WHO @ 75

Happy anniversary!

Today, the World Health Organization turns 75 years old.

April 7 is the anniversary of WHO’s Constitution coming into force. When we celebrate WHO’s anniversary, we celebrate the right to health, established in the WHO Constitution. It reads:

The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.

Equally inspiring given the context then (the aftermath of the Second World War) and now (with another war in Europe and conflicts around the world) is this:

The health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest co-operation of individuals and States.

WHO has had many seminal accomplishments in its 75 years. For me, the top three are:

1. Eradication of smallpox (1980). Smallpox killed more than 300 million people in the last century.

2. Framework Convention on Tobacco Control (2003). WHO's first global public health treaty aims to reduce tobacco-related deaths and disease worldwide. 

3. International Health Regulations revised (2005). Gives countries clear and tested guidelines for reporting disease outbreaks and other public health emergencies to WHO, and triggering response systems to isolate and contain threats.

You can find a timeline of public health milestones through WHO’s 75 years here. What do you think are the top three accomplishments?

The trick to understanding WHO’s impact is not only the milestone accomplishments like those above, but the many things WHO does day in and day out, country by country, to achieve major public health benefits.

In 1990, about 12.8 million children under the age of five died each year. Now, that number is about 5 million. That’s still 5 million too many. But its a remarkable achievement for the world. And WHO had a lot to do with it.

WHO is a specialized agency of the United Nations. It is made up of 194 Member States and the Secretariat, led by the Director-General. Headquartered in Geneva, WHO has 6 regional offices and more than 150 country offices. Its budget is financed at about US $4 billion per year (about the size of a large academic hospital) and it has about 8000 staff.

What does WHO do? Its mission is to promote health, keep the world safe, and serve the vulnerable. Its strategic goal, approved by Member States in 2018 in the 13th General Programme of Work (GPW 13), is to help the world reach the SDG based “triple billion” targets: 1 billion more people living healthier lives, 1 billion more people benefitting from Universal Health Coverage, and 1 billion more people better protected from health emergencies. (The fundamental responsibility for the health related SDGs and these triple billion targets lies with governments; WHO is there to help countries reach them.)

How does WHO do it? There are three core functions of WHO, which also represent its comparative advantage:

1. Leadership and governance. An example of leadership was Dr Tedros’ relentless focus on equity during the pandemic, and of governance is the current negotiations around the pandemic accord.

2. Norms and standards, including technical products, data, and research. Examples include the many evidence-based guidelines produced, the World Health Statistics that track the health-related SDGs, and the emergency use listing of COVID-19 vaccines.

3. Country support. Perhaps the least appreciated function is the support to governments provided by more than 150 country offices and the WHO Secretariat as a whole, and the social capital and trust that exists between governments and WHO.

What is the current progress in global health? It’s not good. Overall, the world is progressing at less than 1/4 the pace needed to reach its Universal Health Coverage billion target. Progress on healthier populations — those factors outside the health system that affect health like water and sanitation, nutrition, and road safety — is also lagging. And no country was prepared for a pandemic of the scope and scale of COVID-19. Just to take one specific example: described as “staggering backsliding,” an estimated 25 million children were un- or under-vaccinated in 2021 – 6 million more than in 2019.

How could WHO support countries to speed up progress?

1. Continue to support countries to promote, provide and protect health. Like any good soccer team, WHO needs to play both a good offense (supporting countries to reach the health related SDGs and triple billion targets) and a good defense (helping to protect countries from health threats related to disease outbreaks and pandemics, conflict, natural disasters and climate change). This is the bread and butter of WHO’s work.

2. Help countries to accelerate their progress through improved systems of delivery for impact, data and digital health; innovation in science and technology, service delivery and finance; and partnerships with multilateral, civil society, and private sector organizations. I have explored these topics in detail in my recent (and upcoming) blog posts.

3. Make itself more fit for purpose to deliver on the above. Some key recent achievements have been improvements in sustainable financing and the percentage of budget going to country offices hitting 50%.

I have had the great privilege of serving as Special Advisor to the Director-General of WHO for six years. I can say without hesitation that WHO is an essential actor, arguably the most essential one, in global public health. The counter-factual of a world without WHO is unthinkable.

Looking forward to WHO’s 100th anniversary in 2048, I would like to see a WHO that continues to sharpen its focus on measurable impact in countries. A WHO that is always asking itself, ‘how can we help countries to make even faster progress in saving and improving lives?’ A WHO that remains, as it has been since its founding day, the last line of defense for the health of the poorest and most vulnerable people in the world.