June 30, 2021 | International Organizations Monograph

World Health Organization

June 30, 2021 | International Organizations Monograph

World Health Organization

Introduction

The World Health Organization (WHO), a UN specialized agency, was formed in 1948 with the principal objective of “the attainment by all peoples of the highest possible level of health.”1 The WHO’s mandate was originally focused on coordinating global health policy and conducting limited research. Its operations have expanded to account for many health-related challenges, including monitoring public health risks, managing responses to health emergencies, and organizing large-scale vaccination programs.2

Today, the WHO’s goals include achieving “triple billion” targets by 2023 – that is, 1 billion more people benefitting from universal health coverage, 1 billion more people better protected from health emergencies, and 1 billion more people enjoying better health and well-being.3

The WHO is supported by a biennium budget, which totaled $5.84 billion dollars in 2020–2021, a slight increase from its 2018–2019 budget of $5.62 billion dollars.4 The organization relies on financial contributions from member states (both assessed and voluntary) as well as from private donors, such as the Bill and Melinda Gates Foundation. The United States, the WHO’s top funder, contributed approximately $893 million during the 2018–2019 budget cycle, $237 million of which was assessed and $656 million of which was voluntary.5

WHO Director-General Tedros Adhanom Ghebreyesus delivers a speech via video in Shanghai, China, on November 4, 2020, for the opening ceremony of the 3rd China International Import Expo. (Photo by STR/AFP via Getty Images)

Problems

COVID-19 has exposed major weaknesses in the WHO’s pandemic surveillance system and raised important questions about China’s efforts to influence global health standards. Although all WHO member states are signatories to the binding 2005 International Health Regulations (IHR),6 the WHO and United Nations have no legal means to enforce the IHR.7 This enforcement gap includes the IHR’s requirement that WHO member states report public health emergencies of international concern in a “timely manner.” The WHO also remains wholly reliant on member states to provide data and access to WHO investigators following an outbreak within their borders, even if those same member states are perceived as “obstructing the response.”8

The flaws in the WHO’s response to COVID-19 have been compounded by numerous structural, governance, and prioritization deficiencies, many of which have persisted for decades. Central to the WHO’s challenges are its vague mandate and ever-expanding list of priorities, rather than a more narrow focus on a select number of core functions, such as providing technical advice.

Following the WHO’s controversial responses to outbreaks of both SARS9 and Ebola,10 expert panels advocated for wholesale WHO reform, with a focus on improving organizational accountability and the WHO’s history of prioritizing political over technical considerations.11 The vast majority of these recommendations remain unrealized. In addition, leaked WHO documents have exposed wasteful spending, included revelations that the WHO spends more on travel than it does on programs to eradicate AIDS, tuberculosis, and malaria combined.12

The WHO’s swelling public health mandate has also left the organization increasingly dependent on voluntary contributions to maintain its operations, which, in turn, has increased the influence of individual countries over the WHO. Over the last seven years, voluntary contributions grew by 18 percent, from $3.9 billion in 2014–2015 to more than $4.7 billion in 2018–2019.13 For its part, China has used strategically timed voluntary donations to buttress Chinese President Xi Jinping’s geopolitical ambitions while portraying the United States as an unreliable funding partner,14 even though the United States contributes 10 times more to the WHO than China does.

Beyond China, the IHR’s governance gaps have also been weaponized by Syrian dictator Bashar al-Assad in his war against Syrian civilians. Since 2013, for example, the WHO has spent millions of dollars on behalf of the Syrian Ministry of Defense to buy blood bags, transfusion equipment, and other medical equipment, even though the ministry prevents any of these supplies from reaching besieged civilians. 15 Instead, these WHO-subsidized items are often redirected to non-governmental organizations run by Assad’s family and friends,16 thereby relieving the regime of the burden of purchasing these items itself. Despite such conduct, the Syrian government won election in May 2021 to the WHO Executive Board, which steers the agency’s work.17

Lastly, the WHO’s annual meetings have maintained an agenda item to debate “health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan.” No agenda item exists for any country other than Israel. On May 26, 2021, the WHO devoted a full day of its eight-day annual session to this agenda item.18 During the session, delegations unfairly condemned Israel for violating the health rights of Palestinians as well as those of Syrians in the Golan Heights. 19 The WHO passed a resolution requiring its director-general to submit another report on this matter in 2022. The 2021 report makes no mention of Hamas or its role in instigating violent anti-Israel demonstrations and insinuates that Israel is responsible for Palestinian domestic violence. 20 While criticizing Israel is certainly fair, holding Israel to a different standard than the rest of the world meets the working definition of antisemitism adopted by the International Holocaust Remembrance Alliance (IHRA) and the U.S. State Department. 21

Recommendations

While the Trump administration in June 2020 announced plans to withdraw from the WHO,22 the Biden administration reversed that decision. Continued U.S. participation in the WHO could provide Washington with an important platform to advocate for improved global health standards, increased accountability for member states, and a more streamlined WHO portfolio in keeping with the organization’s original mandate – if both the administration and Congress are willing to forcefully leverage U.S. contributions to achieve reforms.

