Hi,

It has been a restive summer. (It seems we cannot, not publish)

Today we bring you a response from Andrew Harmer, a meticulous academic and expert who looks at WHO financing matters with rare dedication and responsibility.

He puts forth his arguments in response to a recent contribution we published: Rethinking the Role of WHO in a Transformed Global Health Order. This a biting critique and is provoking us to be cautious on the prescriptions for reassessing the role of the WHO.

The truth though is, everything needs to be underwritten by hard cash and political will - both scarce at the moment. Given this reality, things will likely get worse, before (and if) they can get better.

We hope you find this debate useful in light of the many directions, diverse impulses on the reform of the WHO. We strive to reflect what we hear.

(Harmer’s essay today takes off from his recent post. We recommend his writings - a treasure trove on global health financing numbers.)

Also below, what WHO has said on its on-going prioritization exercise.

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More soon!

Best,

Priti

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I. GUEST ESSAY

Doing Less With Less - A Caution Against The Race To The Bottom For WHO

By Andrew Harmer

Harmer is with the Wolfson Institute of Population Health at Queen Mary’s University of London. He can be reached at a.harmer@qmul.ac.uk

Ilona Kickbusch, Michel Kazatchkine and Peter Piot have written a Guest Essay for Geneva Health Files in which they rethink the role of the World Health Organisation in a transformed global health order. Despite the authors’ academic credentials and years of experience leading global health institutions, I argue in this reply that their arguments are poorly constructed, highly problematic, unsupported by any evidence, and undermine important governance processes within the Organisation that were agreed by Member States at the previous two World Health Assemblies.

What is the motivation for this essay? In the opening paragraph, the authors note that although the Covid-19 pandemic “highlighted longstanding structural limitations in the global health architecture” Trump’s withdrawal from the WHO in January was the main driver of their “fundamental rethinking of what multilateral global health efforts should be”. In other words, it is a reaction to one of WHO’s 194 Member States withdrawing its funding, which has left the WHO with a funding gap of approximately $660m for its 2024-25 biennial budget.

There are two responses that one could make to managing this shortfall in funds: one would be for the remaining Member States to simply pay the shortfall. $660m divided by as few as 150 Member States would equate to just $4.5m each. Another response would be the one taken by the authors of the essay: to construct an elaborate suite of constitutional, administrative and economic reforms, and implement them through an autocratic process that would undermine trust and accountability, and at great cost – both financially and in terms of the wellbeing of WHO’s staff.

Although no specific examples of said ‘structural limitations’ are provided in the essay, the general thrust of the argument echoes some (if not all) recommendations of the Independent Panel on Pandemic Preparedness and Response (IPPPR) which called for, among other things, “a more focused and independent WHO” (IPPPR 2021, p45). The IPPPR’s Final Report notes that “structural problems have been exposed” by the Pandemic and that while “WHO is and should be the lead health organization in the international system…it cannot do everything.” So, in this new essay, the authors are revisiting many familiar arguments and debates.

For example, they are correct to point out that the Covid-19 pandemic revealed the fragility of the global health ‘system’ and the rules and principles that underpin that system. Els Torreele’s work on The People’s Vaccine project, for example, described the shortcomings of global efforts to govern global vaccine production. Architectural ‘structures’ such as COVAX was “a beautiful idea, born out of solidarity” but which, ultimately failed because “rich countries behaved worse than anyone’s worst nightmares” (Gavin Yamey quoted in Usher 2021, p2322).