India’s golden opportunity

India has got a privileged opportunity to lead world leaders to commit itself fully to the cause of global public health with autonomy and impartiality. Union Health Minister Dr Harsh Vardhan is chairing the ongoing 148th Executive Board (EB) meeting of the World Health Organisation (WHO).

Is it going to be another waste of time or time to restore WHO as directing global health with authority? That is question asked by many health activists and people’s health movements from many developing countries.

We have been hearing about a reform agenda since last virtual General Assembly during the Covid-19 pandemic. There are some procedural aspects and changing formats listed in the agenda. Is that all? The EB needs to reclaim its executive role in the governance of the organisation. It should boldly and independently lead a thorough reform process.

Transformation should not only agreed and initiated in this EB but also shaped and nurtured to take its roots in the organisation. Various recommendations have emerged after careful deliberations and healthy debates from civil society groups. Those are aspirations from the grassroots which need to be listened to, rather than granting tokenism of representation from non-state participants.

Thomas Schwarz of Medicus Mundi International who has listened to various sessions in WHO for more than a decade, disclosed during a webinar organised by the Geneva Global Health Hub recently, that member-state representatives excelled in ceremonial talks, but never listened to each other.

There are general appeals with scant specification of roles and responsibilities to be implemented. The dominant voice is of those member-states who contribute more. It needs to regain its relevance and legitimacy by being more involved in the health issues of the world. The EB must accept and display its leadership in engaging the organisation effectively in issues that have relevance in global public health.

University of St Gallen’s Julian Eckl opined that discussions on reforms must not be abstract but should focus on how to avoid interruptions in governance processes which have happened in the recent past. The reform agenda must be clear and operable. Suerie Moon from The Global Health Centre-Graduate Institute said that many decisions have not been taken democratically and wished that the EB transform WHO into directing and coordinating authority in global health.

Priti Patnaik from Geneva Health Files highlighted the need for more retreats among EB members and consultations with member-nations; also, transparency in the norms and decisions taken on who sits on technical committees. Member-nations should send the most competent person to the EB and once selected, they should be allowed to complete the three-year term of office. There should not be frequent recall and interruptions of the service. It takes at least a year of familiarisation for them to be fully into the business effectively.

The pandemic response has increasingly exposed WHO to instances of conflict of interest from powerful actors - both member-countries and private or corporate sector - with their hidden agenda.

Trump administration threatened to withdraw USA’s support to WHO for its soft stand on China in its failure to timely report the pandemic. WHO was slow to declare the global emergency and provide technical directions. Failure to accept aerosol mode of transmission of the virus and use of face mask was another example.

WHO promotes equitable allocation theory, but does not advance purchase agreement of rich countries sabotage the practice of that theory? Self-financing countries are allowed by some strange arrangement to pre-book supply from the vaccine manufacturers. Covax facility is created for the cost sharing for the supply of vaccine more equitably among the low- and middle-income countries. But the share of vaccine for low and middle-income countries in Phase-1 of supply plan was just 3%. Entire Africa is to get Covid vaccine only in 2022-23 as per the schedule. What a long wait!

WHO Director-General Dr Tedros Adhanom Ghebreyesus, expressed his disappointment when scientists, who had been to China to begin investigations on the origins of SAR-CoV-2, were turned away as a result of alleged delays in internal procedures.

Salvaging independence

WHO’s porosity at pandemic times affected its legitimacy and credibility. For this, some of the member-nations are themselves to be blamed, and rescuing the organisation from itself has become an emergency in itself. For this, the EB has to seriously look at its constitution and set in motion its key provisions to salvage its independence in doing its technical work.

There is a need for the effective representation of the developing nations and high disease-burden countries on different decision-making processes in WHO’s technical committees. Also, it should consider actively leveraging the support of experts, academicians and policymakers from the high disease-burden nations in the decision-making and policy formulations.

WHO has long been overshadowed by its richer partners in global health. Establishing strong and robust financial accountability frameworks will enable maintaining integrity in financial flows. It should empower the emergency committee by improving transparency in its proceedings.

It is important to ensure fair, affordable and equitable access to all tools for combating Covid-19 pandemic and, therefore their allocations must be just. The tools for controlling Covid-19 pandemic such as vaccines are a global public good and nobody should make profit out of a human calamity. So, TRIPS (Trade-Related Aspects of Intellectual Property Rights) waiver by WTO as proposed by India and South Africa would be most effective to control Covid pandemic.

Bjorn Kunnel from Germany, who is the current vice-chair of the EB, admitted that the Board has not been playing the role as it should be. Many are timid to express their opinions as they did not have confidence in their team members. There is lack of trust and quality of the relationship was much to be desired.

EB can play a pivotal role in reordering the global health architecture through WHO. Hope Dr Harshvardhan can captain this ship and navigate through the troubled waters. “Building an independent and authoritative WHO” is a priority for everyone.

(The writer is a Consultant in Public Health in Kochi and Independent Monitor for National Health Mission)