Who's Zooming WHO?

We must keep the World Health Organization focused on fighting infectious diseases.
By Anne Applebaum
Today, the front page of my morning newspaper featured a photograph of uniformed Mexican policemen, machine guns at the ready, surgical masks strapped to their faces, seemingly ready to defend their countrymen against the sudden outbreak of swine flu. I live in Warsaw, Poland, which is pretty far from Mexico City. But even if I lived in Paris, my morning paper would have contained similar pictures, so would it have done if I lived in Sydney or Kuala Lumpur.
ust about anywhere in the world, in other words, I would have caught a whiff of swine flu panic. I would also have been told what the World Health Organization in Geneva is doing about it. WHO is the organization we all turn to at times like this, and rightly so: With more than 60 years' experience and real achievements under its belt—it led the successful campaign to eliminate smallpox in the 1970s—WHO may well be the only international organization that we genuinely cannot live without. When infectious diseases spread rapidly across borders, WHO is expected to coordinate the scientific response of national public-health officials from France to Malaysia, as well as the global information campaign needed to explain it. No national government can do the same.
Fortunately for the rest of us, current WHO Director-General Margaret Chan is an experienced public-health official, among other things responsible for the containment of the 2003 SARS epidemic in Hong Kong. Unfortunately for the rest of us, the presence of Chan at what could be a crucial moment is, if not actually a fluke, then a piece of monumental good luck.
For, of course, WHO is not a stand-alone organization but, rather, a part of the United Nations. As such, it is afflicted by many of the same illnesses, so to speak, as other U.N. agencies. Like them, WHO is by definition not accountable to voters, and it is rarely scrutinized by the press. Its leaders are chosen according to the opaque rules that govern top U.N. appointments. (If too many Africans have top jobs, then the director-general has to be an Asian, etc.) Though it does occupy itself most of the time with concerns such as flu pandemic preparedness, some of its other priorities reflect its members' political agendas. For example, a large chunk of money is devoted every year to tackling the "social and economic factors that determine people's opportunities for health," such as poverty, education, and climate change—all worthy issues that would nevertheless seem well beyond the scope of an organization that should primarily be concerned with infectious disease.
It gets worse. Like their other U.N. colleagues, WHO bureaucrats also spend much unnecessary time writing papers on legally dubious notions like the "right to health"; others are scheming to create an international bureaucracy that would regulate all drug research and development, while still others get sidetracked by issues such as obesity and automotive safety. WHO's 2008-13 strategic plan speaks of promoting "programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches," whatever that means. WHO is not exempt from other aspects of U.N. politics, either: Taiwan's repeated attempts to join WHO are always vetoed by China, for example, and U.N. officials (speaking of human rights-based approaches) routinely refuse Taiwanese journalists permission to cover WHO events. When the next epidemic starts in Taipei, we'll be sorry.
I am not trying to bash the World Health Organization. My point is that this is an institution that could easily drift away into irrelevance under the influence of the institutional culture of the United Nations in Geneva. Look how much time and money it wastes, despite the fact that its director-general is competent, and imagine how much more time and money it would waste if she were not—as some of her predecessors were not. Look how little effort is made to ensure the organization stays focused on the one task—infectious-disease control—that only it can carry out. At the same time, look how much diplomatic energy is also wasted on institutions of far less importance. I am thinking here of last week's U.N. World Conference on Racism, notable largely for the fact that the president of Iran, a country that openly persecutes religious dissenters, used it to launch an anti-Semitic diatribe.
The truth is that we tend to treat the really important U.N. institutions the way we treat the local water utility: Most of the time we don't care who runs it or how well—but in an emergency, we expect a superhuman response. Now, just as we might really be on the brink of an emergency, it is worth reminding ourselves that if we want WHO to be there when we need it, the organization must be constantly monitored and fully funded. U.N. member governments should make absolutely sure it stays on focus. After all, only WHO is equipped to carry out the international monitoring of the spread of a new infectious disease: Let's cross our fingers and hope that this time it hasn't been distracted by something else. (Slate)

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