World Health Organization – Role, Importance, Issues

who upsc

World Health Organisation (WHO), the world’s largest coordinating body for healthcare, has the irreplaceable role of integrating global resources. It is the only organisation with the global reach. Being caught amid a tug-of-war between the US and China is therefore not helping the organisation to deal with the pandemic. Apart from losing out vital funds, the WHO is also facing a credibility crisis, which undercuts its ability to fulfil its other roles on global health. Thus, India, in its unique position, must take a stance in rescuing this organisation from the current crisis.

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What is the World Health Organisation?

  • The World Health Organisation (WHO) is a specialised agency of the United Nations.
  • It was inaugurated on 7th April 1948, a date that is now observed as World Health Day.
  • The organisation originated from International Sanitary Conferences, which convened between 1851 and 1938 to combat diseases like cholera, yellow fever and bubonic plague.
  • The WHO’s mission is the “attainment by all peoples of the highest possible levels of health”.
  • Internationally, it is involved in numerous roles like advocating for universal healthcare, monitoring public health risks, setting health standards and guidelines, coordinating international responses to health emergencies, fighting infectious diseases, promoting better nutrition and housing and sanitation in the name of overall well-being.
  • Headquartered in Geneva, Switzerland, it has 6 regional offices and 150 field offices.
  • It is headed by Director-General Tedros Adhanom Ghebreyesus, the former health minister of Ethiopia since 2017.
  • Since its origin, the WHO was successful in reducing tuberculosis and measles through mass vaccination programmes and near-eradication of polio. It has even completely eliminated smallpox in 1979.
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What is the World Health Assembly?

  • The World Health Assembly (WHA) is the WHO’s critical decision-making body.
  • The two-day assembly is usually held annually in Geneva. This year’s 73rd World Health Assembly was held virtually due to the COVID-19 pandemic.
  • World Health Assembly is attended by representatives of the UN’s 194 member states.
  • During this assembly, WHO’s work is reviewed, new goals are set and new tasks are assigned.

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What is the Resolution 73.1 adopted by the WHA member nations?

  • The World Health Assembly (WHA) Resolution 73.1 on COVID-19 response, which was adopted on March 19, requests Director-General of WHO to initiate stepwise independent and comprehensive evaluation of WHO’s response to the coronavirus pandemic.
  • It was initially proposed by 60 countries, including Australia, Bangladesh, Brazil, Canada, India, Japan, Russia, etc., leading to the backing of more than 120 member countries.
  • The purpose of the independent evaluation of WHO’s response is to “review the experience gained and lessons learned from the WHO-coordinated international health response to COVID-19”.
  • It aims to look into:
  1. The effectiveness of WHO’s mechanisms
  2. Functioning of the International Health Regulations (IHR) and implementation of recommendations by previous IHR review committees
  3. The WHO’s contribution to UN-wide efforts
  4. The actions of the WHO and their timelines pertaining to the pandemic
  • The review would also recommend ways to improve the WHO’s emergency programme and strengthen its pandemic response.
  • The resolution allows the Tedros to set up a new mechanism for this purpose though there are already two mechanisms to conduct reviews – the Review Committee under the IHR and the Independent Oversight and Advisory Committee of the WHO Emergencies Programme.
  • The Resolution, however, would not review member nations’ actions. It would only review the WHO’s actions, making it one-sided against the WHO.
  • While the Director-General already has the power to review the actions of both the WHO and its members-states without consultation, the new resolution requires him to act in consultation with the member-states even to “initiate” a review.
  • Article 50 of the IHR, 2005 empowers the Director-General to independently establish a review committee that can recommend amendments to the IHR, modification or termination of standing recommendations and changes to the IHR’s functioning.
  • Also, Article 43(4) allows the WHO to assess the member states’ additional health measures, including those beyond what the WHO has recommended.
  • The new resolution provides for no such powers to the Director-General and directly undermines his power.

Why are countries backing an independent probe on WHO’s response to COVID-19?

