The World Health Organization (WHO) is a specialized agency of the United Nations under the Economic and Social Council. Founded on 7-April-1948 its goal is to “ensure the attainment of all peoples of the highest possible level of health.” Its current mission is to “promote health, keep the world safe and serve the vulnerable.”

The WHO has 194 member states and 2 associate members and its headquarters is in Geneva, Switzerland. Each year its highest governing body, the World Health Assembly (WHA) consisting of the representatives of all the member states, meets to set the annual objectives and priorities and approve the budget and activities. The WHA also elects the head of the organization, the Director-General, every five years. The WHO Executive Board, meeting twice a year, implements the decisions and policies of the Assembly. The current Director-General is Dr. Tedros Adhanom Ghebreyesus, former health and later foreign minister of Ethiopia. He supervises the Secretariat, 6 regional offices (Africa, Western Pacific, Eastern Mediterranean, Southeast Asia, Europe and the Americas), 149 country offices, and some 8,500 personnel. During a health emergency, an extraordinary event that requires immediate international action, the Director-General receives advice and recommendations from the Emergency Committee before taking necessary action.

The organization’s budget comes from the assessed contributions of the members and voluntary contributions from generous members, private foundations, and other donors. Interestingly the members’ assessed contributions represent only 25% of its annual budget; hence, not all programs identified by the organization are adequately supported because some donors choose specific health agenda to fund. The WHO’s 2020-2021 budget is US$4,840.4 million, up by US$418.9 million from the previous year.  The top three donors are the US, UK, and the Bill and Melinda Gates Foundation.

With limited resources, WHO entered into and maintains partnership and collaboration with a number of International Organizations and UN Agencies (UNICEF, UNHCR, WFP, etc.), Nongovernmental Organizations (International Medical Corps, International Council of Nurses, World Association for Disaster and Emergency Medicine, etc.), and Academic Institutions (Columbia University, John Hopkins University, Harvard Humanitarian Initiative). It also deals with Specialized Agencies (US Centers for Disease Control and Prevention, Public Health England, Public Health Canada, etc.), Donors (European Commission Humanitarian Aid Office, Department for International Development- UK Government, Office of Disaster Assistance- US), and Observers (Medicins Sans Frontières, International Committee of the Red Cross, The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, etc.).

Since inception, the organization has addressed several notable health programs to fulfill its goal and mission. In 1951 the WHO spearheaded the publication of the International Sanitary Regulations, later renamed in 1971 to International Health Regulations (IHR) and updated in 2005, to “prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risk and which avoid necessary interference with international traffic and trade.” In June 2007 WHO issued Interim Guidelines entitled “Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases (ARDs) in health care” that provide non-pharmacological recommendations to prevent and control ARDs.

Through relentless campaigns in cooperation with the national health authorities of the members and other partners, WHO succeeded in increasing the human life expectancy from 48 years in 1955 to 69 years in 1985, and in reducing the infant mortality rate from 148 to less than 59 per 1,000 live births during the same period. Apart from focusing on the infant mortality rate the organization pursued the child survival and development revolution consisting of growth monitoring, oral rehydration, breastfeeding and immunization. In 1974, it embarked on massive immunization program against polio, measles, diphtheria, whooping cough, tetanus and tuberculosis. It had completely eradicated the smallpox disease worldwide in 1977, and the yellow fever epidemics in Brazil and Congo in 2017. It nearly wiped out polio (99%) and iodine deficiency disorder and continues to control the spread of tuberculosis, malaria, hepatitis, HIV/AIDS, SARS, MERS, Zika virus disease, Ebola virus disease, the swine flu H1N1 disease, and other diseases. WHO estimates that infectious diseases account for 13-15 million deaths per year.

In spite of these gargantuan efforts to address universal health care and wellbeing, WHO’s ability to monitor public health risks and respond to health emergencies is wanting.

It drew criticisms in the mishandling of 3 health emergencies: the 2003 SARS epidemic (origin: Guangdong, China), 2009 H1N1 swine flu pandemic (origin: Vera Cruz, Mexico), and the 2014 Ebola Virus Disease outbreak in West Africa (origin: Guinea). The West Africa’s Ebola outbreak is the first health emergency incident where the UN Security Council sent a UN Mission for Ebola Emergency Response. As a result of the Ebola outbreaks, several commissions including the WHO Ebola Interim Assessment Panel, Joint Harvard University-London School of Hygiene and Tropical Medicine Independent Panel Global Response to Ebola, US National Academy of Medicine Commission on the Global Health Risk Framework for the Future, and UN High Level Panel on Global Response to Health Crisis, scrutinized the organization’s capability. Four years earlier, 3 other independent panels reviewed the WHO actions on the H1N1 swine flu pandemic.

