75 years of the WHO: Not a 'global health police'

In April 1945, politicians from around the world gathered in San Francisco to establish the United Nations.

At the meeting, leaders from Brazil and China suggested the creation of another global organization: one specifically devoted to global health rather than global politics.  

The World Health Organization (WHO) was born three years later, when its constitution came into effect on April 7, 1948.

It states that health is a human right that every human being is entitled to, "without distinction of race, religion, political belief, economic or social condition" and that "the health of all peoples is fundamental to the attainment of peace and security."

The organization's headquarters are based in Geneva, Switzerland, with six regional and 150 country offices across the world. 

"Without a doubt, we will experience more frequent and more severe health threats in the future," Wafaa El-Sadr, a professor of epidemiology and medicine at Columbia University in New York, told DW. "We have to work hard at coming together to confront these health threats. This means thinking beyond nationalistic priorities, it means coming together around joint priorities, and most importantly it means supporting organizations like WHO that work for the collective good."

In its 75-year-long history, the WHO, which has been led by Director-General Tedros Adhanom Ghebreyesus since 2017, has had some major successes ― as well some failures.

Eradication of smallpox

One of the biggest successes in the WHO's quest to ensure the global population's well-being came in 1980, when the organization officially announced it had wiped out a common but deadly centuries-old infectious disease.

"Perhaps the most noteworthy [success] was the eradication of smallpox, the only human disease to be eradicated," said El-Sadr, who also leads Columbia University's Mailman School's Global Health Initiative. "While there were others involved in this effort, the WHO played a key role galvanizing the world around this goal."

Christoph Gradmann, a professor of the history of medicine at Norway's University of Oslo, said smallpox eradication was a perfect example of when the WHO works best: In situations of political agreement.

"When member states aren't on the same page about how to proceed, the organization is paralyzed," Gradmann said. "During the Cold War, there was wide-reaching agreement across the two blocs that the eradication of smallpox was a goal to be tackled. That's when the WHO has seen its biggest successes: When members agree on which projects are worthy to be undertaken and how."  

2014 Ebola outbreak in western Africa: A WHO failure?

Many experts agreed the 2014 Ebola outbreak in Guinea, Liberia and Sierra Leoneoffers an example of a WHO job less well done. The organization was criticized, among other things, for not reacting swiftly enough to address the epidemic.

But El-Sadr says a lot of the criticism following the outbreak, which ended in 2016, was due to a misunderstanding of how the WHO works.

"There were unrealistic expectations for WHO, with many expecting [the organization] to go in force to the affected countries to confront the outbreak," El-Sadr said. "This is not within the WHO’s mandate. Its role is to guide the response, develop guidance, but not to go into a country to help address a specific health threat."

Gradmann agreed. 

"The WHO is a democratic organization," Gradmann said. "It is not a world health police made for quick interventions."

In fact, the WHO has no authority to take action in a member state unless that member state asks for help.

Still, Rüdiger Krech, director for health promotion at the WHO, says that after the Ebola epidemic from 2014 to 2016, the organization made significant changes to its structure. One example: It now relies to a lesser degree on national governments for crucial health information, thus lowering the chances of missing the start of another serious disease outbreak.

"We also cooperate with tech companies," Krech told DW. "They might be able to tell us about an outbreak before any official government information comes through by saying 'we're seeing a lot of people googling symptoms for this disease.' And we use satellite images from space agencies like ESA and NASA, which can show us regions where many people are running a high fever."

The WHO's widely criticized response to the 2014 to 2016 Ebola epidemic led to a wholesale "transformation" of the organization, Krech said.

The failed attempt to eradicate malaria

The organization's agreement to give up on trying to eradicate malaria in the 1960s represents another example of what some consider a botched job. 

The WHO launched the Global Malaria Eradication Programme (GMEP) in 1955. It looked promising, with 15 countries and one territory managing to eradicate the disease.

But there was little to no progress in sub-Saharan Africa under the program, and in many places, failure to sustain GMEP actually led to a resurgence of malaria. In 1969, the program was discontinued.

GMEP "led the WHO to the edge of bankruptcy," Gradmann said. "Member states were losing faith in the program while it was still going and withdrew funding."

One reason that the eradication didn't work, Gradmann says, is that malaria isn't solely a human disease, but has reservoirs in nature. This differentiates it from smallpox.

And what about COVID-19?

Some critics, then-US-President Donald Trump among them, complained at the beginning of the COVID-19 pandemic that the WHO was not doing enough to support member states in their fight against the disease. But experts like El-Sadr and Gradmann say that it wasn't the WHO's job to take action and introduce initiatives at the height of the coronavirus pandemic.

"During COVID, the WHO provided data and did administrative work," Gradmann said. "But initiatives to fight the disease had to come from the individual member states. I don't think the WHO played a large role in the COVID pandemic."

El-Sadr stressed that members' national governments were in charge of making decisions on how to best contain the pandemic in their country. They had advice from the WHO, but those recommendations weren't binding.

The WHO "was stymied by a divided world with nations advancing their own interests at the cost of others — forgetting the principles that informed the creation of WHO," El-Sadr said. "WHO does not have the authority to enforce its recommendations — countries can take it or leave it." 

Edited by: Clare Roth