Swine Flu: The WHO's Moment
Yesterday, the front page of my morning newspaper featured a photograph of uniformed Mexican police officers, machine guns at the ready, surgical masks strapped to their faces, seemingly prepared to defend their compatriots against the sudden outbreak of swine flu. I live in Warsaw, 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.
Just 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 is doing about it. The Geneva-based 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 -- the WHO may well be the only international organization that we cannot live without. When infectious diseases are 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 us, the WHO's director general, Margaret Chan, is an experienced public health official and one who was responsible for, among other things, the containment of the 2003 SARS epidemic in Hong Kong. Unfortunately for us, Chan's presence at what could be a crucial moment is, if not a fluke, a stroke of monumental good luck.
For of course the WHO is not a stand-alone organization but 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, the WHO is not accountable to voters and is rarely scrutinized by the media. Its leaders are chosen according to the opaque rules that govern top U.N. appointments. (If too many Africans have top jobs, the director general has to be Asian, etc.) Though it does occupy itself most of the time with concerns such as preparedness for flu pandemics, 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 diseases.
It gets worse: Like their U.N. colleagues, WHO bureaucrats spend much unnecessary time writing papers on legally dubious notions such as the "Right to Health"; others are scheming to create an international bureaucracy that would regulate all drug research and development; still others get sidetracked by issues such as obesity and automotive safety. The 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. The organization is not exempt from other aspects of U.N. politics, either: Taiwan's repeated attempts to join the 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, rather, is that this is an institution that could easily drift into irrelevance under the influence of the institutional culture of the United Nations in Geneva. Look how much time and money it wastes, even though 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 that the agency 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 deliver 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 the 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 focused: After all, only the 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.