While these investigations found “no evidence of inappropriate conduct or undue influence,” the panels identified some common issues: (1) lack of an “emergency culture” in responding to crises; (2) bureaucratic inefficiency; (3) inadequate human and financial resources due to disproportional level of “voluntary contributions”; and (4) technical capacity and unhelpful competition between the WHO headquarters and the regional offices. They recommended the following: (1) increasing the members’ yearly payments; (2) refining its work priorities; (3) establishing a new Global Health Emergency Workforce (GHEW); (4) creating Health Emergency Contingency Fund (HECF); and (5) increasing the Secretariat’s transparency and accountability.

The organization took the recommendations seriously. It established the GHEW and HECF in 2016 and launched the World Health Emergency Program (WHEP) highlighting policy and human resource management changes. The WHEP is designed to ensure a 72-hour on-the-ground assessment after receiving official notification of “high threat pathogen” and to bring speed and predictability to emergency work using an “all-hazards approach,” enhancing collective action and integrating preparedness, readiness, response, and early recovery activities. The GHEW and HECF, however, did not attract sufficient funding sources to make them fully responsive. Similarly, the amount of members’ annual contribution remains unchanged. The incumbent WHO Director-General assumed in 2017.

In just over 4 years after containing the Ebola epidemic in West Africa, a new infectious disease emerged: the corona virus disease of 2019 (COVID-19). Emanating from Wuhan, China the new viral disease of zoonotic origin attracted some local doctors’ attention in early December 2019 when some patients showed symptoms of pneumonia-like illness. Taiwan reportedly informed the WHO about this observation. Wuhan doctor Li Wenliang noted on 25-December-2019 the mysterious disease when a number of health care workers got infected, inferring human-to-human transmission. On 29-December-2019, he messaged some of his fellow doctors to wear a facemask to avoid contracting the disease. The following day, December 31, China informed the WHO about the disease. On 1-January-2020, China shut down Wuhan’s Huanan seafood wholesale market, the alleged source of the virus. China identified on 7-January-2020 the microbe as a new corona virus, SARS-CoV-2, but denied 3 days later the existence of an outbreak even as more patients were being admitted to hospitals. Technical experts from Hong Kong, Macao, and Taiwan visited Wuhan during January 13-14. Around this time, the US Centers for Disease Control and Prevention also requested China to send over an infectious disease team but never received a response.

On January 15, the WHO Director-General kowtowed to China’s line that there was no outbreak. From January 16 to 22, several countries including Thailand, US, Japan and South Korea reported confirmed cases of the viral disease. The WHO sent a team to Wuhan on January 20-21 to observe. The next day, the WHO Emergency Committee convened but deferred making recommendations. On January 23, China locked down Wuhan, with 300,000 persons beating the deadline, and nearby cities in the Hubei province.  Five days later, on January 27, the WHO Director-General, along with Western Pacific Regional Director Dr. Takeshi Kasai and WHO Health Emergency Program (WHEP) executive director Dr. Michael Ryan, traveled to Beijing and met with Chinese President Xi the following day. In this meeting, the former conveyed WHO’s appreciation for the latter’s action to contain the disease and suggested that WHO send a team of experts. President Xi agreed to form a joint mission. On January 29, the Director-General convened the Emergency Committee and declared a public health emergency of international concern (PHEIC) the next day, January 30. On the same day, the Philippines and India reported cases of infection. On January 31, US declared a public health emergency within its borders that banned travelers from China while Russia, UK, Sweden and Spain reported new cases.

After the WHO’s PHEIC declaration reports of new cases, and deaths started piling up. On February 1, China had 14,388 cases and 300 deaths. On February 2, the first COVID-19 death outside China occurred in the Philippines; China finished the 10-day construction project of a 1,000-bed hospital in Wuhan for COVID19 patients. On February 3, China started clinical trial of an antiviral drug, Remdesivir, used in Ebola virus disease. Cruise ship “Diamond Princess” arrived in Japan and subjected the 3,711 passengers and crew, including 500 Filipino seafarers, to quarantine and conducted tests. On February 7, the WHO noted global disruption in the market for personal protective equipment (PPEs). Three days later, the WHO sent an advance team to China to have a workshop with China Center of Disease Control and Prevention and visit several affected areas including Wuhan. On February 11, the UN activated its Crisis Management Team led by Dr. Michael Ryan of WHEP, and the WHO gave the official name of the disease as COVID-19.

