The global health get together - #WHA69 - last week in Geneva was full of must dos. We must combat obesity, we must address the ageing crisis, we must have strong leadership - preferably female - in global health, we must do something about Zika, we must strengthen health systems, and we must end infant and maternal mortality. Attached to these must-dos was a variety of programmes and strategies of how the World Health Organisation (WHO) would address them through technical guidance for member states. This happens every year. The stand out of WHA69, however, was the new Health Emergencies Programme - a strategy that seemed to go beyond the usual must-do to can and will do.
The WHO's Health Emergencies Programme had to happen. The WHO's epic cluster!$%* over Ebola and fears over Zika meant the Organisation had to do something to reassert its legitimacy as the go-to institution for health emergency response. The Health Emergencies Programme goes some way in an attempt to reassert the institution's legitimacy in its frank 'no regrets' approach to emergency response and emphasis on action. The one committee, one budget, one programme is a valid attempt to cut through the institutional inertia that can often limit the WHO's ability to do something. If this programme is fully funded it will go a long way in enabling the WHO to do its job in responding to health emergencies.
A big question mark is, as always, over the funding. The World Health Assembly approved the US$494million budget for the programme for 2016-17. The WHO was quick to praise Japan's US$50million contribution to this and the commitment of Sweden, Australia, and Germany. However given the budgetary constraints of the core financing of WHO (the WHO is made up of roughly 25% assessed contributions from member states and 75% voluntary contributions) it is unclear how the rest of the programme will be funded if not for this year, then the future costs of US$150million per year that the programme projects. In effect, the new Health Emergencies Programme boils down to: nice plan, but few want to pay for it.
Given the horrors of Ebola, the fear over Zika, and the threat of Yellow Fever, it would appear a no-brainer that states would want to pay to limit the spread of these disease and protect their citizens. However, the issue is not the need to act, but whether the WHO is the best actor to do so. While the Programme is an attempt to reassert the WHO's legitimacy, part of the problem is that for an actor to be legitimate, those who commit to its existence and authority have to believe in it. And this is where the problem lies: the WHO has lost legitimacy among a number of member states and actors in global health who no longer believe in its ability to act.
On the one hand, the fact that member states voted to approve the Health Emergencies Programme suggests that the WHO has clear formal legitimacy to act in this area. On the other hand, the legitimacy of the WHO has been informally questioned through the ongoing process of institutional reform, growth of actors that replicate aspects of its institutional mandate, and bilateral responses to health emergencies.
The result of which is many member states believe that bilateral action in response to health emergencies is more effective than waiting for delayed and ineffective multilateral action. This is clear when you look at how the UK and US have responded to Ebola and Zika respectively - the onus is on a commitment to multilateralism but in practice bilateral action is the method that is seen to work.
A lack of belief in the legitimacy of the WHO is a big problem for the success of the Health Emergencies Programme and the future of the institution. Unless member states such as the UK believe that the WHO has the legitimacy and ability to act in response to health emergencies, funding for ambitious life-saving programmes will not be forthcoming and the WHO will remain an institution of must-dos without action.