WHO Reforms and Reimagining Global Public Health: Can India Play a Role?
The ongoing global health crisis in the form of the spread of the Novel Coronavirus disease has generated a renewed scrutiny of the global public health systems, with calls for strengthening international cooperation and enhanced data sharing. In this setting, the World Health Organization (WHO), the chief specialized agency that directs and coordinates international health within the United Nations system, finds itself in the midst of a growing controversy, where its ability to efficiently and effectively function in a shifting global governance context has come under severe attack. US President Donald Trump has been scathingly vocal in his accusations of the WHO's complicity with China in downplaying the severity of Covid-19's spread and transmission that led to delayed responses and losing of crucial reaction time.
The outbreak was declared a Public Health Emergency of International Concern (PHEIC) by the WHO on January 30, 2020 and finally characterized as a pandemic on March 11. It has been alleged that despite warnings from Taiwanese doctors, the WHO continued to accept and echo the information coming from China. Japan's Deputy Prime Minister Taro Aso went on to call for a renaming of the WHO as the 'Chinese Health Organization'. Incidentally, Japan is one of the biggest fund contributors among WHO members. India too has been expressing its concern on the workings of the WHO and asking for reforms of the Organization for an effective transition into post Covid -19 global order. Calling for a recasting of the WHO, Indian Prime Minister Narendra Modi, during the G-20 virtual summit advocated for reforming and strengthening the WHO to enable it to adapt to new challenges.
However,it must be noted that this is not the first time that the WHO is being shrouded in controversy and demands for its reforms are being raised. The WHO elicited tremendous criticism for the inadequacy of its response during the catastrophic Ebola outbreak in West Africa (2013-2016). It is alleged that the WHO was delayed and slow in its response to the outbreak and displayed poor operational skills. In fact, the report of its Ebola Interim Assessment Panel (2015) urged the WHO to "develop an organizational culture that accepts its role in emergency preparedness and response" and to "undergo significant transformation in order to better perform".
While the WHO's noteworthy contributions to global public health including eradication of Smallpox and setting standards in medical care and medical ethics cannot be undermined, it is contended that the Organization is increasingly being unable to provide a strong leadership on global health matters. The Constitution of the WHO came into force on April 7, 1948 (a day that has come to be celebrated as World Health Day) and it was the first specialized agency of the UN to which every member subscribed. Yet, it has been accorded with little powerwith no ability to bind or sanction its members (unlike other international bodies like the World Trade Organization). The Organization lacks technical capacities and capabilities and suffers from precariously inadequate access to financial resources. Overwhelming majority of the WHO's budget is dictated by donors and their priorities thus leaving the Organization limited control over its finances.
The current Director-General of the WHO, TedrosAdhanom, who took over office in 2017, had initiated number of positive steps to make the WHO more efficient, adroit, and focused on its core mission. Unfortunately, his own leadership has come under mordant accusations in the wake of the present health crisis. First non-physician and the first African to assume the leadership role of the WHO in whose ascendance China played a significant role;Adhanom has been critiqued for doing China's bidding during the early stages of the pandemic.The US has already suspended funds to the WHO pending review of the body. While international organizations, civil society bodies, medical experts, healthcare bodies and common citizens across the world are exerting pressure on the US to reverse its decision given the extent and urgency of the Covid-19 pandemic, a bipartisan US Committee has asked for Tedros and the WHO's communications with China regarding the virus outbreak.
While it must be acknowledged that the world needs the leadership of the WHO, now more than ever, to help us get past the ongoing predicament; an urgent reimagining of the global public health governance is in order. The world now is acutely aware of the ways in which we are interlinked, where health in one corner of the world is affected and impacted by the other. There is also the realization that global health concerns cannot be centered around or dictated by High Income Countries alone. The handling of the Covid-19 pandemic woke the world up to the reality that the High Income Countries of the North have a lot to learn about health from the Low and Middle Income Countries of the South. The pandemic has also opened up the schisms within advanced healthcare regimes that give access to healthcare to only those who can afford them. Moreover, it is being acknowledged that global health investments must go up as health and economy are intricately linked with global economy taking a massive plunge in wake of the pandemic.
Given that the time is ripe for forging new north-south relationships in global health, the question arises as to whether India can take up the challenge of providing a leadership role in reshaping the global public health agenda. India can play a pivotal role in promoting the interest of the global South in public health priorities. India's nominee is all set to become the chairperson of the WHO's executive boardin May, replacing Japan.The chairperson's post is held by rotation for one year among regional groups and the decision to accord this position to India came last year.As head of the 34-member Executive Board, India's nominee would have to work closely with the Director General of the WHO. India will also be a member of the programme budget and administration committee of the Organization, replacing Indonesia.It is a significant opportunity for India to step up and play a critical and influencing role in world public health.
However, in order to be able to play a prominent role in global public health initiatives, it is imperative that India introspects on the failings and shortcomings of its own existing public health systems and policies. India needs to invest more in the health sector and recognize disease prevention and health promotion as its topmost priority. India's NationalHealth Policy 2016, following the recommendations of the High Level Expert Group on Universal Health Coverage, has urged that at least 2.5 percent of thecountry's GDP should be allocated towards providing for a functional health system. However, the Union Budget 2020-21 falls short of this target. Under the budget, allocation towards health sector is around 1 percent of the GDP. Globally, India has one of the lowest spending on healthcare and ranks 184th out of 191 in terms of GDP percentage spend on healthcare, as per the WHO. According to the World Health Statistics (2015),India has one of the lowest density of health workforce; with density of physicians (7 per 10 000 population) and nurses (17.1 per 10 000 population) as against the global average of 13.9 and 28.6 respectively. India, therefore, must urgently work towards strengthening domestic public health standardsin terms of infrastructure, equipment, resources, training, research and efficient service delivery.
World post Covid -19 would not be the same and would desperately require an overhauling of the current public health systems and empowering of public health leadership. Public health today is an integral concern in the global conceptualizations on equality, justice and human rights. India can certainly play a key mobilizing and facilitating role in this crucial phase of transition and transformation. India must seize this moment and assume leadership in influencing, directing and reshaping both local and global public health governance.
Upasana Mahanta is a Professor at Jindal Global Law School, O.P. Jindal Global University.