Global Health Reform Must Go Far Beyond WHO

Understanding the Depth of a Problem

The World Health Organization (WHO) has recently entered the consciousness of many in Western countries as, justifiably, an example of destructive, unaccountable bureaucratic overreach. Seeking to impose restrictions and extract money from individuals and nations for the benefit of well-heeled sponsors, it plays no useful role in the lives of many beyond providing a potential career path for those who want travel, a good salary, and a feeling of altruistic superiority. Through its role in the abrogation of human rights and impoverishment of hundreds of millions during the Covid response, it has spawned an Exit the WHO movement standing on the supremacy of individual and national sovereignty.

This is understandable, but it also risks being naive and simplistic. If the WHO is to be torn down, those advocating for this should first recognize why it exists, and its limitations and context. It is not a world hegemonic power and cannot be, but it reflects a far deeper and more complex threat to basic human rights, democracy, and global health itself. Formed to help reduce global inequality in human health, it has contributed to a steady improvement in population health in the past, just as it has shown more recently that it can make things worse. Its actions and outputs reflect its masters, not an independent entity gone rogue. 

The WHO therefore needs to be addressed as part of a wider problem. If a privileged few are seeking some sort of global hegemony, the response cannot be based on the wishes of another privileged few. It must involve those who are most helped and most harmed, who pay for the WHO, and who may still rely on it. If this is about sovereign people and sovereign States reasserting their interests, then this is who must own the answer. 

The Betrayal of the Peoples

Since 2020, the WHO has orchestrated and condoned one of the most devastating assaults on individual and societal health the world has seen. At the behest of highly conflicted sponsors, this international bureaucracy promoted policies that overwhelmingly harmed the world’s most disadvantaged. The organization turned on those whom it had been set up to serve, returning to the pre-World War Two mindset of technocratic authoritarianism that characterized public health in the era of eugenics, colonialism, and European fascism.

Knowing fully the impact of their actions, the WHO helped force over a hundred million additional people into severe food insecurity and poverty and up to ten million additional girls into child marriage and sexual slavery. It helped deprive a generation of the schooling needed to lift themselves out of poverty and grew national debts to leave countries at the mercy of global predators. This was an intentional response to a virus they knew from the beginning was rarely severe beyond sick elderly people. The WHO helped orchestrate an unprecedented transfer of wealth from those it was originally tasked to protect to those who now sponsor and direct most of its work. Lacking any contrition, the WHO is now seeking increased public funding through misrepresentation of risk and return on investment to entrench this response.

How an Institution Rots

Through its Constitution written in 1946, the WHO was intended to promote the equality of peoples emerging from the wreckage of a World War and colonialism, with all nation-states standing equal and independent as its only authority. This continued through the Declaration of Alma Ata in 1978, placing the needs and requirements of communities under their sovereign governments as the core focus, and informer, of public health.

Like all human institutions, this could not last. High salaries and business-class travel to exotic places attract people who like, and come to believe they are entitled to, such privileges. Staff dependent on an organization for such benefits come to prioritize its welfare over the needs of those it was supposed to serve. Workers detached from the impacts of their actions soon find self-advancement, tenure, and pensions, which are achieved by listening to their funders rather than those impacted by their actions.

Watching the director of my department at the WHO drop everything when the private funder calls his phone was humiliating, but also a betrayal of the WHO’s core mission. The handshakes of the Director-General with the representatives of corporate authoritarianism at Davos are a similar betrayal. A servant cannot serve two masters.

Grown into a vast and detached bureaucracy nearly 80 years old, the WHO is anything but a representative of the world’s people. Its abortion guidelines instruct countries to ensure abortion to the time of delivery whilst denying requirement for discussion, while guidance it produces for childhood education on sexuality and gender shows, at best, a similar gross disregard for cultural diversity. Incessant climate alarmism from a business class seat, lobbying against improved fossil fuel access for the world’s poorest, reinforce inequality. An apparent war against meat adds a further disregard for science.

The WHO therefore seems ripe for the dustbin of history. However, it is more a tool than a devil. As part of a vast and growing global health industry driving a vertical commodity-based approach, it is one of many institutions serving the desires of those who have hijacked it. Removing one hammer from a wrecker will not prevent him from demolishing a house, just gives those trying to save the house a false sense of achievement. You save the house by stopping the wreckers. Like any other tool, the hammer still has a useful purpose. 

To be specific, the problems that the WHO exemplifies will not go away if the WHO does. The pandemic agenda that has dominated the last few years serves as an example. As a wealth-concentration tool of private corporations, their investors, and the national bureaucracies with which they increasingly partner, it has many alternate paths of implementation. The recent round of International Health Regulation amendments at the WHO was initiated by a United States administration, not the WHO itself. Pharma investors and countries with heavy Pharma sectors dominate the WHO’s funding and specify its actions. The WHO is a willing sycophant and puppet more than a hegemon.

Of equal importance, for all its corruption and abandonment of ethics, some of the WHO’s work still saves lives. So do partner organizations across the global health industry. They support low-resource countries in dealing with endemic infectious disease and demonstrably reduce mortality through this. They play a significant role in reducing exposure to fake pharmaceuticals – one of the largest criminal industries on earth. They still support the strengthening of under-resourced health systems. Their irrelevance in supporting the health of many is not common to all. Advocates for the complete cancellation of the WHO need to explain how they will continue support where WHO support is currently needed. It is not for them to choose who lives and who dies.

Exiting Malfeasance and Greed

To arrest the degradation of health, human rights, and sovereignty, we need an exit strategy from unethical public health. This will require an exit strategy from approaches mired in conflict of interest and an emphasis on evidence rather than corporate profit. And for the sake of both donor country taxpayers and the recipients of their support, we need an exit strategy from external dependency in order to achieve health independence. This is what sustainability and equity mean, words of which global health profiteers are so fond. These changes need to be sector-wide, not just the WHO.

All this is possible, though the end result in terms of structure is uncertain. This uncertainty is important as the path must be developed, not dictated. However, there are blatantly obvious places to start. There is no compatibility between the needs of private corporations and the health independence of the world’s population. The reasons people in wealthy countries live longer – sanitation, nutrition, better living conditions, and access to low-cost and off-patent health commodities – are poor paths to corporate profit. They require the growth of local economies, which thrive on local decision-making and local knowledge. External health agencies may fill gaps and support in times of crisis, but building vertical institutions to entrench external control, as the current pandemic agenda aims to do, is the antithesis of good and sustainable planning.

In a well-functioning system, health agencies would be working themselves out of existence as local capacity replaces them. Long-term tenure and private money could have no role, with countries clearly in charge. Beyond a meeting place and repository of ideas and voluntary standards, and support in requests in times of crisis, supra-national bureaucracies should have little role. Wealthy countries don’t need the WHO now, despite the hype, misrepresentation, and claims of never-ending crises designed to make our international agencies appear relevant. A legitimate WHO would be in Nairobi rather than Geneva, close to areas of greatest need, and if effective in addressing them it would steer itself into irrelevance.

In the meantime, the worst we could do, besides continuing the current destructive course, is to leave a vacuum. That will be fine for the privileged laptop class, but the world is bigger than that. With calm urgency and adherence to the principles intended to underlie public health, radical reform must proceed without exacerbating the very problems we are seeking to address.

How that looks, and how we get there, will be an interesting journey. Proceeding with care and recognizing the diverse needs of all is an essential starting point. But it also has to happen quickly, as the world will not well withstand another round of Covid-like plundering. The recent political changes in the WHO’s largest funder, the United States, whilst distressing to those who have profited so much through the corruption of recent years, open an exciting door through which this journey could happen.