Reasons for supporting the WHO post COVID-19
Elly Howse and Adrian Bauman
The global spread of the coronavirus SARS-CoV-2 and the resulting COVID-19 pandemic have led to criticism about the capacity of individual nation states and multilateral organisations to respond effectively. On the receiving end of this criticism is the World Health Organization (WHO). Some of the criticism includes that WHO did not declare a pandemic soon enough, that WHO’s activities are being curtailed or unduly influenced by a specific nation state, and more general criticism that WHO is an ineffective international body during a pandemic. In Australia, a small number of MPs and Senators have questioned the value of Australia’s engagement with the WHO and called for Australia’s WHO funding to be reviewed.
At best, much of this criticism ignores the history of the WHO, including the important role that Australia played in its formation – Australia was one of the original signatories of the WHO Constitution in 1946. This criticism also ignores the broader influence of figures such as Herbert ‘Doc’ Evatt on the development of multilateral organisations like WHO and the United Nations during this critical period of peace making after World War II.
At worst, this criticism deliberately misrepresents the functions and duties of WHO. Such misinformed criticism leads to uninformed policymaking and reactive decision-making by governments when the international community most needs multilateral organisations to be supported (politically and financially) and global solidarity to be maintained.
We write this piece not to ignore the concerns that have been raised. These concerns have tended to be about how particular nation states respond to WHO and the powers that WHO has. For example, there are valid concerns that nations such as China may have withheld information from the WHO which may have affected the global response. Similarly, the non-acknowledgement of the excellent public health response driven by Taiwan is concerning.
However, such concerns are fundamentally geopolitical questions that require diplomacy and further exploration after a pandemic, not during one. We note at the most recent World Health Assembly that 194 WHO member states including China, Australia and the US unanimously passed a resolution for an independent and comprehensive evaluation of WHO’s response to the pandemic. This is a fair and appropriate public health response after any major disease outbreak.
The focus of this piece is to provide a summary of the history of the WHO, its functions, and what a world would look like without the WHO. In doing so, we hope our fellow Australians can understand the WHO’s importance and why current and future Australian governments and civil society organisations should continue to support it, through and beyond the next global pandemic, epidemic or public health emergency.
The history of WHO
The history of the WHO can be traced back to the late 19th century and early 20th century. Increased travel and trade across country borders resulted in various epidemics and outbreaks of infectious diseases. Developments in scientific and medical knowledge also meant growing interest in how to respond effectively to such health challenges within and between countries and regions. Increasing international travel, particularly due to those returning from war, led to public health problems extending beyond national borders, for example following World War I with the Spanish Influenza epidemic.
The end of World War II in 1945 led to the formation of the UN – an international organisation committed to maintaining peace, security, justice and human rights. Australia played a prominent role in the establishment of the UN, such as drafting and negotiating the various documents underpinning the UN’s creation. Less than a year after the UN was created, on 22 July 1946 the WHO was officially established at the International Health Conference in New York. 61 states, including Australia, formally adopted the WHO Constitution. WHO came into force on 7 April 1948 as the specialised health agency of the UN.
The Constitution of the WHO has a number of statements and principles regarding the right of all people to health and wellbeing. The WHO Constitution includes that membership is open to all States, and that members of the United Nations can become members of the WHO by signing or ratifying the Constitution. There is also an associate membership available to territories or groups of territories.
The Constitution included the creation of the World Health Assembly, an international forum for delegates from member states to meet and discuss issues and topics of global health importance. The Executive and Secretariat for the WHO are responsible for the day to day running of the WHO and report directly to the World Health Assembly.
How does the WHO function?
The WHO is representative in nature, and no one country or world power is in charge. At the World Health Assembly, all member states have an equal seat at the table and decisions are made through consensus, a practice that is used by other UN and international bodies. This is why diplomacy and the art of negotiation are vital skills for member states and their delegates. You can read more about how the World Health Assembly works here.
As a specialised health agency, WHO is part of a broader system of UN multilateral agencies, funds and programmes. These agencies and groups contribute to the building of global solidarity and agreement between nation states in the pursuit of peace and justice worldwide. Like other agencies and funds, it took many years for WHO to become valued and understood by member states. Complex international organisations don’t magically appear overnight – they take a generation (or two or three!) of hard work and sustained investment by many different groups and individuals.
In terms of day to day functioning, WHO employs over 7,000 staff and has 150 field offices. There are also six regional offices of the WHO which direct and coordinate activities across each continent or region: the Americas (PAHO); Europe (EURO); Africa (AFRO); Eastern Mediterranean (EMRO); Western Pacific (WPRO); and South East Asia (SEARO). Australia is part of the WPRO, with the regional office headquarters based in Manila, Philippines.
WHO has an annual budget of approximately USD $4.84 billion in 2020-21. WHO is funded through assessed and voluntary contributions from member states – the full breakdown for 2018-19 is available here. Australia’s assessed fees for 2020 are USD $5.28 million (about AUD $8 million), but Australia also makes additional voluntary contributions to the WHO at least 3-4 times that amount. Member state contributions to the WHO are low-cost, high-return investments for countries like Australia – we contribute substantially to WHO’s budget but this is a tiny proportion of our GDP (which is over a trillion dollars).
What does WHO do – and why do we need it?
The purpose of the WHO according to the Constitution is to promote co-operation between nation states in order to protect and promote health and attain the highest possible level of health for all peoples. WHO is therefore the leading coordinating health authority internationally.