During February 16-24, the joint WHO-China team, consisting of 25 members co-chaired by Dr Bruce Aylward and Dr Wannian Liang, visited and interacted with a number of local government units and response teams, reviewed their official reports, and observed how authorities control and mitigate the spread of COVID-19. The Joint Report came out on February 28. The next day, WHO issued “no travel/trade restriction” guidance as “travel bans to affected areas or denial of entry to passengers coming from affected areas are usually not effective in preventing the importation of cases but may have a significant economic and social impact.”

On March 1, the UN released some funds from its Central Contingency Response Fund to the WHO. On March 2, the worldwide total of confirmed COVID-19 cases was 9 times more in China. Given the rising number, the WHO estimated on March 3 that the health providers would need 89 million medical masks, 76 million examination gloves and 1.6 million goggles each month. By March 7, the number of cases reached 100,000 in 100 countries. On March 11, the WHO declared COVID-19 as a pandemic. The declaration prompted many states to close their borders and impose community quarantine. On March 19, the virus had infected another 100,000 and another 100,000 three days later. By March 24, the total cases rose to 400,000.

Noting that many countries have implemented community quarantine, the WHO on March 25 suggested 6 steps to follow during the period: (1) Expand, train and deploy health care workers (HCW); (2) Create a system to find all suspected case at community level; (3) Increase production and availability of testing; (4) Identify and equip facilities needed to treat and isolate patients; (5) Develop plans on how to quarantine contacts; and (6) Focus the whole government on the suppression and control of the pandemic. It also announced on March 27 that 2 European countries, with 45 others participating, started clinical trials on 4 drugs to treat COVID-19.

On March 28, the COVID-19 infections reached 600,000 with almost 30,000 deaths. By April 2, the cases surpassed the 1 million mark while the number of deaths doubled in a week’s time. Shortly thereafter, the Asian Development Bank revealed that the pandemic could impact on poverty eradication effort. On April 6, the WHO estimated that 90% of students globally, or 1.5 billion, are affected by the pandemic. In the next 2 days, it announced the creation of a Supply Chain Task Force to hasten the manufacture and distribution of lifesaving medical supplies, PPEs, and diagnostic test kits. On April 8, China lifted the lockdown in Wuhan and the Hubei province.

A hundred days after China informed the WHO of the virus on April 9, nearly 100,000 individuals had died from COVID-19. The WHO came up with an estimate of monthly PPE requirements: 10 million medical masks and gloves, 25 million N95 masks, gowns and face shields, and 2.5 million diagnostic tests. The number of cases and deaths remains unabated with the US leading all nations affected by the pandemic.

On April 14, US President Donald Trump announced that he is cutting off the country’s contribution to the WHO for “mismanaging the response” on the pandemic. At the same time, Bill and Melinda Gates Foundation committed to increase its contributions to fund the development of diagnostics, therapeutics, and vaccines for the COVID-19. The next day, the WHO director general reported that the agency is assessing the effect of US withdrawal of financial support and will soon conduct a performance review. China, as expected, reacted negatively to the US decision.

As the pandemic continues to ravage the world, the WHO’s plan to review its actions relative to COVID-19 is highly meritorious. It must begin by reviewing the recommendations advanced by the previous investigating panels on SARS, Ebola and swine flu H1N1. It must also look at its internal policies and procedures governing its Regional and Country Offices, GHEW, HCEF, WHEP, and the Emergency Committee.

But as events unfolded, the WHO’s capability to detect, contain, and trace COVID-19 is far from achieving its goal, mission and priorities.

In addition, its decision-making process does not reflect an “emergency culture” crucially needed in safeguarding the world health. The WHO manifests instead a “risk-averse, reactionary bureaucracy, and highly protective of the organization’s reputation,” which carries the presumption that “it’s best to err on the side of caution.”

Rather, an “emergency culture” requires taking steps against a graver risk that may bring in more deadly consequences.  Without an “emergency culture,” the scenario turns dire within a tighter timeframe, and at that point it becomes too late to prepare when the virus hits.

While the WHO’s current mandate gives no power to enforce compliance to world health regulations, resolutions and conventions or to impose sanctions upon recalcitrant states, the WHO can use its persuasive power by virtue of its expert knowledge on health matters to influence the behavior of the world community and generate more contributions from the philanthropic individuals and groups to finance its noble programs, projects and activities. It should avoid consuming a “large proportion of its resource and credibility in political and ideological disputes that have detracted from its technical mission.”

The forthcoming developments regarding the pandemic will determine the future of the WHO.