January 25, 2019

The directionless World Health Organisation is in urgent need of reform

As one of the biggest contributors to the World Health Organisation (WHO), holding its annual assembly in Geneva this week, the UK has a pivotal role in setting the global health agenda.

The WHOs work has never been more important to address serious and evolving international health threats. It is only a matter of time before there is another global influenza pandemic to match the devastating outbreak of 1918, and, as recent outbreaks of Ebola and Zika have shown, new and deadly diseases can emerge at any time.

As a UN organisation to which almost every country belongs, strengthening national health systems and coordinating defences against transnational disease should be the WHOs priority.

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Alas, superficial involvement in a ballooning number of health areas has made it a directionless, ineffective, and inward-looking player in an increasingly crowded global health scene.

The WHOs tendency to do a lot poorly has seen it fail in its core business of leading international action on transnational disease outbreaks.

Take the organisations response to the West African Ebola crisis of 2014. An expert panel convened by the Harvard Global Health Institute and the London School of Tropical Medicine criticised the WHO for its “catastrophic” delay in declaring a public health emergency.

The worry is that the WHO will fail to handle the next inevitable global pandemic, leading to needless loss of life.

Funding is part of the problem: the WHO spent just 5.7 per cent of its 2014-15 budget on disease outbreaks, a 50 per cent drop on the previous two years. The WHOs core budget, paid by member governments, fell from $579m in 1990 to $465m this year. This less money than India receives each year in foreign aid from the UK alone.

The WHO has topped up its budget with project-based donations from countries and big charities, which now constitute 80 per cent of its overall income. The cost has been its strategic independence. Alongside global health staples like tropical diseases and immunisation, the WHO now publishes recommendations on subjects from adolescent health and headaches to traffic safety and prisons.

This lack of focus and mission creep will be on full display at this weeks World Health Assembly. Bizarrely, large parts of the agenda are dedicated to discussion of how to dilute the intellectual property (IP) protections that drive discovery of new health technologies.

Given the scale of todays global health challenges, it is not clear how repeating a tired debate about IP and access to medicines will help. The vast majority of treatments prescribed in both developing and developed countries are off-patent and therefore unaffected by IP rules, yet far too many still do not have reliable access to them.

The real reasons for this have been well known for decades. There are too few doctors and clinics, and a lack of social and health insurance to protect people from the cost of healthcare expenditures (something the WHO itself implicitly recognises in its efforts to promote universal healthcare). In many places, weak supply chains and poor infrastructure separate people from the treatments they need.

A narrow and divisive focus on IP may tick political boxes, but it does nothing to improve health and will only lead to more unproductive debate. It looks like a power grab by WHO staff to intervene in areas best left to governments.

In 2017, former Ethiopian foreign minister Tedros Adhanom was elected as director general on a mandate to reform and consolidate the WHO. Almost immediately, he appointed no fewer than 14 assistant director generals to oversee a huge number of areas. This is not the work of a reformer.

This is the first World Health Assembly under Tedros leadership. The UK and other member states need to steady the ship. To maintain its relevance, the organisation must get back to basics and do a few things well, not many things poorly. It must unite nations around practical solutions, not divide them in pointless debates.

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Original Article

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