‘WHO as fragile as it is indispensable’. Report probes International Geneva response to Covid crisis

A year on, and 117 million confirmed cases later, health experts and researchers have been trying to dissect how the global health body could have reacted differently in the face of the unfolding crisis and how to overhaul it.

With the 70-plus NGOs and international organisations that gravitate around the WHO and make up its global health hub,  international Geneva has been at the front lines of the global efforts to fight the disease.

A new report released on Wednesday, and commissioned by the Fondation pour Genève, analyses the success and the failures of the WHO and international Geneva organisations in their response to the pandemic, and the implications for the future of multilateralism.

“This deep-dive into 2020, seen from international Geneva, reveals in a crude way the underlying planetary crises: multilateralism at half-mast, states turning in on themselves, the race for drugs and vaccines, and vaccines disrupted by private financial issues and national sovereignty, increasingly noisy alternative truths, etc. But what Covid reveals is also the capacity of the international community to unite to defeat the same common enemy, with a cockpit located mainly in Geneva.”

An already ‘weakened’ WHO. The World Health Organization has been heavily criticised over its handling of the pandemic. However, before the onset of the pandemic, the WHO was already facing one of the deepest crises of its 73 years of existence.  An earlier edition of the Fondation pour Genève study conducted before the discovery Covid-19 showed that at the end of 2019, the WHO was financially and politically fragile.

Its limited budget was funded less and less by member states, whose contributions dropped from 46 per cent of the total budget in 1999 to 17 per cent last year. Meanwhile, voluntary donations by members and private donors like The Bill and Melinda Gates Foundation contribute to around 80 per cent of its overall budget.

“This poses an obvious governance problem: who makes the decisions in Geneva? Civil society made up of Member States and WHO or private donors?,” ask the authors of the report.

The organisation had also yet to fully restore its reputation following the Ebola epidemic in 2014, when it was widely blamed for failing to take leadership and for being too slow in declaring it an international public health emergency.

“The WHO is facing a crisis of confidence and mistrust at the dawn of 2020,” explains the report. The organisation “begins 2020 with a new enemy to face: the coronavirus”.

International Geneva’s Covid-19 response. The international community’s response, at least initially, “overwhelmingly followed the tempo set by the WHO”. More than 20 core organisations based in Geneva or with a direct link to Geneva, like the International Committee of the Red Cross (ICRC), the Global Fund or the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), have played a key role in tackling the crisis, making it “possible to appreciate the extent of the number of actors that have made Geneva an international centre of influence in the fight against the pandemic,” the report finds.

However, the pandemic grew into more than a health crisis and organisations working across the fields of human rights, humanitarian aid, trade and the economy were soon implicated, with various calls for funding support.

Despite its clear need for reform, the pandemic also underscored the crucial role of the WHO, the authors say: “The global crisis generated by the pandemic has also shown the importance of multilateralism, of which the WHO is a tool that is as fragile as it is indispensable".

It was only with the support of the international global health institutions, including Geneva-based “heavyweights” such as the Global Fund and Gavi, that it was able to respond to the emergency and launch one of the greater successes last year: the ACT Accelerator to speed up access to vaccines, treatments and diagnostics against Covax-19.

Within the ACT Accelerator, its vaccine pillar, the Covax initiative was designed to ensure that vaccines reach poor and middle income countries, with the rollout having reached the first three countries in Africa, Ghana, Cote d’Ivoire and Ghana last week.

“The Covax initiative is a good illustration of the raison d'être of International Geneva and its ability to find solutions. It offers the prospect of a world that is both interdependent and united," says Olivier Coutau, delegate for International Geneva at the directorate of international affairs of the canton of Geneva.

Key achievements. Among some of the other key successes of International Geneva’s health cluster, the report lists:

• The international randomised clinical Solidarity trials, which "made it possible to evaluate the effectiveness of already existing treatments against Covid-19", such as dexamethasone.

• A fundraising that allowed the WHO to raise $241m (status as of January 25, 2021).

• Overall, "Experts believe that the WHO has risen to the challenge by providing technical and normative guidance, taking the lead in coordinating the scientific response to the pandemic and shaping logistical operations with a number of other international organisations," says Priti Patnaik, founder of Geneva Health Files and a global health journalist who follows health policy development, who is cited in the report.

Read also: Covid-19 vs WHO and the world: successes, failures and hopes a year on

The road to reform. The report concludes with some recommendations for International Geneva, but in particular, the World Health Organization and its need to reform. Antoine Flahault, director of the Institute for Global Health, said:

“The Member States of the WHO, which ensures its governance through the World Health Assembly and its Executive Board, will first have to ask themselves what prerogatives they wish to entrust to the WHO in the event of a health emergency… As long as the WHO General Secretariat has no independent investigative powers in member states, it cannot be expected to play the role of conductor that it is sometimes criticised for not playing.”

WHO's funding also needs to be reviewed, as explained by Gian Luca Burci, former WHO legal adviser and associate professor of international law at the Graduate Institute of International and Development Studies (IHEID) in Geneva, "because it is dysfunctional. Voluntary contributions, which represent about 80 per cent of the budget, are too volatile. The WHO must have sustainable and predictable funding in the future.”

For Priti Patnaik, "the decisions that shaped the international response to the pandemic quickly and decisively shifted from WHO to some donor governments, other actors, including private philanthropists, public-private partnerships, outside the global health field.”

This has lasting consequences for global health governance, as WHO Member States have fewer opportunities to voice their concerns in a multilateral setting, she adds. This implies that member states increase their mandatory contributions.

“The involvement of the Bill and Melinda Gates Foundation is symptomatic of the situation. If philanthropic action is desirable, the role of these major donors must be clarified. The governance of the WHO is at stake: the member states that run the WHO should be more involved in this transparency work.”