What should the World Health Organization add to its agenda?
That's a question to ponder as WHO marks its 75th anniversary on April 7.
It's been a storied history: the World Health Organization has helped eradicate smallpox, prevented millions of deaths through its vaccination efforts and condemned attacks on health-care facilities in conflict zones like Ukraine and Tigray, Ethiopia.
It's also weathered its share of criticism, including critiques that it mismanaged the H1N1 flu in 2009 and an Ebola outbreak in West Africa in 2014. Its handling of the COVID-19 pandemic, including understanding the origins of the SARS-CoV-2 virus, has received lackluster reviews in some corners.
Today, this U.N. agency, which was founded "to promote and protect the health of all peoples," has set these key priorities: moving toward universal health coverage, improving protection against health emergencies and guaranteeing all people can live healthy lives at all ages.
But those are sweeping goals. What kinds of new initiatives might WHO adopt We asked eight global health specialists to offer a bold new agenda item to add to WHO's docket. Their answers have been edited for length and clarity.
As a pediatrician, I would like to see adolescent health become a larger focus for WHO.
They've done very well to promote child health, but then these same children fall through the cracks of the health-care system when they become adolescents.
These young people suffer from mental health challenges, depression, obesity, drug use and sexually transmitted infections. And they become parents when they are still children themselves. Many girls, for instance, become pregnant before the age of 18. Children born to adolescents are at risk of not getting immunized as they should and not growing up properly, so it becomes a vicious cycle of health failures.
WHO has done a lot to promote adolescent health. But it needs to do more. It needs to globalize its agenda so that it can reach every country and every single one of the 1.2 billion adolescents in the world. That will allow these young people to transition into adulthood where they can make healthy choices for themselves and their communities.
That's my bold request for WHO.
--Sabrina Kitaka, infectious disease pediatrician and adolescent medicine specialist at Makerere University, Kampala, Uganda
The COVID pandemic revealed that WHO wasn't seen by all countries, all constituencies and all citizens as a trusted organization. That leads to misinformation, disinformation and conspiracy theories. So for me, the most important element is to increase trust in WHO so governments can take and implement their advice. For that, WHO needs to have better financing, better governance arrangements and a clearer mandate.
First, this organization needs to be financed properly. WHO needs more money and that money has to come from higher mandatory contributions.
Second, in difficult situations, countries and political leaders must be able to strengthen how WHO operates.
Finally, if you look at what happened with COVID, WHO was not able to conduct a proper investigation. That's because the international health regulations require the organization to gain consent from the country it's investigating — in this case, China. WHO should be able to conduct an investigation with or without consent and move quickly and flexibly to provide evidence-based advice in a short period of time. That's a tall order but it's crucial to understand where diseases are coming from to be able to contain those already in the world today and prevent future ones from emerging.
If they do all this, WHO will be on better grounds going forward. Citizens will see a single, unique and clear voice and that will improve the way they engage with health locally and globally.
--Javier Guzman, director of the Global Health Policy Program at the Center for Global Development
What happens when you have a country bombing its own civilians? How does WHO navigate that?
And what are the ethics around new technologies like CRISPR and ChatGPT? In scenarios where the local regulatory health mechanisms aren't very good, these computational and data science tools can have a significant impact on the health care of vulnerable communities. Imagine if, for instance, ChatGPT (the artificial intelligence program that can generate human-like responses to prompts or questions) starts pulling information from individual patient records or if ChatGPT starts to serve as a de facto clinician in a community. If an artificial intelligence makes a bad diagnosis, who's liable, who's protected and who's not protected?
For WHO to serve as a leader in navigating this complex terrain, we need to engage technologists, scientists, ethicists, historians, social scientists, humanists and artists.
Another ethical concern I have is that at times, the senior WHO staff in a country has very little information or cultural knowledge of that place. I've seen it personally where these individuals can't understand the local language or read the local newspaper. The U.N. model is based on the fact that we're all the same. In principle, that idea is very good. But if a person is unable to understand the local language and culture, they'll be limited in their ability to serve that community. So we need people with language skills or a shared regional background to engage with, learn from and contribute to the countries they're serving.
--Muhammad Zaman, professor of biomedical engineering and global public health, Boston University
We need specific guidelines for low- and middle-income countries on how to protect our environment.
There's an idea that's been kicking around for a while — that the environment, plants, animals and humans are all interrelated. A healthy environment, a healthy food chain and healthy animals mean healthy humans. The idea is called One Health.
