In the third year of the COVID-19 pandemic, Prime Minister Narendra Modi once again brought up the much-discussed issue of reforming the World Health Organization while addressing the heads of countries at the second global COVID-19 summit. That reforms are urgently needed to strengthen the global health body and its ability to respond to novel and known disease outbreaks in order to limit the harm caused to the global community is beyond debate. The long delay and the reluctance of China to readily and quickly share vital information regarding the novel coronavirus, including the viral outbreak in Wuhan, and its stubborn refusal to allow the global agency to investigate, freely and fairly, the origin of the virus have highlighted the need to strengthen WHO. But any attempt to build a stronger WHO must first begin with increased mandatory funding by member states. For several years, the mandatory contribution has accounted for less than a fourth of the total budget, thus reducing the level of predictability in WHO’s responses; the bulk of the funding is through voluntary contribution. Importantly, it is time to provide the agency with more powers to demand that member states comply with the norms and to alert WHO in case of disease outbreaks that could cause global harm. Under the legally binding international health regulations, member states are expected to have in place core capacities to identify, report and respond to public health emergencies. Ironically, member states do not face penalties for non-compliance. This has to change for any meaningful protection from future disease outbreaks.
While Mr. Modi has been right in calling for reforms in WHO, the demand for a review of the health agency’s processes on vaccine approvals is far removed from reality. Covaxin is not the first vaccine from India to be approved by WHO, and the manufacturer of this vaccine has in the past successfully traversed the approval processes without any glitch. The demand for a review of the vaccine approval process is based on the assumption that the emergency use listing (EUL) of Covaxin was intentionally delayed by the health agency, which has no basis. That the technical advisory group had regularly asked for additional data from the company only underscores the incompleteness of the data presented by the company. As a senior WHO official said, the timeline for granting an EUL for a vaccine depends “99% on manufacturers, the speed, the completeness” of the data. To believe that the agency was influenced more by media reports than the data submitted by the company is naive; the media were only critical of the Indian regulator approving the vaccine even in the absence of efficacy data. Also, the rolling submission began in July 2021 after the company had completed the final analysis of the phase-3 data. Any reform in WHO should not dilute the vaccine approval process already in place.
