"WHO and the COVID-19 outbreak: its place in this global public health threat; its strengths and weaknesses”

"WHO and the COVID-19 outbreak: its place in this global public health threat; its strengths and weaknesses”

Since the start of the Covid-19 pandemic, the World Health Organization (WHO) has played a leading role. At the center of the scene, the press conferences, almost daily since January 22, 2020, of its Director General, Doctor Tedros Adhanom Ghebreyesus (of Ethiopian nationality), during which he distils recommendations to the States and urges them to mobilize. The WHO is, in fact, the United Nations specialized organization for health and one of its missions is the surveillance of infectious diseases and the coordination of the international response in the event of an epidemic.

Initially, attention was focused on the delay and inadequacies of national responses, and WHO was hailed for reacting more quickly and forcefully than during the Ebola epidemic in western Africa in 2014. Nevertheless, international cooperation having quickly shown its limits, with states developing disparate strategies, the international organization began to look like a conductor that its musicians would not follow. Then the WHO came under attack, led first by Taiwan and the Trump administration, accusing it of being in China's payroll and of delaying warning the rest of the world of the severity of the pandemic.

The spectacular announcement by the White House, on April 15, 2020, in the midst of the health crisis, of the suspension of American funding to the WHO (about 15% of its budget, the largest financial contribution), put the spotlight on the organization. While many countries such as Canada, France, Germany and South Africa have reaffirmed their support by emphasizing the "essential role" that the WHO plays and by calling not to weaken it, calls for reviewing the WHO's response to the pandemic and for organizational reform have increased. To better understand them, this article aims to contextualize the management of the pandemic by the WHO and the criticisms to which it is subject, by reviewing the role and means of action of the organization, as well as its reaction during previous epidemics.

Problematic: Faced with diplomatic, economic and national sovereignty constraints, what are the room for maneuver of the WHO in managing this Covid19 crisis?

1. Challenging global health security governance

1. A fragmented international management

According to its Constitution, which dates from 1948, WHO is the directing and coordinating authority for international health. Its centrality in the international response to the health crisis is nonetheless remarkable in view of the changes in global health governance in recent decades. Since the beginning of the 21st century, the field of global health has indeed experienced very strong development. Funding for international health actions, all donors combined, has increased from ten billion US dollars in 2000 to forty billion US dollars today, that is to say a quadrupling in twenty years (1), among these, only 7% are devoted to the WHO budget, which is, for 2019, 2.8 billion US dollars (which represents, by comparison, about a third of the annual budget of Paris public hospitals [APHP] and less than half of the annual budget of the Centers for Disease Control and Prevention [US Centers for Disease Control and Prevention, CDC].This development in the field of global health has gone hand in hand with its fragmentation. New actors have emerged that give influence to funders: philanthropic foundations like the Bill and Melinda Gates Foundation (2), “vertical funds” which finance the fight against specific diseases (such as the Global Fund against AIDS, tuberculosis and malaria), public-private partnerships such as Gavi (Global Alliance for Vaccines and Immunization, Global Alliance for 'access to vaccines and immunization) or the Cepi (Coalition for Epidemic Preparedness Innovations, Coalition for innovation in epidemic preparedness).

Other intergovernmental organizations have also entered the field of global health since the end of the 20th century. This is the case of the World Bank, the largest financial contributor since the 1980s for health programs thanks to the loans it makes, also the United Nations Security Council, which had declared the epidemics of HIV and of Ebola in West Africa as "threats to security and international peace".

But, during the Covid-19 pandemic, WHO finds itself alone on the front line. If the World Bank is mobilizing to respond to the economic crisis, as regards the more specific response to the health crisis, it finds itself entangled in the failure of its "pandemic catastrophe bonds". These “bonds for pandemic catastrophes” have been developed since 2017 to free up financing in the event of an epidemic: by buying them, investors take the risk of no longer receiving interest or losing part of their capital in the event of an epidemic outbreak. On the other hand, as long as no epidemic occurs, they achieve a very high yield. However, it was not until the end of April 2020 to know the amount of funding that could finally be released: 195 million US dollars for 64 of the poorest countries on the planet, which is far too little and far too late.

1. The weight of the normativity of the organization

The specificity of WHO, within this diverse institutional landscape, is to be the only intergovernmental health organization with a universal vocation, which brings together 194 Member States, developed and developing, on the principle that one State equals one voice. Created after World War II, it integrates the international health organizations that preceded it, including regional organizations such as the Pan American Sanitary Bureau. This explains the organization's specific governance structure: a headquarters in Geneva, around one hundred and fifty local office in the countries but also six regional offices which have broad autonomy, with regional directors elected by assemblies comprising the member states of a region, a feature often criticized for its ineffectiveness. At the headquarters in Geneva, we find the WHO secretariat, a technical and administrative body that implements the actions of the organization, headed by the Director-General. He is elected by the member states sitting at the World Health Assembly and is supported in his work by the Executive Board of the organization made up of thirty-four Member States, also elected by the World Health Assembly for three years. The universality of the organization gives it the legitimacy to carry the global cooperation between all states, which is crucial in the event of a vaccination campaign or infectious disease surveillance, for example, if a state fails to do so, this will be problematic for everyone facing in this case a threat of a disease that have the capacity to spread globally.

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