What does the WHO need? Public health experts are unanimous: More power, more independence, and more transparency.

This is an onsite edited excerpt of the G|O Briefing newsletter

Throughout 2020, as the world was trying to develop a vaccine against COVID-19, a novel coronavirus, the WHO itself was being closely observed by an army of experts, independent researchers and specialists, all determined to answer two haunting questions: What went wrong? And how can we avoid it in the future?

Why, with all the warnings and all the information available today, was the world not able to prevent a pandemic that has so far killed over 3 million people around the world? And what should be done to avoid a repeat and ensure that the next pandemic, when it hits, won’t have the same deadly consequences?

Over several months, in total three different panels analyzed and assessed the WHO’s performance. While different in scope, the three studies reached the same conclusions: the system failed, and broad reform is urgently needed to avoid another such catastrophic collective failure.

The WHO, all three reports concur, needs to be more independent and see its investigative powers strengthened. The organization also needs to operate with more transparency. And its funding should allow it to fulfill its mission. If you’re thinking “easier said than done,” you’re right.

The three reports by the Review Committee on the Functioning of the International Health Regulations, the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme, and the Independent Panel for Pandemic Preparedness—the most scathing of the three—will all be debated next week at the 74^th World Health Assembly (WHA), WHO’s governing body, arguably the most important WHA meeting since the 2003 SARS epidemic. In fact, all of the reports result from decisions taken during last year’s meeting.

Debating and accepting the reports’ conclusions might be the easy part. Agreeing to transfer power to the organization and fund it adequately might prove to be more difficult and require some serious diplomatic jostling. It is expected that a resolution calling for the strengthening of the organization will be approved by consensus—the draft is circulating—but after that things will proceed incrementally once the low-hanging fruits are dealt with.

For consensus’ sake, an initial resolution proposal presented by the EU calling for strengthening and extending the investigative powers of the WHO has been watered down over the last days. It faced massive resistance by China, Russia and Brazil. None of these countries were ready to grant access to WHO’s investigative teams under the argument of a disease outbreak.

Instead, the resolution may well only mention the need to enhance WHO’s assessment capacities in terms of potential outbreaks.

Here is a comparative look of the three sets of recommendations contained in the report:

Sounding the alarm

One of the main questions relates to the alert system created more than a decade ago, part of the International Health Regulations (IHR): a set of binding legal obligations for the 194 WHO Member States that define rights and obligations, notably the obligation to report public health events.  

By establishing these requirements, WHO thought the system would have been enough to force countries to monitor and report outbreaks and to share the threat level with the world.  The hope was also that in fully implementing the IHRs, countries would be equipped to respond to a pandemic.

The report by the Review Committee on the Functioning of the International Health Regulations sought to answer key questions relating to their functioning during the COVID-19 pandemic, such as what did and did not work in their implementation and whether the shortcomings were due solely to a lack of proper implementation of the IHR, or whether the issues also lay in the IHR themselves. The answer is both.

The Review Committee has thus presented forty recommendations to optimize the way the WHO and the IHR work. The recommendations call for a more transparent decision-making process for convening an Emergency Committee when having to declare a “public emergency of international concern.”

But the most salient proposal is to abandon the requirement for a consensus to be reached before an emergency is declared and move to a “scale system” to allow for an alert to be sounded, even if a full emergency is not declared.

The proposal is not new. Before the pandemic, countries in Africa had circulated the idea. But when COVID-19 arrived, it exposed the failures of the mechanism. On January 22, 2020, the emergency committee called by the WHO to evaluate the case did not reach a consensus on whether the event was an international threat.

It was only eight days later that, in a new meeting, the emergency was declared. During those eight days, the virus travelled the world.

Now, the review wants new paths to be explored. For events that may not meet the criteria for a public health emergency of international concern but may nonetheless require an urgent escalated public health response, WHO should actively alert the global community. It calls for the creation of a new World Alert and Response Notice (WARN) system to prevent an event from developing into a global crisis.

In addition, more power and independence should be given to the WHO. When the allegedly affected State Party does not respond to WHO’s verification request concerning a possible outbreak, then WHO should provide information about the event. Once a year, WHO would also report how governments have complied with the implementation of the regulations including instances of sharing unverified information.

The Review Committee also suggested WHO should develop a mechanism for governments to automatically share real-time emergency information, including genomic sequencing.

Full transparency, by all

Broader powers and independence were also recommended by the Independent Panel for Pandemic Preparedness and Response. In its report, it recommends the establishment of “a new global system for surveillance based on full transparency.”

“This system would provide the WHO with the authority to publish information about outbreaks with pandemic potential on an immediate basis without needing to seek approval and to dispatch experts to investigate at the shortest possible notice,” it claims.  

It also recommends governments to transform the current ACT-A into a truly global platform aimed at delivering global public goods including vaccines, diagnostics, therapeutics, and supplies that can be distributed swiftly and equitably worldwide. The proposal, if implemented, would also place WHO at the center of any response to a pandemic or outbreak, shifting from a market-driven model to one aimed at delivering global public goods.

The Panel recommended that the WHO D-G and the regional directors' mandate be limited to one seven years term only.

Finally, countries should also adopt a Pandemic Framework Convention within the next six months, in order to create the necessary legal base for the future health system.

“Our message is simple and clear: the current system failed to protect us from the COVID-19 pandemic,” said the Panel Co-Chair and former President Ellen Johnson Sirleaf.  “And if we do not act to change it now, it will not protect us from the next pandemic threat, which could happen at any time,” she claimed.

“The shelves of storage rooms in the UN and national capitals are full of reports and reviews of previous health crises. Had their warnings been heeded, we would have avoided the catastrophe we are in today. This time must be different,” Sirleaf concludes.

Financial independence

At least two different evaluation committees pointed out how none of this independence can be guaranteed if governments are not willing to strengthen the authority and financing of the WHO. According to the Panel, one of the suggestions is to create a new funding model to end earmarked funds and to increase Member State fees.  

It also suggests the creation of an International Pandemic Financing Facility, which would have the capacity to mobilize long term (10-15 year) contributions of approximately US$5-10 billion per year to finance ongoing readiness.

The financial independence of the WHO was also an issue raised by the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme.

“The predictability and sustainability of funding for the WHE Programme must be improved through an increase in assessed contributions, non-specified multiyear funding arrangements for core voluntary contributions and a wider donor base,” it claimed in its final report, also to be delivered at the WHA.

It recommends an “increased proportion of WHO core flexible funding be allocated to the WHE Programme.”

“In the longer term, further discussions should take place among Member States to review whether WHO is equipped with the strategic capacity to support country preparedness and response and whether WHO’s funding is adequate for the WHE Programme to lead multidimensional and large-scale emergencies such as the COVID-19 pandemic, alongside the increasing number of graded emergencies that it routinely manages,” it concludes.

According to the Independent Oversight Committee, “WHO’s capacity and ability to handle a global pandemic has been severely tested.” But it remains to be seen what institution will emerge from the pandemic.

-JC