In practice, the WHO has led the advancement of health for over 70 years through:
Eradicating diseases such as smallpox and polio
Promoting population vaccination and childhood immunisation, particularly in low- and middle-income countries or resource poor settings
Promoting universal health coverage
Supporting the development of health systems in resource poor settings
Driving global responses to major epidemics and pandemics such as HIV
Promoting family planning and birth control to empower and enable girls and women worldwide
Setting global standards for environmental health hazards
Providing direct support and funding to countries experiencing ongoing health challenges such as malaria, tuberculosis and other major diseases
Driving policy action for non-communicable (chronic) diseases, such as through healthier diets, physical activity, tobacco control and reducing alcohol consumption.
The WHO also goes beyond policies and programs – it provides technical support, advice and monitors global trends and statistics in health. Surveillance, monitoring and inter-country comparisons provide data that are important to achieve the UN’s Sustainable Development Goals (SDGs). The WHO also supports countries to develop more robust monitoring systems and provides training and technical support to assist countries in program implementation and in developing surveillance systems.
In addition, WHO has expert working groups and technical advisory groups providing the best available evidence to improve global decision making in health. Many of these groups include leading Australian experts and medical advisers. For example, currently WHO supports over 800 Collaborating Centres across more than 80 countries. These centres carry out research activities in support of the WHO’s programme of work, utilising the knowledge developed through universities and research institutes to provide up to date scientific and medical expertise to support WHO’s programs. Australia currently hosts 51 WHO Collaborating Centres focused on infectious diseases, chronic disease, health promotion, women’s health and adolescent health. You can search the global directory of WHO Collaborating Centres here.
There are many more activities and successes of the WHO that we have not listed or mentioned. But the value add of WHO’s work for 70 years is overwhelming. Global vaccine provision prevents 2-3 million deaths every year. Substantial reductions in child and maternal mortality between 2000 and 2015 have resulted in at least 21 million lives saved. For chronic and non-communicable diseases, the WHO’s Framework Convention of Tobacco Control (FCTC) is one of the most ratified international treaties of all time with 181 countries having signed, with the treaty having saved many millions of lives due to increased tobacco control measures worldwide.
What’s the alternative to the WHO?
For those of us working and researching in public health, there is no real alternative to the WHO that would result in improvements for population health and equity. It would take decades to develop and implement a functioning alternative agency that has the broad support and trust of member states. During that time, millions of people would lose their lives, goodwill between countries would collapse, and more global health emergencies would be likely to occur with catastrophic effects. Without WHO’s global coordination and guidance, responsibility would relapse back to the national level. This would contribute to many millions of unnecessary deaths, particularly in low and middle income countries, and widen inequalities and induce greater poverty.
While substantially reducing funding to the WHO may not necessarily change health status in a high income country like Australia, the impact of this reduction in funding would affect all of WHO’s programs, with the burden falling on low- and middle-income countries. Furthermore, a substantially reduced or invisible WHO would create policy vacuums, which could result in dangerous, non evidence-based approaches promulgated by non-qualified people, or by countries seeking to dominate neighbours through the provision of health training or financial aid. It also would mean increased reliance on private donations and philanthropic funding. Such a shift would seriously compromise international trust and cooperation and undermine global solidarity – the key values and principles that Doc Evatt spent his entire life fighting for in Australia and abroad.
What should Australia do?
It’s imperative that during global health emergencies like COVID-19, countries focus on and prioritise their own pandemic control strategies, not deflecting issues, blaming others or inflaming existing geopolitical tensions. Reflection or evaluation on any pandemic should occur after the pandemic is over, or at least contained. Australia’s excellent response to COVID-19 is a good starting point, as we have achieved substantial initial reductions in community transmission. Our successful response to what is likely to be the ‘first wave’ of COVID-19 allows us more time to prepare for second or third waves of infections. It’s also allowing us to rethink how we do things, from our transport systems to how we work remotely – these learnings can help other countries adjust to the impacts of COVID-19.
Our success in responding to COVID-19 also allows us to continue our work as a good global citizen. We can provide support and aid to countries in our region who lack response capacity during a possible COVID-19 outbreak, such as Pacific Island nations. This is responsible action implemented through the Western Pacific Regional Office of WHO, and it fits Australia’s long term, existing foreign affairs strategy of prioritising aid and development with our nearest neighbours who are most in need of assistance.
Australia has also demonstrated its willingness to engage with WHO at the highest levels – such as through co-sponsoring the resolution passed at WHA73 and working constructively with other member states. Australia must continue to work co-operatively with member states, including our regional neighbours in the Asia-Pacific such as China and the US, and use our good relationships to strategic advantage.
Finally, Australia should continue to financially and politically support the WHO, both publicly and privately. We urge MPs, Senators and political leaders to talk with public health experts and our counterparts in other countries about the benefits and successes of the WHO, as well as areas of the WHO that may need reform, before making statements to the media and parliament. To consider or even discuss de-funding the WHO in the middle of a pandemic is ethically irresponsible and the height of political grandstanding with global consequences.
We all have a part to play and continuing the great vision of Doc Evatt to uphold human rights, defend multilateralism and promote global solidarity. The World Health Organization is just one vehicle through which we can uphold those principles and values, and it deserves our full ongoing support.
Elly Howse, Research Fellow with The Australian Prevention Partnership Centre and PhD candidate at the University of Sydney, and member of the Evatt Foundation executive. Prof Adrian Bauman, Emeritus Professor of Public Health at The University of Sydney and Co-Director of the WHO Collaborating Centre on Physical Activity, Nutrition and Obesity.