The World Health Organization is in need of both reform and money to give it the best chance of dealing with potential global health threats in future

Does the WHO have fatal weaknesses? (Image: Espen Rasmussen/Panos)

Update, 7 May 2015: The Bill & Melinda Gates Foundation has announced that it will spend up to up to $75 million establishing the Child Health and Mortality Prevention Surveillance Network (CHAMPS) in developing countries. The network will also help with the problem discussed in the article below: how to respond to an epidemic such as Ebola or SARS. Interviewed this morning on the BBC Radio 4 Today programme, Gates said that the World Health Organization wasn’t financed “to have a standby corps that flies in and tries to solve epidemics”.

Original article, published 6 May 2015

HOW the world has changed. In 1948, the first commercial jet airliner was still a few years away from take-off, and the global population was just over 2 billion. Less than one-third lived in cities. Back then, safeguarding global health seemed an eminently manageable project. The newly formed United Nations agreed, and established the World Health Organization.


Now, over half the planet’s 7 billion people are packed into urban areas. Between us, we travel tens of billions of kilometres around the globe every year, with plenty of pathogens and parasites coming along for the ride. The WHO, largely unchanged since its creation, is ill-equipped to deal with the disease threats that this new world creates.

The recent Ebola outbreak is a case in point. Even the WHO’s director-general, Margaret Chan, said her organisation was “overwhelmed” and admitted that a crisis on that scale “cannot be solved by a single agency”.

Those are chilling words. Shocking and scary as it is, the Ebola crisis has actually been relatively small: 26,000 cases across six countries. The prospect of something much bigger is very real (see “The next plague: How many mutations are we away from disaster?“). A variant of the influenza virus is the most likely immediate threat, but as the emergence of Ebola, SARS, MERS and others shows, there are plenty of other nasties waiting in the wings. As things stand, we are horribly exposed to the worst-case scenario.

Shocking and scary as it is, West Africa’s Ebola outbreak has actually been relatively small

Even more chillingly, we have known as much for a long time. Four years ago, a WHO review of the 2009 swine flu outbreak concluded that “the world is ill-prepared to respond to a… global, sustained and threatening public-health emergency”. The review recommended a string of reforms, including a contingency fund of at least $100 million to respond to similar global emergencies.

The WHO is finally taking those lessons on board. In response to the Ebola failures, Chan has called for sweeping changes, including the creation of an army of doctors and other health workers ready to be deployed in the case of an emergency, backed by the contingency fund. Later this month, at the World Health Assembly in Geneva, Switzerland, member states will vote on her suggestions for reform.

A yes vote is a no-brainer, but is not enough: $100 million is insufficient to contain a medium-sized Ebola crisis, let alone a global pandemic of flu or some other airborne killer. “More funding” is an easy answer to difficult problems, but in the WHO’s case this is genuinely and urgently required. Of its $4 billion annual budget, about $3 billion comes from philanthropic organisations or non-mandatory donations from governments – often with strings attached, such as being ring-fenced for a donor’s pet project rather than spent on the WHO’s own priorities.

The WHO is therefore operating more like an NGO than the global guardian of public health. Chan needs to persuade governments that their mandatory donations should be increased.

The WHO has an illustrious past – most famously the eradication of smallpox, but also less headline-grabbing successes such as reduced infant mortality. It can still play a vital part in global public health. However, it needs reform, and needs it now. Swine flu was a wake-up call, but the world fell back to sleep. Ebola is another, more urgent call. This time we must all hope that the WHO – and its funders – are not allowed to hit the snooze button.

This article appeared in print under the headline “Making the world better”