At the close of the week-long meeting of the World Health Assembly, the governing body of the World Health Organization, it’s worth asking what was accomplished in Geneva to advance global health.
The WHO, which is supposed to set priorities and establish guidelines for the international community’s many efforts aimed at improving health or fighting disease, received the most attention for delaying a decision on whether or not to recommend finally destroying all remaining samples of smallpox virus.
As the Associated Press reported:
After two days of heated debate, the 193-nation World Health Assembly agreed by consensus to a compromise that calls for another review in 2014.
It’s a debate that’s been going on since 1986, following the 1980 eradication of this deadly and terrifying disease. The U.S. and Russia, which hold the remaining known smallpox stockpiles, opposed destruction in favor of continuing research. Most other countries wanted the scourge totally removed from the planet.
The World Health Assembly did make a number of other decisions, or at least passed resolutions, regarding the need to reduce maternal mortality, child injuries and to give increased attention to so-called non-communicable (or chronic) diseases (NCDs) such as cancer, heart disease and diabetes. Not everyone is convinced a focus on NCDs will be productive.
Much of the discussion at the Geneva meeting was about the WHO’s financial crisis and the need for reform. Amanda Glassman and her colleagues at the Center for Global Development asked, and then went on to answer, the excellent question:
Why is the World Health Organization (WHO) facing a financial crisis at a time when international support for global health issues has never been higher?
Basically, Glassman and her colleagues at the DC-based think tank say the problem is that WHO lacks a coherent vision or strategy, donors lack confidence in it and other organizations (like a big philanthropy located here in Seattle) have taken it upon themselves to launch their own global health initiatives.
Margaret Chan, director-general of the WHO, acknowledged the need for reform but also took a shot back at some of the critics in her closing statements:
If you give us an average of 25 resolutions at each Health Assembly, yet give us insufficient funds, how can you hold WHO accountable for implementing your decisions and recommendations?
As Fox News’ George Russell noted, the World Health Organization is today plagued by tightwads who want a say in what the UN agency does but don’t want to provide financial support.
Rapidly developing nations – such as China, India and Brazil – that want an increased role in decision-making at the United Nations are among the stingiest donors to the U.N.’s World Health Organization, which is facing its most serious financial crisis ever.
Chan’s closing remarks, which included thanking Bill Gates (who spoke at the meeting) and others for their support of global health efforts, included a number of lofty statements about the need to continue to fight against poverty, disease and inequity. But she also warned that a depleted WHO and the fragmentation of the global health agenda poses a risk:
As one delegate noted, the fragmentation of health development has weakened the benefits of multilateral agencies like WHO. We now need to get those benefits back and strengthen them.
That sounds more like a plea than a plan. Another DC-based think tank, the Center for Strategic and International Studies, says the WHO needs to re-invent itself by “narrowing its focus” and leveraging its strengths. The CSIS says WHO plays a critical role in global health but does need to focus.
Given the financial plight of the WHO, which is short by about $3 billion over the next two years, there’s little question it will have to make cuts, shrink in size and perhaps narrow its focus whether it wants to or not.
The question is if this will bring more efficiency — and focus — to all of global health or, as Chan warns, just cause further fragmentation and a weakening of WHO’s nominal authority to set policies, conduct research, establish guidelines (such as for drug or vaccine safety) and ensure that the interests of rich nations do not overwhelm the needs of the poor.
However imperfectly or maddeningly bureaucratic and political WHO can be, and it sure can be all of those, the UN agency remains the place where poor nations are guaranteed to have some say in an agenda that is literally a matter of life and death for millions of people.