  • The Resolution 73.1 on COVID-19 response comes as a result of the US-led criticism of WHO’s response to the COVID-19 pandemic.
  • Critics point out that the organisation had failed to exercise global health leadership and instead became a tool of Chinese power and propaganda.
  • This is in response to the WHO’s failure to question China’s handling of the outbreak in Wuhan and to act decisively to prepare the world for the dangerous disease.
  • They also criticise its inability to promptly announce the current outbreak to be a public health emergency of international concern (PHEIC) to enable countries to hasten their response to the pandemic.
  • The UN-body is also criticised for its high trust of the Chinese government, which initially tried concealing the extent of the outbreak.
  • There are also questions about the WHO’s authority to challenge states during serious outbreaks for the good of global health.
  • The WHO has almost no power to control the activities of the independent and sovereign nations. Unlike organisations like the World Trade Organisation, it cannot sanction or bind its members.
  • WHO’s budget, split among a large number of public health and research projects, is less than that of many university hospitals.
  • Moreover, the international order on which the WHO relies on is fraying, as aggressive nationalism has become the norm across the world. This led to reduced importance on global health needs.
  • Yet, previously, the WHO was able to deal with these situations.
  • Under former Director-General of the WHO, Brundtland, local contacts, diplomatic channels and internet were used to monitor the epidemics.
  • During the SARS outbreak, this strategy proved to be fruitful as the WHO was able to monitor the situation even when the Chinese government failed to alert the organisation.
  • Although the WHO does not have formal powers, under Brundtland’s leadership, China was made accountable for its withholding of the information.
  • Brundtland’s approach successfully contained SARS not with vaccines or medicines, but with “non-pharmaceutical interventions”, which is travel warning, tracking, testing and isolation of cases and huge information-gathering operations across multiple countries.
  • The success is mostly because of the WHO’s willingness to wield authority that it had.
  • After SARS, the WHO drew up a new version of the International Health Regulations (IHR), the central legal document that asks all states to prepare for public health threats according to set standards and to report any outbreaks and all subsequent developments. It also allowed the WHO to declare PHEIC, during which time the countries are to follow WHO’s guidelines and report any deviations to the organisation. However, it does not give the power to the WHO if the states refuse to comply.
  • Though the WHO’s response to SARS was successful, many countries became wary of its higher power over the sovereign states, leading to them not complying to its rules.
  • This resulted in the WHO sacrificing its credibility by overlooking China’s obvious blunders in December and January in exchange for its compliance in February.
  • After the SARS outbreak, the WHO struggled to get the nations like the US to prepare themselves future pandemics.
  • Even now, many countries have failed to abide by the guidelines despite the rulebooks mandate them to do so.
  • The declaration of PHEIC is more to garner nations’ response than to promote coordination among them.
  • WHO’s strategy focuses on tracking and tracing, which has proven to be a success in South Korea and Germany. It also called for international cooperation on the sharing of scientific information and resources.
  • This was completely ignored by countries like the US and the UK to pursue their own national strategy for public health.
  • The WHO is battling against a breakdown in international cooperation that is far beyond its capacity to control.
  • The organisation has a high reliance on the unspoken norms of international collaboration, which is currently worsened by the COVID-19 outbreak.

How is the WHO funded?

  • This is not the first time that the WHO is being criticised for its slow response.
  • It was previously condemned for its lack of effective response to the West African Ebola outbreak in 2014-15, which led to unnecessary fatalities.
  • An independent commission by then Director-General Margret Chan claimed that the organisation was badly underfunded, thus leading to the inability for quick responses.
  • Funding comes from participating nations, the UN and private entities.
  • The US is the biggest single donor to the Geneva-based organisation. It contributed more than $400 million, which in 2019 is roughly 15% of the organisation’s annual budget.
  • The member dues make around a quarter of the money the US gives to the WHO. They are based on the members’ wealth and population.
  • In 2019, the US contributed around $553 million. The WHO’s biennial budget was around $6.3 billion in 2018-19.
  • Most of the US’ funds go to programmes like polio eradication, vaccine development and increasing access to essential health and nutrition services.
  • Just 2.97% of the US’ contribution goes towards emergency operations and 2.33% deal with outbreak prevention and control.
  • The top beneficiaries of the US contribution in terms of the region are Africa and the Eastern Mediterranean.
  • Though epidemic control and preparedness are given higher priority, it is the least important thing the WHO has ever done historically.
  • The US’ announcement of fund freeze comes at a time when the WHO was already appealing for emergency finance of $675 million to fight the pandemic.
  • This fund cut would have a significant impact on the on-going health programmes and operations of the WHO during the time of a global pandemic.

