Programme on Immunization); today, every country in the world has a national immunisation programme.

Another landmark was the Framework Convention on Tobacco Control, which provides countries with a common template of actions that can be implemented locally to reduce tobacco-related deaths and diseases.

The WHO’s sore spot, however, has been in its ability to contain some recent pandemics. It was widely criticised for acting too late and failing to achieve global cooperation on the Ebola epidemic of 2014. And, according to many, the COVID-19 pandemic demonstrated the limitations of the WHO’s leadership. Its scientific guidance was deemed controversial and, in some cases, misguided, and countries took their own ad-hoc measures and failed to notify the WHO of departures from the International Health Regulation.

The pandemic also exposed the WHO’s limited power when it came to centralising and mobilising resources at pace. Despite the creation of the COVAX initiative – which aimed to provide equitable global access to diagnostics, treatments and vaccines – in January 2021, 90% of COVID vaccines went to high-income countries. Equally, when India issued a cry for help – it needed thousands of respirators to address a wave of COVID-19 – the WHO simply lacked the capacity to act fast enough, and individual governments came to the rescue instead.

Global health governance: an evolving landscape

Arguably, with its mixed record, the WHO’s ability to maintain its position of health governance requires careful scrutiny. Its role has also evolved as privately backed philanthropic organisations – including the Gates Foundation, Bloomberg Philanthropies and the Clinton Health Access Initiative – have entered the global health landscape. And that’s not to mention the increasing role played by the World Bank and vertical funds focused on specific diseases, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. These shifts do not necessarily threaten the role of the WHO but do make it critical that the WHO ensures close collaboration with others to optimise the impact of their combined efforts, avoid duplication and achieve cohesive global health governance.

The need for reform – and the opportunity to shape it from within

With all this being said, it is undeniable that the WHO needs some reforms. But criticisms about bureaucracy, inertia and lack of transparency are not unique to the WHO; they could probably be levied against most large organisations, regardless of the sector in which they operate.

One important question is whether the WHO has sufficient resources and decision-making power to play its role effectively. This is where the withdrawal of US funds and trust in the organisation is bound to have a huge effect. But, as many commentators have asked, would it not make more sense for the US to stay and work with others to change the WHO from within? Surely its members – particularly those who, like the US, sit on its executive board – share a unique opportunity to do this.

What’s next for the WHO?

The undeniable dent in funding left by the US’s withdrawal is of immediate concern. It puts at risk essential Sustainable Development Goals – to combat poverty and climate change, achieve universal health coverage and decrease preventable mortality. Invariably, these will be weakened without US participation, brainpower and resources.

However, it is also important to consider what would happen if we did not have a WHO, or had a weakened one. This is best answered by looking at what the US may have to lose by withdrawing. The country will be isolated, intellectually and scientifically, from coordinated action against global health threats, as its scientists will no longer be privy to the WHO’s databases on emerging infections. This will potentially limit its ability to respond quickly in the case of an epidemic or pandemic. The continuous dialogue between its own Centers for Disease Control and Prevention and WHO scientists is, officially at least, severed.

Of course, opinions will differ on how much this matters. But our world, whether we like it or not, is global. Science is global. Common health challenges – rising inequalities, antimicrobial resistance, the effects of climate change, and workforce shortages – affect us all.

Resolving these issues requires dialogue, collaboration, expertise, multi-stakeholder thinking and compromise. Any country that chooses to sit on the sidelines of such concerted action will invariably lose out; the US may miss important opportunities to help shape a stronger, healthier world. Sadly, the rest of the world also has much to lose, not just in our ability to improve global health, but in the security that we share the belief that we are better by acting together than by venturing out alone.

The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.