How to Fix the World Health Organization

I n early 2020, the reality had set in that COVID-19 was moving toward becoming a deadly pandemic and a global economic disaster. Fair or not, the World Health Organization (WHO) has received much of the blame for confusion over public-health guidance, devastation to the global economy, and millions of COVID-19 deaths. Reforming the institution now tops the list of requirements to ensure that what happened with this pandemic never happens again. Doing so, however, will be an uphill battle. Even the definition of reform is far from agreed upon, and beneficiaries of the status quo are formidable.

COVID-19 has reminded us all of the necessity of WHO’s mission, especially its duty to coordinate international responses to global health threats — a role that the U.S. helped build and one upon which our own health security depends. A WHO back-to-basics reform agenda is thus useful both for the WHO, protecting it against those who exploit its weaknesses, and for U.S. national security, as geopolitical and public-health challenges are intertwined in a way that vaulted health from near obscurity to the top of the director of National Intelligence’s global-threats list.

The first major reform challenge is the expansion of WHO’s agenda beyond its essential roles. Institutional mission creep has developed over time in response to challenges ranging from affordable access to medicines to pandemic threats. It has been driven by its own member states, including the U.S., and has very often been politicized, wading into international trade disputes or economic or social and cultural issues that draw attention away from global health security. The forces behind the WHO’s expansion haven’t gone away.

The U.S. was in a good position to set the reform agenda last year while holding the rotating presidency of the G-7. Despite unsettling our allies with an unconventional attitude and approach toward WHO, a reform “road map” was carefully and successfully negotiated over many months among the member states. But the effort came to a screeching halt by late July, when Germany and France stunned other members in announcing their last-minute opposition to the package after more than 20 direct, minister-level discussions about the pandemic and WHO reform. Substance wasn’t the problem, they said. Rather, their leaders refused to be associated in any way with the U.S. “approach” — mainly, President Trump’s May 29 announcement that the U.S. would withdraw from WHO unless reforms were achieved.

A Franco-German proposal quickly appeared, containing many of the same G-7 ideas but also a major difference: favoring “strengthening” the WHO with more funding and more mandate. The European Union recently proposed a global pandemic treaty putting the WHO at the center of an expansive global pandemic architecture. But expansion of the WHO’s role would further dilute its focus on its essential mission. We risk making the mistake of confusing expansion with reform.

Interest groups, global competitors, and even allies will seek to persuade the Biden administration to back these and other “reform” ideas that will further expand WHO’s role.

At the WHO’s annual governing meeting later this month, the Biden administration must instead push for reforms focused on fundamentals of global health security, establishing global technical standards, writing public-health guidance, and providing expertise, support, and coordination to prepare to meet the next, inevitable pandemic threat. The U.S. has a strong hand as the unchallenged leader in global health. Leadership on WHO reforms will help cement America’s hard-earned lead position both within and outside the WHO that global competitors are working overtime to undermine.

A second major reform challenge relates to how the WHO handles key aspects of its essential missions. Chief among these is the WHO’s standards on pandemic-related travel restrictions. Prior to COVID-19, the public-health dogma that shaped the WHO’s guidance held that travel restrictions were ineffective and would damage trade, thus exacerbating the public-health response. It turns out, however, that during an outbreak of a highly infectious respiratory disease easily spread by breathing people, restrictions on the movement of virus vectors (people) do indeed slow the spread. Consider how much worse the global economy would have suffered had we allowed for unchecked travel. President Biden recognized this by maintaining many Trump-administration travel restrictions and instituting new ones on India. The Biden administration must lead the push for a new WHO doctrine and guidelines to protect and maintain international trade by de-linking it from emergency travel restrictions.

The third major reform challenge is the most obvious and most critical to protect the WHO from poor decision-making internally and external manipulation. The International Health Regulations (IHR) agreement — which obligates all countries to monitor, report, and respond to outbreaks — lacks both the ability to enforce compliance and creates a disincentive for the WHO secretariat to seek compliance. The WHO’s lack of transparency about China’s slow and incomplete information-sharing early in the pandemic moved world leaders to praise China when instead they should have been demanding more openness and preparing for the worst. Absent a mandate to report on IHR compliance, the WHO will almost always remain silent for fear of offending member states, especially powerful ones.

A potential fix the Biden administration should seek is a universal IHR compliance-review mechanism along the lines of the U.N. Convention Against Corruption or the WTO Trade Policy Review mechanisms. Real-time reporting by the WHO is still needed, but it would put pressure on countries to comply with the IHRs routinely and keep the WHO honest. Such a commonsense change could make a big difference, with successful U.N. models to inform its design.

The fourth reform challenge is money, ensuring that reform doesn’t get conflated with funding problems stemming from an outmoded and now inequitable formula for calculating assessed contributions required of each WHO member state. The failure with regard to Wuhan was noncompliance with the IHRs, not funding. The G-7 road map sought reform of WHO’s budget to make it fit for purpose. The Franco-German proposal simply calls for massive funding increases. The right level of funding is important, but calls for more money before real assessments of what went wrong and how to fix the WHO puts the cart before the horse. The Biden administration must verify that funding is on the table to leverage reform and incentivize compliance with the IHRs.

A final reform was nearly achieved before the pandemic, when the U.S. and the WHO completed negotiations on a “performance agreement” for WHO management and budgeting. It is a tool to make sure that both are fit for the purpose (like pandemic preparedness). The pandemic derailed the finalization of the deal in January 2020. The Biden administration should take this across the finish line for an easy but real win.

These and other commonsense reforms do not require a new global treaty or even amending the IHRs. Rather, they would shore up the WHO’s ability to do its most important missions and do them well. Biden-administration reengagement with the WHO and its generous financial contributions to global vaccine access over and above the success of Operation Warp Speed have strengthened the White House’s position. Congress can further bolster it by using the power of the purse. Leading on reform and making common cause with our allies are essential to make an effective WHO, better suited to American interests and a world safer from the next pandemic.