What is India’s role in all this?

  • In the past few years, New Delhi has stepped up its efforts to have a decision-making seat in every global assembly and membership in every elite club.
  • Now, India has the biggest opportunity of them all. In the midst of a pandemic, India is heading Executive Board of the World Health Organisation – the decision-making panel.
  • WHO Executive Board, consisting of 34 individuals, holds two meetings annually in January and May, immediately after WHA.
  • Its main functions are the implementation of the decisions of WHA and facilitate its work.
  • Indian is making use of this opportunity to strengthen its role by leveraging its relatively advanced pharmaceutical industry and playing a technocratic role.
  • As a major emerging power, presiding over the world’s highest health body during the global health crisis makes it inevitable for India to be a part of the geopolitical squabble at the WHO involving China and the US.
  • Both the US and China are taking measures to bring India to their side.
  • The US made use of Taiwan card to counter China and India was one among the many countries to support its inclusion in WHA.
  • China, on its side, invited India to participate in the Shanghai Cooperation Organisation.
  • Traditionally, India has balanced its ties with both China and the US, without taking sides with either of them.
  • However, amid the coronavirus crisis, India took a new stance.
  • Apart from openly supporting Taiwan, India complained against faulty Chinese medical goods and benefited from vital medical equipment from Taiwan.
  • India’s relations with China are increasingly becoming hostile with the border disputes escalating along the Himalayas.
  • It is evident that India is making use of this situation to counter the Chinese presence in South Asia.
  • The US, for a long time, waited for this opportunity and would push more aggressively for New Delhi to take more sensitive political stands.
  • However, India would act on its own accord so that it is not seen as a tool for the US interests.
  • Yet, it should be noted that India’s bilateral ties with the US are also proving to be a difficult feat under Trump’s leadership. The President had earlier threatened India with retaliation if New Delhi imposed an export ban on Hydroxychloroquine. This led to the Indian government relenting by lifting of the ban on the anti-malarial drug.

What can be the way forward?

  • The increasing dispute between the US and China with the WHO as a focus point shows that the pandemic is being politicised at the international level.
  • Furthermore, the one-sidedness of Resolution 73.1 and the inability of the countries to listen to the WHO’s guidelines reveals that the states are not willing to promote accountability and transparency.
  • The political scuffle between the countries and the WHO would only subvert the independent unbiased evaluation of the responses of the WHO and the states to the COVID-19.
  • The first causalities of the aforementioned differences will be science and evidence, which are the vital aspects for countering the pandemic.
  • India, which is going to lead WHO’s activities for three years, is caught between these differences.
  • The US has lost its position as a global leader and Beijing is doing everything in its power to claim this spot.
  • This may increase the challenges for India in the future. Therefore, New Delhi must play a larger role in international politics to prevent a similar crisis from taking place.
  • It now has the opportunity to rescue the organisation from this crisis.
  • However, New Delhi would have to do this while upholding its own independence, interests and credibility as an emerging global power.
  • India must do its bit to shake up the consciousness of international organisations, their member states and officials.
  • They must be made to realise that the pandemic is not a national issue but a global one.
  • Therefore, global cooperation with little to no differences in the science of the pandemic is vital to address this crisis.

Conclusion:

The world must put aside differences in order to achieve the common goal – countering the COVID-19 pandemic. The global order, which is increasingly becoming protectionist in nature, needs a relook. Global cooperation in addressing this shared crisis must be put to the forefront and the WHO, which is important in dealing with a pandemic, must be supported by all players without any differences.

Practice question for mains:

Critically examine the significance and limitations of the World Health Organisation. How does the recent resolution made by the member states in the World Health Assembly undermine its role in the pandemic?

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