WHO at a Crossroads

Amid waning global support and a deepening financial crisis, the World Health Organization (WHO) must embrace significant reforms to remain effective in confronting global health challenges, two experts with the Duke Global Health Institute (DGHI) assert in a new commentary. 

“Today, WHO stands at a crossroads,” write Shenglan Tang, M.D., Ph.D., and Michael Merson, M.D., in a commentary published in The Lancet on April 9, two days after the 78th anniversary of the WHO’s founding. “This creates a rare opportunity for the organization to improve its efficiency and effectiveness through far more extensive institutionl reform, rather than incremental change.”

Formed in 1948 as the United Nations’ arm to coordinate multinational efforts to improve public health. WHO is facing scrutiny following the U.S. government’s January decision to withdraw support, which could reduce the global organization’s overall budget by as much as 20 percent. But even before the U.S. departure, there were calls for WHO to become nimbler and more efficient, note Tang and Merson, who both held previous positions within the organization. 

They note, for example, the lack of integration among WHO’s loose network of country and regional offices, which complicated the organization’s ability to respond quickly and consistently to global health emergencies such as the 2014 Ebola outbreak in West Africa and the COVID-19 pandemic. Consolidating responsibility for pandemic preparedness and response in WHO’s central offices would significantly reduce administrative costs and lead to more coordinated interventions, they say.

“WHO must seriously consider the reorganization of these regional and country offices to make it more efficient,” says Tang, the Mary D.B.T. and James H. Semans International Distinguished Professor of population health sciences and global health at Duke and co-director of the Global Health Research Center at Duke Kunshan University

WHO can further shed costs and streamline operations by focusing on what it uniquely provides as a transnational organization, the professors write. That means reinforcing programs that provide benefits to all countries – such as climate mitigation, pandemic protection and science-based guidance on emerging health threats – while abandoning efforts that have limited scope or can be carried out by country governments or NGOs. 

Tang and Merson assert that WHO can and should continue to play an essential role in directing and coordinating multinational efforts to prevent diseases, interrupt outbreaks and promote public health. But it can no longer fall back on a “business-as-usual” approach to address its financial and structural shortcomings. Its ability to sustain its long record of global health leadership will hinge on bolder reforms. 

“Our article is not meant simply as a criticism of WHO or its current leadership,” says Merson, founding director of DGHI and the SingHealth Duke-NUS Global Health institute (SDGHI) in Singapore and now a professor at the New York University School of Global Public Health. “It is a call for a stronger WHO, which is needed now more than ever.”