WORLD HEALTH ORGANIZATION
WHAT IS THE ISSUE?
Since its founding, the WHO has been mandated to support countries to detect, prevent and control possible outbreaks and health emergencies. WHO has been at the centre of the Covid-19 response, continuously gathering and analyzing information, working with national governments, publishing guidelines, and calling for the global community to cooperate to get the pandemic under control. At the same time, in Covid-19 as well as past health crises, it has been heavily scrutinized for its technical recommendations, operational performance and political decisions. Covid-19 has brought to light serious limitations the organization faces to fulfill its mandate. Its tools of persuasion are largely limited to diplomacy and epistemic authority, and lack the binding power of hard law. Its funding is also unstable: more than 80% of its budget comes from voluntary contributions, which funders can withdraw or reduce at will. This can limit WHO’s political space to take actions opposed by a Member State even when in the broader interests of global public health, and may also impede rapid responses to a health emergency.
WHAT WAS DONE BEFORE COVID-19 TO ADDRESS THIS ISSUE?
Debates on WHO are longstanding. Following the 2014 West African Ebola crisis, the organization became the focus of multiple reform efforts focused on strengthening its operational capacity. Among them was the creation of the Health Emergencies (WHE) Programme in 2016 to assist countries with outbreak preparedness and response, which also included an Independent Oversight and Advisory Committee as an accountability mechanism. In addition, WHO elevated health emergencies as one of its three priorities in 2019. A Contingency Fund for Emergencies (CFE) was created to make funds readily available and allow WHO to respond quickly to threats. These mechanisms did not, however, address its vulnerable funding situation, nor did it bolster the organization’s autonomy from the political pressures of its Member States.
WHAT HAVE COVID-19 INTERNATIONAL REVIEW PANELS RECOMMENDED TO ADDRESS THIS PROBLEM? *
Some panels recommend that the WHO focus on supporting countries to improve pandemic preparedness and response ², or emphasize its role in providing technical guidance for countries to improve their health systems and implement the IHR ³ ⁴. Other recommendations to strengthen WHO include improving coordination between its different parts, and clear allocation of responsibilities and budget lines for programs such as the WHE ³ ⁴.
In terms of financing, there is wide agreement on the importance of ensuring adequate and stable financing of the WHO by increasing the amount of assessed contributions from its Member States ¹ ² ³ ⁴. Some reviews recommended that the WHO’s financial independence should be guaranteed through fully unearmarked resources, and Member States’ fees be increased to ⅔ of its budget². Others recommend that an increased proportion of WHO’s core flexible funding be allocated to the WHE Programme to ensure better emergency preparedness ³.
WHICH REFORMS ARE UNDER DISCUSSION?
Strengthening WHO has emerged as a central priority, and the 74th (2021) World Health Assembly agreed in Resolution 74.7 that a number of steps were needed to do so. Two Member State Working Groups were established in 2021 on strengthening WHO in pandemic preparedness and response, and on sustainable financing, respectively. A special session of the WHA also agreed in late 2021 to establish an Intergovernmental Negotiating Body, tasked with drafting the text of a “WHO convention, agreement or other international instrument on pandemic preparedness and response”. In January 2022, the Working Group on Sustainable Financing produced a proposal for half of all funding for the WHO to come from assessed contributions. An updated draft in April 2022 suggested that increases in assessed contributions after 2025 should be conditional on reforms to improve WHO’s efficiency. The Working Group reportedly reached a consensus on 27 April 2022 on a package of recommendations that will be submitted to the 75th WHA at the end of May 2022, including aiming to reach the 50% target for assessed contributions by 2028-9.
* This section is derived from a systematic comparison (available here) of recommendations from four international reviews: ¹ the Global Preparedness Monitoring Board (GPMB), ² the Independent Panel for Pandemic Preparedness and Response (IPPPR), ³ the Independent Oversight and Advisory Committee (IOAC) for the WHO Health Emergencies Programme, and ⁴ the International Health Regulations (2005) Review Committee.