But in countries such as Honduras, where I live, we don't see enough of this approach.
Our environment is degrading. We have water problems. We have open pit mining [mines that extract minerals from giant pits carved from the land as opposed to tunneling] that devastates landscapes. Every day, we can see hundreds of trucks carrying trees that have been cut down by the logging industry. There's both drought and heavy flooding. The destruction is accelerating here, so we need to protect our land and animals, and our environment and human populations.
I applaud WHO's One Health global action plan but low- and middle-income countries need more guidance on how to safeguard our ecosystems. One Health means planetary health, and I am counting on WHO for that.
--Jackeline Alger, physician and parasitologist, Hospital Escuela, Tegucigalpa, Honduras
I think that looking at where changes can be made in terms of the decision-making will help identify how to shave down WHO's bureaucracy.
For instance, when reflecting on the West African Ebola epidemic in 2014, many global health experts said WHO took too long to declare the outbreak a public health emergency, an action that would have likely sped up access to essential treatments, financing and personnel. And even after that declaration came, the critique continues, the response was not well coordinated, allowing the Ebola outbreak to get out of hand.
Even now, there is a Marburg virus outbreak in Equatorial Guinea, the first in this nation, and WHO is having difficulty obtaining accurate case information as the country isn't reporting all their data.
Outbreak response is, of course, not the only thing that WHO does, but it's visible at a global level so it gains a lot of attention. This is how many people judge how well the organization performs. Showing that you can actually do something effective is really important.
With six regional offices and 194 member states, WHO is inevitably large and decentralized. But that creates bureaucracy, which introduces inefficiencies: it's unclear what everyone is doing and where some of the bottlenecks are in terms of getting things implemented.
I would examine the responsibilities of regional and country offices and assess how information moves through the organization. Then, WHO needs to work to reduce its bureaucracy to, among other things, gain quicker access to outbreak data. This will allow for a cleaner line of communication and implementation between those at the highest levels and what's happening on the ground.
--Abraar Karan, infectious disease physician, epidemiologist and researcher, Stanford University
What I would like to see is for WHO to be able to step up in terms of all types of emergencies. In addition to epidemics and pandemics, I mean natural disasters, conflict, migration and the climate emergency and its effects. The organization needs to be able to lead the health response while working with local and national governments, NGOs, pharmaceutical and health-care companies, and hospitals and clinics.
For that to happen, besides sufficient funding, WHO needs more autonomy and the ability to speak out without political consequences. That may require creating a subdivision within the organization that doesn't follow the same administrative and financial procedures.
I'm not suggesting a separate U.N. organization for this, but rather for the U.N. to change its internal structure to give WHO the power to move more quickly, nimbly and responsively in a crisis than is possible at the moment.
--Paul Spiegel, director of the Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health
Long COVID really bothers me. It affects people who have recovered from COVID, whether they had severe symptoms or not. Some of them live with long COVID for a long time. These are individuals with brain fatigue, tiredness, difficulty in recalling things, even diabetes. Given that access to health care is poor in Africa, long COVID is like a disaster waiting to happen. We could have a huge epidemic on our hands.
Yet most African leaders are not doing anything about it. Very little research is taking place. So we require a group like WHO that already coordinates health efforts across the continent to spearhead an effort to examine long COVID and ensure that sufficient resources are mobilized to address it. This has implications for not just the health of Africans but also our economic well-being.
--Ifeanyi Nsofor, medical doctor, global health equity advocate and senior New Voices fellow at the Aspen Institute
Now is the moment for WHO to focus on what it is that it needs to do, and how to evolve its mission to meet the unprecedented health challenges the world faces in this day and age. What are its priorities? How can it best respond to global health emergencies? And how it can it be most effective in a changing world?
First, WHO should start by looking at which diseases are impacting people the most in various parts of the world. What are the health challenges that individuals, families, and communities are facing from region to region — everything from dengue to cholera, diseases with pandemic potential, to chronic illnesses like malaria? And how do we, as a global community, try to tackle those? It's an endless list and we can't address them all, so prioritizing is key.
Secondly, it's critical for WHO to identify the most vulnerable populations. It might be people who live in low-income countries. It might be refugees and displaced peoples. It might be those who have been marginalized by structural inequities. WHO can then act as their voice, as their partner, and be the champion they need to address the major health issues they face and help remove the obstacles between them and a brighter future.
--Wafaa El-Sadr, executive vice president, Columbia Global