Facing the destructive aftermath of World War II, nations around the globe convened to form the United Nation in 1945. At one of its first conferences, representatives from Brazil and China proposed the concept of a global health organization, which would facilitate collaboration between countries to fight the spread of diseases. Three years of additional conferences, commissions, and proposals later, the constitution of the World Health Organization (WHO) came into effect on April 7th, 1948. Armed with an initial budget of 5 million USD and 55 member states, WHO embarked on campaigns to prevent infectious diseases while promoting sanitation, nutrition, and maternal and child health.
Fast forward 75 years, WHO has 194 participating member states and an approved budget of 6.8 billion USD for the upcoming year 2024-2025. Since its inception, WHO has been instrumental in implementing vaccination programs, eradicating smallpox, and reducing global deaths from infectious diseases such as malaria, measles, and tuberculosis.
One of the most successful operations by WHO has been the near eradication of polio. Poliomyelitis (polio) is caused by poliovirus, which infects the nervous system and causes a wide range of symptoms including fever, stiffness in the neck, pain in the limbs, and permanent paralysis. During the 20th century, repeated polio epidemics in developed countries left thousands dead and paralyzed. For example, there were more than 21,000 paralytic cases in the United States during the year 1952 alone. Fortunately, the invention of polio vaccines by American scientists, Jonas Salk and Albert Sabin, allowed the number of cases to drop significantly. In fact, dissemination of vaccines across the country eliminated polio entirely from the United States by 1979. However, polio remained a persistent problem in developing countries. Recognizing the need for vaccines in resource-limited regions, WHO launched the Global Polio Eradication Initiative (GPEI) in 1988. In collaboration with other humanitarian organizations such as Rotary International, WHO helped to escalate vaccine production and immunization programs in affected countries. Their concerted efforts eradicated wild poliovirus from the Americas, Western Pacific, and Africa by 1994, 2000 and 2020, respectively. Altogether, wild poliovirus cases have decreased by 99% since 1988. As of 2023, there have been 11 reported cases of wild poliovirus in Pakistan and Afghanistan – and WHO continues its endeavors to achieve complete eradication of polio worldwide.
Despite its successes, the 75-year-old global health agency has not been exempt from criticisms, accusations, and controversies. For example, WHO was heavily criticized for its delayed and insufficient response during the Ebola virus epidemic in West Africa. While the number of lethal and infectious cases rose in March 2014, WHO did not declare Ebola a Public Health Emergency of International Concern until August of that year. Public health experts claimed that such delay in reporting the risks and scale of the outbreak to international communities was costly – as there were 1,711 more cases and 932 deaths during the five-month period. They also claimed that WHO was not prepared to tackle the various factors that exacerbated the outbreak – including political and economic tensions in West Africa, weak national health systems, and lack of funds allocated for emergency responses. By publishing a formal report in The Lancet, these experts demanded WHO address three main objectives: 1) increase transparency, 2) establish lines of accountability and 3) re-organize its structure so that WHO and its budget are protected from political pressures. In total, the West African Ebola epidemic resulted in 28,000 cases and claimed 11,000 lives from 2013 to 2016. Considering the criticisms WHO received during this time, one cannot help but wonder whether the number of cases and deaths would have been reduced had WHO responded in a timely and effective manner. Most recently, WHO was embroiled in another controversy during the coronavirus disease related 2019 (COVID-19) pandemic. More specifically in 2020, then United States president Donald Trump announced his intent to withdraw the country’s membership and funding from WHO. He justified this decision by accusing WHO of mismanagement, slow actions, and deferential stance towards the Chinese government. The Trump administration and WHO further disagreed on trade and travel restrictions, as the former advocated for imposing these restrictions on affected countries including China while the latter advised against such actions. In the midst of multiple accusations and disagreements, WHO faced potentially massive cuts to its funding and its ability to address rising COVID-19 cases. Luckily, Trump’s withdrawal plans were quickly revoked by the new Biden administration and were never realized. However, Trump’s actions towards WHO highlighted the extreme vulnerability of the health agency to the whims and fancies of political superpowers.
During the 75 years since its inception, WHO has controlled the spread of diseases and saved countless lives. It has also made mistakes and implicated itself in tense, political situations. Riding through the ups and downs, WHO stands as a leader of global health as the international community looks up to the organization for its reports, decisions, and guidance. Inevitably, new epidemics and pandemics will continue to appear and challenge the human race – it is imperative that WHO perseveres in its efforts to protect and promote global health.
References:
1. Pinkbook: Poliomyelitis | CDC. https://www.cdc.gov/vaccines/pubs/pinkbook/polio.html (2023).
2. Higgins-Dunn, N. Dr. Fauci to lead U.S. delegation at WHO meetings as Biden plans to reverse Trump withdrawal. CNBC https://www.cnbc.com/2021/01/20/dr-fauci-to-lead-us-delegation-at-who-meetings-as-biden-plans-to-reverse-trump-withdrawal-.html (2021).
3. Withholding funding from the World Health Organization is wrong and dangerous, and must be reversed. Nature 580, 431–432 (2020).
4. Updated WHO recommendations for international traffic in relation to COVID-19 outbreak. https://web.archive.org/web/20200414223627/https://www.who.int/news-room/articles-detail/updated-who-recommendations-for-international-traffic-in-relation-to-covid-19-outbreak/ (2020).
5. Coronavirus Updates: Trump Halts U.S. Funding of World Health Organization. The New York Times (2020).
6. Wenham, C. What we have learnt about the World Health Organization from the Ebola outbreak. Philos Trans R Soc Lond B Biol Sci 372, 20160307 (2017).
7. Moon, S. et al. Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola. The Lancet 386, 2204–2221 (2015).
8. Boseley, S. & editor, S. B. H. Experts criticise WHO delay in sounding alarm over Ebola outbreak. The Guardian (2015).
9. Poliomyelitis (polio). https://www.who.int/health-topics/poliomyelitis#tab=tab_1.
10. History of polio vaccination. https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-polio-vaccination.
11. McCarthy, M. Examples of WHO activities over the years. The Lancet 360, 1111–1112 (2002).
Jennifer Ahn
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