The WHO is only as good as its members want it to be

From 2004 to 2005, I chaired the drafting group within the World Health Organisation that revised the International Health Regulations which were adopted by the World Health Assembly in May 2005. These regulations, which entered into force in 2007, are the fundamental legal basis underpinning international co-operation in dealing with international public health emergencies. Since the emergence of Covid-19 there has been increasing focus on the adequacy or otherwise of existing mechanisms for addressing international health emergencies and strident criticism from some sources of the WHO, the primary institution charged with promoting public health.

Much of this criticism is unfounded and unfair. Where deficiencies exist, their causes frequently lie in the actions or inactions of some member states of the WHO. Indeed, it is not the WHO which should be the focus of this criticism but rather the limitations inherent in multilateral co-operation within and indeed outside of the UN system.

The International Health Regulations (IHR) give significant power to the director-general of the WHO to declare a public health emergency of international concern. In the present crisis, some have said that the director-general Tedros Adhanom Ghebreyesus did not act with sufficient urgency and that, especially in the early stages of the outbreak, he was too deferential to China, the source of the infection.

Such criticism is debatable. If the initial response seemed hesitant, this may reflect a need to secure full co-operation from China in order to gather information, attempt to contain the outbreak and buy time for other countries to develop effective responses.

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It is a sad but incontrovertible fact that larger states exert a very strong influence on international organisations through their budgetary contributions and their political influence. Unfortunately, in the past and no doubt in the future, the initial response to a crisis is to deny, play down and, in some cases, to deflect attention. The outbreak of a disease is seen as much as a stigma as a challenge. In the present international environment, this is seen by the US administration’s insistence in putting a geographic element into the name of the pandemic. The WHO’s actions were effective in eventually securing Chinese buy-in to international efforts to contain the outbreak and to an extent, in delaying its spread.

It is frequently the case that senior leadership in international organisations is peopled with those unlikely to “call out” larger influential member states. Often such positions are held by people of outstanding ability including the ability to handle myriad overlapping issues including health, economic and security issues arising from major challenges. However, to secure the backing of major players they are unlikely to be outspoken critics of states on whose co-operation their organisations depend.

When it came to following WHO advice some governments decided initially to try something different, partly perhaps to mitigate the major economic damage to their economies. This “having a dog and barking yourself” approach is difficult to understand. It is difficult to have a co-ordinated international response to a health crisis if national responses differ or indeed, if a beggar thy neighbour approach is adopted towards obtaining medical supplies and or effective remedies for dealing with the outbreak.

And then we come to resources. In fighting an epidemic or a pandemic the national or international response is only as good as its weakest link. While not being dismissive of efforts made to build up national capacities to strengthen national health systems and to combat disease, clearly when faced with a massive health threat the deficiencies have been more obvious than the successes.

While the US president talks about withholding $400 million (€370m) in annual payments to the WHO, one can only consider how little that amount is compared with the final cost of this pandemic which will run into the trillions of dollars. In too many areas of its work the WHO has for too long been dependent on voluntary contributions to address major health problems especially in poorer countries. For too long there has been a failure to address the problem of the weaker links in the global health networks.

In the century since the great influenza pandemic of 1917-1918, governments and epidemiologists have known that an event of similar magnitude was likely to recur. Despite this knowledge and despite the Sars, Mers and Ebola outbreaks, in 2020, countries across the world and at all stages of development woke up to find that they lacked adequate stockpiles of basic equipment from face masks to protective clothing to more sophisticated equipment such as breathing apparatus. This is really quite extraordinary.

When this is all over, the WHO will have to look at its achievements and its failures and try to rebuild and strengthen its response against future public health emergencies. However, governments should acknowledge that it is only as good as its member states want it to be and only as good as their political and financial support enables it to be.

Mary Whelan is a former Irish ambassador and was permanent representative to the United Nations in Geneva (including the WHO) between 2001 and 2006