As a starting point, the United States should push the WHO to make the following reforms:

  • Demand an independent UN investigation into the WHO’s and China’s COVID-19 responses. The WHO’s internal investigation into its own COVID-19 response,23 as well as investigative exposés,24 have uncovered damaging information regarding China’s efforts to conceal the extent of the outbreak at its onset. These investigations have raised serious questions about the WHO’s credibility and objectivity. Similar to the UN investigation into widespread fraud in the Iraq Oil-for-Food Program, the United Nations must establish a fully independent panel to investigate the WHO’s COVID-19 response as well as Beijing’s violations of its IHR obligations.
  • Narrow the WHO’s mandate. The WHO was never intended to implement global health activities and has strayed too far from its original mandate.25 The WHO’s Constitution underscores its role in coordinating and promoting global health cooperation – not in overseeing its execution.26 The WHO should therefore aim to outsource certain functions to other responsible entities already leading the way in those fields, 27 thus allowing the WHO to focus on a smaller number of core functions wherein it maintains a comparative advantage.28 These efforts should include renegotiating key aspects of the IHR to improve accountability over rogue states, as well as streamlining the organization’s operations.
  • Lead a coalition of like-minded WHO members in passing a resolution wherein the WHO formally adopts the IHRA’s working definition of antisemitism. This would enable the WHO to insist that standing agenda items solely focused on Israel violate the agency’s own policies and must be removed. If the agency does not adopt and implement the IHRA working definition, Congress should consider tying U.S. funding to the WHO to such adoption and implementation.

At its best, the WHO is a vehicle to promote global health standards. At its worst, it provides cover to regimes that disregard international norms. The world failed to reform the WHO after both SARS and Ebola. Repeating that mistake could have disastrous consequences for global health in the future.

