Global Health Governance: COVID-19 and WHO

During the 19th and 20th centuries, states increasingly realized that they faced a variety of transnational issues which they could not tackle on their own. Hence, for catering such concerns birthed the need of cooperation and joint efforts. The states’ responsibility towards their citizens’ welfare requires them to come together and put aside their differences. This has resulted in a phenomenon called global governance. Lawrence Finkelstein defines it as “any purposeful activity intended to ‘control’ or influence someone else that either occurs in the arena occupied by nations or, occurring at other levels, projects influence into that arena”.  The various issues that global governance deals with range from; nuclear weapons, migration and gender inequality to environmental degradation, human rights and health concerns. Diseases do not care for manmade borders; everyone and anyone can be affected irrespective of where he or she lives. This is especially true for today’s globalized world when barriers between countries have broken down with improvement in communication and transportation.

As the largest entity working to ensure international public health, the World Health Organization (WHO) is the centerpiece of global health governance. Being a United Nation (UN) specialized agency with 194 member states, its headquarters are in Geneva, Switzerland. WHO establishes health norms and provides technical assistance to countries when needed. The organization sees health as physical, mental and societal wellbeing. It has been instrumental in the eradication of smallpox, the fight against polio and development of an Ebola vaccine.

Since December last year, the world has been gripped by the novel coronavirus which has seeped to this day. The pandemic has resulted in nearly 32 million and almost a million deaths worldwide. On 30th January 2020, the WHO declared it an international health emergency. Since then, countries have adopted varying degrees of lockdowns, the economies have crumbled disastrously and political confrontations have become the new normal. Inequalities between the developed and developing world has increased and people continue to suffer with no end in sight.

WHO has been one of the leading health institutions amidst this pandemic. As the spotlight of global health governance, WHO should have prevented the pandemic from even happening. However, once it happened, the organization should have tried to curtail it. But WHO did not succeed in either of those goals. Even the breakout of the pandemic was a failure of global transparency and coordination. Experts have rightly pointed out that “another pandemic whose speed and severity rivaled those of the 1918 influenza epidemic was a matter not of if but of when.” This clearly proves that this pandemic only highlighted the already existing hollowness of global health governance. WHO has also been accused of covering up the Chinese situation. Though, the organization has been providing education and latest scientific information on the pandemic through its website, social media platforms and offices. However, it has been unable to establish an infrastructure to fight the virus and improve disease surveillance. It has fell short of creating a supply chain that ensures equity and justice. Most importantly, WHO has been unable to reduce the number of cases worldwide, which keeps on increasing every single day.

Is WHO solely to be blamed? Well yes, but no. The world lacks a supranational global government which can dictate what states should do. Only cooperation on behalf of states in intergovernmental organizations is possible. So, the ineffectiveness of WHO, is essentially irresponsibility on the part of member states. In April this year, WHO conducted a conference for an “Access to COVID-19 Tools Accelerator” agreement. The European Union (EU) and United Kingdom (UK) were part of it but there was no presence of United States (US), Russia or India. Also, China only lowly participated. President Trump first cut funding to WHO. He then announced that the US will be leaving the organization, blaming WHO of being “China-centric”.  A major power that has historically taken leadership roles and has presently shown similar intention opted out of actively combating the pandemic collectively. Global health governance thus is likely to suffer because major powers have the money, the technology, the health care that smaller countries lack.

It seems that even as their people lay dying, states will try to monopolize a pandemic to advance national interests.

There has also been a dearth of coordination on vaccines. Instead of bringing together the best minds from across countries to work on vaccines, states have chosen to work independently. They rely on corporations wanting to profit off of human life. In this political debacle, poor countries are the losers. The structure of WHO is an impediment in itself to effective policy-making. The requirement of implicit consensus makes for a slow decision-making process. A meager annual budget of $5.6 billion which is dependent on member’s donations also impedes WHO’s ability to carry out its functions. States that contribute more financially exercise greater influence in the organization.  WHO’s funding comes from countries’ assessed dues and voluntary contributions with the latter making up 80% of its entire budget. The largest donor is the US followed by the US-based Bill and Melinda Gates Foundation. Each contributes around 15% and 9% to the organization’s funds. While Chinese contribution is a fraction of its rival, it has risen by 52% since 2014. Experts claim that WHO’s increased dependence on voluntary contributions have made it “highly susceptible to the influence” of its donors. Moreover, restrictions by national governments such as during the 2013 Syrian polio outbreak prevented WHO’s programs to be implemented. State restrictions also hinder diseases’ surveillance because the organization’s working is through domestic institutions instead of supranational bodies.

WHO has certainly not been a successful agent of global health governance but the fault for this lies with states and not the organization itself. This is just the beginning. We do not know how long the virus will last. There is no guarantee that a new health disaster will not insidiously seep into communities soon. It seems that even as their people lay dying, states will try to monopolize a pandemic to advance national interests. Taking advantage of the US exit from the organization, China is slowly increasing its influence in WHO. One such manifestation of increased Chinese sway is the continued exclusion of Taiwan from such an international entity

None of the possible recommendations will matter unless states have the will and desire for effective multilateral approach to global health. WHO cannot help states if states do not take responsibility.

When a vaccine is developed, corporations will advocate for intellectual property and market exclusive rights. Consequently, the availability of the vaccine and its access for the citizens will be hindered. For example, South Africa was prevented from fighting HIV/AIDS due to high prices of the patented treatments. A similar situation arose with the pneumonia vaccine PCV13, the lack of access to which resulted in preventable deaths. Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and it’s supplementary, Doha Declaration regarding equitable access to health facilities, lack implementation.

Who is going to tell these states that securing national interests will not matter if there are no people left within the country to protect? Do they not know that monopolizing access to health relief such as vaccines might result in conflict and social anarchy? It seems that what appears to be liberal institutionalism on paper is essentially realism in practice.  WHO is for states; it can be an effective tool to protect global health. There are recommendations such as an independent governing authority in WHO, accountability for states’ financial contributions and improvement in procedural rules. However, none of the possible recommendations will matter unless states have the will and desire for effective multilateral approach to global health. WHO cannot help states if states do not take responsibility. WHO has failed in its leadership role only because state governments have failed in their leadership roles.

Nabiya Imran

Nabiya Imran

Ms. Nabiya Imran is an undergraduate, studying International Relations at NDU, Islamabad. Her area of interest includes postcolonial studies and sustainable development.

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