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WHO | Between public health and global politics

It is common knowledge that any international agency is only as powerful or important as its funding members want/allow it to be.

The World Health Organization (WHO), catapulted to centre stage by the COVID-19 pandemic, is no different. Its funding comes from countries or member states paying their assessed contributions (countries’ membership dues), and voluntary contributions from member states and other partners. In its 72 years of existence, the WHO has seen a lot of ups and downs, and faced a lot of criticism, more so in the past year, but it has always been called on to anchor and guide member nations in times of a global health crisis.

With its army of specialists and access to information and best practices across the world, it remains the world’s best bet — not only to write out prescriptions, but also maintain a vigil over inequities and access to health care services.

Its avowed aim is “to promote health, keep the world safe, and serve the vulnerable. Our goal is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and well-being.” Universal health coverage and health emergencies continue to be its two-pronged focus areas.

It was on April 7, 1948, that the WHO came into being with 61 members on board. It’s precursor was the Office of International Public Health that was formed in 1907 conceived with the idea of creating a pan-national outfit that would coordinate nations’ responses to public health crises. The WHO works through its country offices that report to six regional offices.

Immunisation drive

The seeds for the organisation’s arguably biggest success — the elimination of small pox — might have been sown with its efforts to intensify the immunisation campaign globally. Small pox, also caused by a virus, was one of the most devastating diseases known to humanity before it was eradicated. Edward Jenner had developed a vaccine way back in 1796, but vaccination received a boost with the WHO prioritising immunisation.

It was in 1980 that the WHO declared that the disease had been eliminated from the world, through sheer human effort. If one is looking at reasons for the pre-eminent, compelling need for an organisation such as the WHO, technically one need look no further than small pox. Its work on malaria, and neglected tropical diseases, among others, also are recognised.

It was as a result of the criticism that it failed to pick up rampaging Ebola in the 1990s, and delayed picking up HIV/AIDS early enough, that the WHO rolled out the Global Public Health Intelligence Network in 1997, to predict potential epidemics using information on the Internet, and function as an early warning alert. With the growing use of the Internet, such a system gains better traction, and in 2000, it was supplemented with the Global Outbreak Alert Response Network (GOARN).

And yet, criticism was laid at the door of the WHO, because of its initial measured response to the COVID-19 pandemic. On January 23, 2020, Tedros Adhanom Ghebreyesus, the WHO’s Director General, said it was early to declare “a public health emergency of international concern”.

And yet, a week later, the WHO declared a public health emergency of international concern, the highest level of alarm. At that time, there were 98 cases and no deaths in 18 countries outside China. Four countries had evidence (eight cases) of human-to-human transmission outside China.

“For the moment,” Dr. Tedros said, “the WHO does not recommend any broader restrictions on travel or trade. We recommend exit screening at airports as part of a comprehensive set of containment measures.” The Director General’s lavish praise for China in handling the crisis also came in for criticism. “We would have seen many more cases outside China by now — and probably deaths — if it were not for the government’s efforts, and the progress they have made to protect their own people and the people of the world.”

“The speed with which China detected the outbreak, isolated the virus, sequenced the genome and shared it with WHO and the world are very impressive, and beyond words. So is China’s commitment to transparency and to supporting other countries.” Clearly, he had spoken too soon. Outgoing American President Donald Trump tore into the WHO with being a China acolyte, cut funding and pulled the U.S. out of the organisation.

Changing statements

Later, changing statements on the use of masks, hydroxychloroquine and even the mode of transmission, by the WHO, have raised eyebrows. But it is also necessary to understand the nature of the functioning of the WHO and the nature of the beast, or the virus, in this case. The WHO works with information shared with it by nations, China, in this case. It is bound by these limitations, as also its innate inability to police nations, or have them conform with recommendations. Representatives of the WHO also repeatedly mentioned, in their defence, that they were guided by scientific principles, backed by solid evidence, and in an evolving epidemic, instructions must necessarily be dynamic.

Subsequently in March, the WHO issued a consolidated package of existing guidance covering the preparedness, readiness and response actions for four different transmission scenarios: no cases, sporadic cases, clusters of cases and community transmission. It unleashed its armamentarium to help the world handle its most unprecedented health crises of all time.

SOLIDARITY trial

The WHO and its partners launched the SOLIDARITY trial, an international clinical trial that aims to generate robust data from around the world to find the most effective treatments for COVID-19. It was designed to accelerate the process of conducting randomised clinical trials which normally take years to design, conduct, and see the results of. The organisation also worked with the European Commission and multiple partners to launch the ACT Accelerator, to ensure that once a vaccine is available, it’s available to everyone — especially those who are at the greatest risk.

The battle against COVID-19 is far from over. While vaccines are now available, and the administration of the vaccine has begun, challenges continue in monitoring this massive immunisation exercise, and ensuring that every one has access to the recommended doses.

The WHO also has a duty to counter the fatigue that has set in after prolonged efforts to test, quarantine and treat COVID-19. “This is a defining moment in the pandemic, health workers are stretched and we are seeing supplies of oxygen run dangerously low in some countries. We must act together as common humanity and roll out vaccines to health workers and those highest at risk,” Dr. Tedros said recently.

The COVID-19 pandemic that has over 93 million cases and over 2 million deaths so far might just have sealed the WHO’s place in the UN firmament, it’s place in a world that lives in fear of pathogens, cemented its raison d’être and possibly, secured its funding component.

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Printable version | Mar 4, 2021 10:31:36 PM | https://www.thehindu.com/news/national/who-between-public-health-and-global-politics/article33589370.ece

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