When it comes to emergency preparedness for pandemics, the World Health Organization is falling short. It has not provided prompt and clear leadership to the world in combating either the Ebola or Zika viruses. Its leadership has been low energy, its representatives contradict each other in their public advisories, and it is regarded as more of a policeman than a partner by national governments. Its many dedicated scientists produce useful reports on the global state of public health, but the WHO's bureaucracy impedes the decisive action necessary to get out in front of emerging pandemics.
A new report says as much. The report comes from The Commission on Global Health Risk Framework for the Future. It makes 26 recommendations which aim to strengthen the WHO’s leadership role in coordinating international preparedness and response. Not surprisingly, the report is written by bureaucrats for bureaucrats. A sample recommendation is that the WHO should “devise a regular, independent, transparent and objective assessment mechanism to evaluate country performance” against precise benchmarks defined in conjunction with member states. A second is that the United Nations and the WHO should establish clear mechanisms for coordination and escalation in health crises.
Collectively, the recommendations present a worrisome take on the WHO’s current capabilities. At the same time, they lack the specificity needed to be inspirational or actionable.
"The WHO would probably be a more effective and nimble organization if it was half its current size, not double"
But, instead of concluding that the WHO, as currently structured, led and governed, is unable to deliver emergency preparedness, the report merely advocates for extra funding: double the existing WHO budget with an extra $4.5 billion in annual funding; a $100 million contingency fund for emergencies; and a $1 billion annual research and development fund to be coordinated by a Pandemic Product Development Committee.
The annual World Health Assembly in Geneva, starting May 23, may vote support for these recommendations but it is unlikely that these funds will ever be raised. National governments, deeply unimpressed by the WHO's inefficiencies and leadership deficit, will be reluctant to give more. Foundations may provide a little. Some private companies may support the R&D fund but only if they are given a greater role in WHO governance and if there are guarantees of purchase contracts for new drugs and vaccines at sensible prices. Both seem unlikely, as the WHO's culture has always winced at cooperation with the private sector.
WHO's track record not encouraging
The report admits the difficulties of making a commercial case for the new funding. The Commission estimates pandemics could cost $60 billion per year and argues that the extra funding recommended is a worthy, preventative investment. However, the WHO's track record hardly guarantees that the $60 billion would be avoided or even significantly reduced. In fact, the WHO would probably be a more effective and nimble organization if it was half its current size, not double.
The WHO's role in preparing for, providing early monitoring and managing pandemic crises should be transferred to a Health Emergency Unit within the Health, Nutrition and Population Practice of the World Bank. Relevant WHO scientists and field health experts could be seconded to this Unit; they would work out of country offices in partnership with World Bank executives and national public health agencies. The World Bank has the clout to ensure these national public health ministries meet standards for pandemic risk preparedness, resource allocation, and monitoring capability. A country that doesn't pass an annual audit on these dimensions could be denied World Bank funding and other facilities.
The World Bank already spends more per year on health programs than the entire budget of the WHO and has played a major role in aiding recovery in the Ebola-hit economies of West Africa. The Commission's report hints at but never quite concedes that the World Bank should take a more prominent role. It recommends that the World Bank's Pandemic Emergency Facility should rapidly deploy money in conjunction with the proposed WHO $100 million contingency fund for emergency outbreaks.
Why not let the World Bank, with its broadening social mission under president (and former WHO executive) Jim Yong Kim, its superior budget management and its connections to the private sector, take over leadership of the WHO's important emergency preparedness functions?
