The World Health Organisation (WHO) is the leading and coordinating authority in global health and therefore the key institution in the world when it comes to international health policy and coordination on health issues. The organisation’s goal is to improve and promote the health of all peoples. The WHO sets various medical standards, collates science-based health policy principles and plays a part in shaping the world’s medical research agenda.

Founding the WHO: An organisation to fight diseases that don’t respect borders

At the founding of the United Nations (UN) in 1945, diplomats were already discussing the need for a specialist health agency that had international oversight: the cholera epidemics in the mid-1800s and the Spanish flu epidemic of 1918 made the need clear. Those diseases, and the ones to come, did not respect borders or walls. The world’s response had to transcend them as well.

By early April 1948, the WHO had officially been founded, replacing its forerunner – the League of Nations’ Health Organization. Referencing Article 25 of the UN’s Universal Declaration of Human Rights in its first Constitution, the WHO declared “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”.

The WHO sent 14 surgeons to Warsaw in 1948 to demonstrate the latest surgical developments to Polish doctors © picture-alliance / PAP

Back then, 61 countries signed the WHO’s Constitution. Today the WHO has 194 member states, spread across six global regions. The organisation, which is based in Geneva, Switzerland, employs more than 7,000 staff across 150 sites and six regional offices around the world.

Milestones in global health

To help achieve its worthy but challenging goal, the WHO began to coordinate various border-crossing initiatives. For example, in 1948, it became the custodian of the International Classification of Diseases, which allowed the world to identify not just diseases, but also global health trends and statistics, using a common language.

In 1969, WHO members introduced a set of rules called the International Health Regulations that were, at first, concerned mostly with cholera, plague, smallpox and yellow fever. These regulations set standards for international trade and travel, including the disinfection of aircraft and ships, the kinds of health documents travellers were required to carry and the procedures for member states to notify the WHO, if they were affected by those diseases. The latter regulations have since gone through numerous changes, most recently in the 2000s, to deal with infectious diseases like Ebola and Covid-19.

A colour lithograph made for the World Health Organisation in Ethiopia publicizing the importance of protective clothing when handling toxic substances © Wellcome Collection / WHO

Over the 20th century, the WHO also set up international programmes to deal with malaria, smallpox and tuberculosis, among other sicknesses. Later it would add infections and diseases like measles, cancer and HIV/AIDs to its list of global priorities. The WHO also started monitoring things like cancer research, tobacco use, reproductive and sexual health and diet and physical activity. In 2008, the WHO recognised climate change as a threat to human health.

The organisation prides itself on its contributions - through, for example, decades-long vaccination and awareness campaigns - toward the virtual eradication of diseases like childhood polio and smallpox, as well as on its engagement in the development of a vaccine for Ebola and in the advancement of basic health care in less developed nations.

Who runs the WHO?

The WHO is a member-states driven organization, with the World Health Assembly, the Executive Board and the Secretariat being its three pillars. On a day-to-day basis, the WHO is run by its Secretariat. The WHO’s Constitution states that the Director-General is the key administrative and technical officer of the organization. The WHO’s agenda and strategies are set at the World Health Assembly (WHA), an annual event where all 194 member states meet in Geneva. Delegations from all member countries attend to discuss policies, appoint senior staff and approve the WHO’s finances.

Every five years the WHA also elects a new director-general for the WHO. One re-election is possible. This position is currently held by Tedros Adhanom Ghebreyesus, a public health researcher and former Health and Foreign Affairs Minister from Ethiopia. Ghebreyesus is well known for his work in malaria research and the improvements he oversaw in his homeland’s health system; he is also the first African to hold the job, which he will have until 2022.

The World Health Assembly in 2007: The event is organised by the WHO every year in Geneva © Keystone

Just as with the UN, member states pay into the WHO’s biennial budget. The payments are a mix of membership dues (assessed per country and depending on Gross Domestic Product) and voluntary contributions. Besides the WHO’s current Global Programme of Work, the budget, which sits at around 5.8 billion dollars for 2020-2021, is a strategic tool to set priorities, as members decide how much is spent on which aspects of the WHO’s work. The top funders for the 2018-2019 budget included the USA, Germany and the UK, as well as charitable institutions like the Bill &Melinda Gates Foundation.

Currently less than 20% of the WHO’s funding comes from regular membership contributions and just over 80% are voluntary contributions - which makes the WHO vulnerable.

A global pandemic underscores the need for strengthening the WHO

The COVID-19 pandemic has shown again how important a supranational, coordinating body like the WHO is, when it comes to infectious diseases. “Isolated national answers to international problems are doomed to fail,” Germany’s Federal Minister of Health Jens Spahn said at a meeting with the WHO in Geneva, this June.

However, the pandemic has also caused controversy around the WHO because it has highlighted the budgetary and political pressures the organization is under. Several countries, including the USA and Brazil, have threatened to leave the organisation – in fact, the USA has said it will leave next summer - and others have criticised the WHO’s handling of the pandemic, blaming political pressure for perceived missteps.

Among many member states and expert observers, it is generally accepted that there is now an increasingly urgent need for comprehensive reform at the WHO, with a view to strengthening its capacities, as the organization faces various health, fiscal and political challenges. The European Union has an important part to play in formulating these proposals for reform, making the WHO fit for the 21st century, and assisting in their implementation - especially if larger donors like the USA leave the WHO.

Proposed reforms should make the WHO more efficient, sustainable and transparent and they should clearly outline the organisation’s responsibilities, as it works together with, and alongside, other important actors in global health.

Better funding would also help: the WHO has the broadest mandate of all health agencies but rather limited financial abilities. For the 2020-2021 budget, member states are expected to provide around 957 million dollars through their membership fees. The WHO’s current budget is only around the same as that of a large regional hospital and over three-quarters of the funding is earmarked in advance for specific purposes and not predictable. This leaves little planning security for the organization and limited extra money to cope with emergencies like the current pandemic.

The Covid-19 pandemic has again shown that the international communities’ expectations regarding the WHO far outweigh its given abilities. Future reforms need to address this discrepancy between member states’ expectations and their willingness to respectively equip the WHO for these expectations, and they will need to find ways of balancing expectations with capacities. Certainly, this also includes empowering its independence and expertise.