  1. World Health Organization, “Constitution,” accessed May 20, 2021. (https://www.who.int/about/who-we-are/constitution)
  2. World Health Organization, “Smallpox,” accessed May 20, 2021. (https://www.who.int/health-topics/smallpox)
  3. World Health Organization, “Thirteenth General Programme of Work 2019−2023,” accessed May 20, 2021. (https://www.who.int/about/what-we-do/thirteenth-general-programme-of-work-2019—2023)
  4. “The U.S. Government and the World Health Organization,” Kaiser Family Foundation, January 25, 2021. (https://www.kff.org/coronavirus-covid-19/fact-sheet/the-u-s-government-and-the-world-health-organization)
  5. Pien Huang, “Trump And WHO: How Much Does The U.S. Give? What’s The Impact Of A Halt In Funding?” NPR, April 15, 2020. (https://www.npr.org/sections/goatsandsoda/2020/04/15/834666123/trump-and-who-how-much-does-the-u-s-give-whats-the-impact-of-a-halt-in-funding)
  6. World Health Organization, “International Health Regulations (2005), Third Edition,” January 1, 2016. (https://www.who.int/publications/i/item/9789241580496)
  7. Ilona Kickbusch, “COVID-19 Is Smoke and Mirrors—What Matters Is International Law,” Think Global Health, April 15, 2020. (https://www.thinkglobalhealth.org/article/covid-19-smoke-and-mirrors-what-matters-international-law)
  8. Francesco Checchi et al., “World Health Organization and emergency health: if not now, when?” The BMJ, Volume 352, Number i469, January 28, 2016, pages 1–8. (https://www.bmj.com/content/352/bmj.i469)
  9. David L. Heymann, John S. Mackenzie, and Malik Peiris, “SARS legacy: outbreak reporting is expected and respected,” The Lancet, Volume 381, Issue 9869, March 9, 2013, pages 779–781. (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60185-3/fulltext#bib13)
  10. Suerie Moon et al., “Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola,” The Lancet, Volume 386, Issue 10009, November 28, 2015, pages 2204–2221. (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00946-0/fulltext?rss%3Dyes=)
  11. Francesco Checchi et al., “World Health Organization and emergency health: if not now, when?” The BMJ, Volume 352, Number i469, January 28, 2016, pages 1–8. (https://www.bmj.com/content/352/bmj.i469)
  12. Maria Cheng, “AP Exclusive: Health agency spends more on travel than AIDS,” Associated Press, May 22, 2017. (https://apnews.com/article/1cf4791dc5c14b9299e0f532c75f63b2)
  13. World Health Organization, “Source and distribution of funds available – 31 December 2015,” December 31, 2015. (http://extranet.who.int/programmebudget/Biennium2014/Contributor); World Health Organization, “Contributors,” accessed March 31, 2021. (http://open.who.int/2018-19/contributors/contributor)
  14. Kinling Lo, “Coronavirus: China donates another US$30 million to WHO after US funding halt,” South China Morning Post (Hong Kong), April 23, 2020. (https://www.scmp.com/news/china/diplomacy/article/3081280/coronavirus-china-donates-another-us30-million-who-after-us)
  15. Annie Sparrow, “Hypocritic Oath: How WHO and other international agencies aid Assad’s war against Syria’s civilians.” Foreign Policy, February 9, 2018. (https://foreignpolicy.com/2018/02/09/hypocritic-oath)
  16. “WHO’s Elizabeth Hoff pressed on Syria healthcare crisis,” Al Jazeera (Qatar), January 18, 2018. (https://www.aljazeera.com/videos/2018/1/8/whos-elizabeth-hoff-pressed-on-syria-healthcare-crisis)
  17. David Adesnik, “Global health policy shouldn’t be shaped by a country that bombs hospitals,” The Washington Post, June 9, 2021. (https://www.washingtonpost.com/opinions/2021/06/09/syria-seat-board-world-health-organization)
  18. Elaine Ruth Fletcher, “Israeli – Palestinian Conflict Blocks Full Day At World Health Assembly,” Health Policy Watch, May 26, 2021. (https://healthpolicy-watch.news/israeli-palestinian-conflict-blocks-full-day-at-world-health-organization)
  19. “WHO Meeting Deviates From COVID-19 to Single Out Israel As Violator of Health Rights,” UN Watch, May 26, 2021. (https://unwatch.org/who-meeting-deviates-from-covid-19-to-single-out-israel-as-violator-of-health-rights-2)
  20. World Health Organization, Report by the Director-General, “Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan,” A74/22, May 20, 2021. (https://apps.who.int/gb/ebwha/pdf_files/WHA74/A74_22-en.pdf)
  21. U.S. Department of State, “Defining Anti-Semitism,” accessed June 21, 2021. (https://www.state.gov/defining-anti-semitism)
  22. Helen Branswell, “Trump administration submits formal notice of withdrawal from WHO,” STAT, July 7, 2020. (https://www.statnews.com/2020/07/07/trump-administration-submits-formal-notice-of-withdrawal-from-who)
  23. “Second report on progress,” Independent Panel for the Pandemic Preparedness and Response, January 2021. (https://theindependentpanel.org/wp-content/uploads/2021/01/Independent-Panel_Second-Report-on-Progress_Final-15-Jan-2021.pdf)
  24. Nick Paton Walsh, “The Wuhan files: Leaked documents reveal China’s mishandling of the early stages of Covid-19,” CNN, December 1, 2020. (https://www.cnn.com/2020/11/30/asia/wuhan-china-covid-intl/index.html)
  25. Ranu S. Dhillon, “The future of WHO: outsourcing?” The Lancet, Volume 385, Issue 9973, March 21, 2015, page 1070. (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60594-3/fulltext)
  26. Tine Hanrieder, “WHO orchestrates? Coping with competitors in global health,” International Organizations as Orchestrators, Eds. Kenneth W. Abbott, Philipp Genschel, Duncan Snidal, and Bernhard Zangl (Cambridge, UK: Cambridge University Press, 2015), pages 191–213.
  27. International Organizations as Orchestrators, Eds. Kenneth W. Abbott, Philipp Genschel, Duncan Snidal, and Bernhard Zangl (Cambridge, UK: Cambridge University Press, 2015).
  28. Julio Frenk and Suerie Moon, “Governance Challenges in Global Health,” The New England Journal of Medicine, Volume 368, Issue 10, March 7, 2013, pages 936–942. (https://www.nejm.org/doi/full/10.1056/NEJMra1109339)

Issues:

China COVID-19 International Organizations Syria