The World Health Organisation(WHO) is currently facing an image problem. We all are aware about the existence of WHO but very few have any idea about what it does. Is it a world medical association,a transnational health body or a source for technical medical reports with an overview ofbureaucracy. According to the organisation’s constitution drafted in 1948 the objective is “the attainment by all people of the highest possible level of health” where health is defined as complete, physical, mental, social well being and not just the absence of disease or infirmity. The WHO’s covers much ground by acting through the member states(currently 194), directing and coordinating the access to health care, improving access to medicines, preparing for emergencies amongst other training and influencing health policy decisions.
The current pandemic caused by COVID-19 has raised worrisome questions about the objective, role and duties of WHO in global health. Does WHO have direct powers to improve people’s health globally? Is politicization of WHO have skewed the global health role it is obligated to advance? How did WHO failed to preempt and prepare for pandemic (COVID-19) of this nature which being one of its top priorities? Has the WHO-China relationship become ‘interdependent’ leading to the sacrifice of global health in exchange? Can we raise the question of legitimacy of WHO every time it fails to deliver a pandemic? These questions are timely and will not only remove the skepticism of neutrality but also WHO as a reliable institution of global health.
The Timeline of COVID-19 & WHO’s Absence
Let us look at the sluggish and almost reluctant response of WHO to the novel coronavirus crisis through the time line which necessitates raising questions of WHO passiveness.
On 5th January 2020 WHO reports on pneumonia of ‘unknown cause’ in China;
10th January 2020 ‘WHO does not recommend any specific health measures for travelers and dismissing any claims to restrict travel to China;
20th January 2020 WHO states there is no human to human transmission of COVID-19 fully agreeing with the preliminary investigation being conducted by the Chinese authorities;
21st January 2020 WHO delegation makes field visit to Wuhan, China and do not release any report;
22nd January 2020 WHO blocks Taiwan from attending an emergency meet on COVID-19 at the direction of China and did not declare Pubic Health Emergency of International Concern (PHEIC);
24th January 2020 China locked down Wuhan with 36 million people;
28th January 2020 WHO appreciates measures taken by China to prevent the outbreak;
30th January WHO declared Pubic Health Emergency of International Concern (PHEIC);
4th March 2020 WHO praises China for the substantial amount knowledge generated by the novel coronavirus;
8th March 2020 China donates US$20 million to WHO;
10th March WHO issued guidelines for schools with UNICEF and finally on
11th March 2020 WHO declared COVID-19 as a Global Pandemic.
The above trajectory recognizes the absenteeism of WHO from the global health field when its presence was most required.
One crucial difference in the reaction during SARs epidemic of 2002-03 was WHO was expeditious in issuing travel restrictions as well condemn China for impeding the submission of information. The research paper ‘SARs coronavirus as an agent of Emerging and Reemerging Infection’ published in Clinical Microbology review categorically stating the mutable nature of virus, coupled with China’s urbanization and its proximity to wildlife(illegal) were together a ticking ‘time bomb.
It is bemusing why armed with years of data and research of outbreak as well as containment of SARS, Dr Tedros Adhanom Ghebreyesus WHO chief lauded the ‘commitment to transparency’ of China in the early days of the pandemic. These early missteps and miscalculation by the global health body have affected millions of life and led to a world economic mishap. The organisational challenges, underfunding and opaque regional offices give arise to two pertinent questions of a) the Legitimacy of WHO in acting towards global health equity and b) dilution of neutrality by WHO which are opening gates of conflict.
Indentifying the crisis of legitimacy of WHO
It is difficult to ascertain the legitimacy of any organization when it is functioning in the international arena. As Hurrell termed legitimacy is the ‘tendency of individuals or groups to accept and follow the rules of political order’. To make it functional the notion of consent, representation, accountability, transparency and due process are vital elements. Moreover, legality and broad based consensus pertaining to the values of the society are required notions of legitimacy in a democracy. Of course the application of the legitimacy internationally becomes fuzzy WHO being no exception.
Similarly we argue the lack of legitimacy of WHO is sourced in the democracy deficit which WHO practices. Firstly, the main reason for the democracy deficit is that all states in WHO are not equal participant in the decision making. The one-country one vote weighs heavily against the smaller State’s. Secondly, the absence of people’s participation thus putting the lid back on principle of consent and finally, the absence of equity and inclusiveness in the process of decision making. The mishandling of COVID-19 pandemic by WHO have intensified the crisis of legitimacy thus leading to a democracy deficit. WHO is racing to restore the confidence of the world now and but it has certainly lost its agency for now.
Need to Re-assert Neutrality
Neutrality is an old established concept in international law and it is not seriously discussed anymore. It is a fundamental principle that international organizations needs to enjoy the confidence of all and not engage at anytime in controversies be it political, religious, racial or ideological meaning to be neutral. Neutrality not necessarily emphasize of abstaining but also taking timely actions.
To recapitulate, after SARs the International Health Regulations (IHR) were revised in 2005 to grant extraordinary powers to the World Health Organization.Firstly, IHR authorizes the WHO-director general to declare a PHEIC even over the protest of the State or States directly affected (which was not done in COVID-19) immediately. Secondly, IHR authorizes WHO to act even on non-state sources information allowing WHO to take immediate actions in case of outbreaks as States tend to cover their acts ( WHO needs to justify the delay in reporting) and third, WHO has the power vested in them to name and shame the country who do not comply with the IHR requirements. Inspite of the powers, inspite of the data, inspite of the outbreak WHO favoured one State over the others.
Are we witnessing a post-neutrality phase in the working of WHO were neutrality is ambushed by concentration of powerful few State’s. How will the post-neutrality phase play out in global health equity distribution is something to ponder upon? We urge to believe in lack of any alternatives that neutrality is an alternative and a realistic one for avoiding the impact of today’s as well the next pandemic. Instead of image correction WHO now needs to develop and maintain its coordinating function as derived from its Constitution. Moreover, in these unfathomable times infusion of legitimacy and neutrality by WHO will facilitate the ongoing dialogue on health pluralism.
Jitamanyu Sahoo & Syed Mujtaba Hussain are Research Scholars working in (Comparative Heath Law, Human Security & Constitutional Law).