WHO Is in Charge?: The Role of Multilateral Institutions in Global Health

Next week, heads of state, political and health leaders, policymakers, and healthcare champions will descend on the United Nations building in Manhattan for the UN High-Level Meeting on universal health coverage. The meeting seeks to garner financial and political commitments from countries and sustain investments in strengthening health systems around the world.

Achieving universal health coverage, whereby all individuals and communities receive the health services they need without suffering financial hardship, has been the mantra of the World Health Organization (WHO)—the Geneva-based UN agency charged with public health—under the mandate of its current Director General, Dr. Tedros Adhanom Ghebreyesus. With at least half of the world’s population still lacking access to essential health services, Dr. Tedros—as he is commonly known within the global health community—has made it the institution’s goal to ensure that a billion or more people have access to quality, affordable health services.

This highly ambitious goal is contingent on high-level political buy-in from leaders whose health systems and ideological priorities are widely dissimilar, as well as much-needed financial support from an incongruent donor community. In addition, Dr. Tedros’ noble aspiration is strongly contrasted by the continued common perception that the WHO does not have real recourse to hold governments accountable if progress stagnates.

Nevertheless, it is a highly welcome step away from the WHO’s previous policy and budgetary focus on operational work at the country level, and towards reclaiming its leadership position in global coordination and normative development.

Is There a Doctor in the House?

The post-WWII global health framework had traditionally been defined by a handful of players, namely the WHO, United Nations Children’s Fund (UNICEF), the Rockefeller Foundation and more recently, the World Bank. Nowadays, however, we are confronted with an entirely different global health landscape which is much more diverse and flexible, with access to more funds and resources.

The private and non-profit sectors have developed as a formidable force in global health. The Gates Foundation has recently surpassed the United Kingdom as the second largest provider of development assistance for health. International NGOs like Médecins Sans Frontières, Oxfam or CARE play indispensable roles in disaster relief and health emergencies.

Multinational corporations have also played a crucial part in addressing global health issues and filling in the gaps left by inaction and the lack of a clear institutional leader. Pharmaceutical companies are undertaking vital efforts to improve access to medicines among people in low and middle income countries. Major public-private partnerships such as The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Global Alliance for Vaccines and Immunization (GAVI), have effectively replaced the WHO at the helm of global health governance through their multi-billion dollar budgets, multi-stakeholder compositions and elevated organizational flexibility.

While these new players and funds have undoubtedly brought immense benefits to global health, the absence of a clear overarching coordinating institution has resulted in an increasingly fragmented and uncoordinated global health agenda.

Lead me, Follow me, or Get out of my way

The WHO is the only institution with the legitimacy to develop international health norms and muster policy consensus among governments and other global health actors. This unique convening authority, derived from its constitution, is crucial to enable cooperative supranational action on global health issues.

The institution’s recent launch of a global registry on human genome editing, representing the first attempt to develop global standards for governance and oversight in the ethically challenging field of human genome editing, is a cardinal example of what the WHO’s core global functions should be in a rapidly developing world.

This is particularly important when looking at myriad emerging health threats that we are likely to confront in the coming years, ranging from outbreaks of vaccine-preventable diseases like measles and diphtheria, increasing indications of drug-resistant pathogens, and growing rates of obesity and physical inactivity, to the health impacts of climate change and environmental pollution, as well as multiple humanitarian crises.

The global health community, including multinational corporations and NGOs, will be closely watching the unfolding of next week’s milestone event in New York. It could represent the reemergence of a much-needed leader in the fractured world of global health, which would help to encourage the development of unified and coordinated efforts involving governments, corporations, NGOs and other stakeholders, to address global health issues.