The World Health Organization needs urgent reform if it is to survive

EPA/MARCELO MSAYAO

A picture made available on 03 June shows a mosquito Aedes aegypti on a plant ‘Impatiens Walleniana’ (Maria sem vergonha) at the Lab of Biomedicine of the Federal University of Rio de Janeiro, in Rio de Janeiro, Brazil, 02 June 2016. 

The World Health Organization needs urgent reform if it is to survive


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In less than 12 months, the World Health Organisation (WHO) will elect a successor to Margaret Chan, the current Director-General, who was first appointed in 2006.

Ten years ago Ms. Chan used her inaugural speech to underline her intent for the WHO to focus on “the people in greatest need”, but when WHO board members held their annual meeting in Geneva in January this year, many expressed the need for urgent reform, with trust eroded after a series of missteps under Ms. Chan’s watch.

The sad truth is that WHO is not fit-for-purpose, largely controlled by vested interests and facing its biggest crisis since it was founded in 1948.

Weighed down by bureaucracy, its muddled response to major health emergencies heavily criticized, the WHO is mired in accusations of lack of transparency, corruption, and even stifling press freedom – in strict contravention to the UN Charter. 

Ms Chan’s reign has been mired by poor judgement and errors such as its overreaction to the 2009-10 H1N1 flu pandemic and its slow response to the Ebola crisis in West Africa, let alone its confused response to the Zika virus. 

Even its friends are scathing… “underlying WHO’s relationship with its member states is a lack of trust in the WHO Secretariat’s ability to deliver” laments Charles Clift, Senior Consulting Fellow at Chatham House. 

And recently, Dutch Health Minister Edith Schippers said “It’s time to prioritize, it is time to put global health security at the center of all WHO activities … Fine slogans, statements and promises will not prepare us for the next calamity — serious commitments, shown by actions and proper, stable financing will.”

WHO faces intense pressure not least because in 2011, hit by the global financial crisis, member states cut the WHO’s budget, reducing it by 13% from the previous year.

Around 80% of the WHO’s revenue is now made up of ‘voluntary contributions’ from member states that want to contribute more as well as educational institutions, trusts and charities, including the foundation of Mike Bloomberg, the financial-information mogul and former New York mayor.

More than 90% of these donations come with conditions and are earmarked for specific projects or diseas-es.  Should an organization linked to the United Nations allow its strategy to be dictated by powerful vested interests?

Is it any wonder, then, that there is proof of serious malpractice.  The UN’s own Office of Internal Oversight recently conducted a damning audit of WHO stating that 2015 saw a 66% increase in the demands for in-vestigation of wrongdoing.  Incidents of reported fraud were up 20% over the previous period, and instanc-es of fraud shot up 166% in 2015.

As an example, an official at an unnamed regional WHO office bypassed established procedures to improp-erly purchase $2.1 million of equipment from a friend, even though the equipment was available for much less through other vendors.

Rather than embracing innovation, WHO seems to have developed a collective allergy to innovative health solutions. For instance, at the forthcoming Framework Convention on Tobacco Control Conference of the Parties (COP)7 international conference in India, WHO is trying to persuade countries that vaping of e-cigs should be regulated in the same way as conventional cigarettes, or possibly even banned. 

Last year, Margaret Chan, declared that “all governments should ban e-cigarettes”.

This is a ludicrous suggestion given that Public Health England stated recently that e-cigarettes are 95% safer than using conventional cigarettes.  The highly respected Royal College of Physicians agreed – saying that the long-term negative effects from e-cigs were “unlikely to exceed even 5% of the harm from smoking tobacco”.

In other words, over-regulating e-cigarettes will cause people to stick with conventional cigarettes instead of switching to reduced risk products.  This is perverse and closed-mind thinking from WHO, and sympto-matic of the lack of clear direction and leadership.

Another accusation levelled against WHO – a critical component of the UN – is that of stifling press free-doms.  In response to growing concerns over the UN’s treatment of the media, more than 50 journalists and thought-leaders from 18 countries signed a letter – on UN-designated ‘World Press Freedom Day’ in May – demanding the UN abide by the same principles of press freedom it expects from its member nations.  The letters’ signers called on the UN “to stop its hypocritical conduct and live up to the principles of press free-dom.”

The election campaign that has just begun for a new Director-General offers the organisation the oppor-tunity for serious debate and introspection.  WHO is at a crossroads and must surely embrace the values of transparency, inclusion and good governance.  Too often in the past, these values have been overlooked, conveniently side-stepped or trampled on. 

This isn’t acceptable, and has undermined WHO’s legitimacy.  The world deserves, and needs, better.  WHO must reform significantly or risk becoming marginalised and  letting down those people in greatest need.     

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