In the event of an exceptional crisis, WHO can declare a Public Health Emergency of International Concern (PHEIC), which it has done six times: during the swine flu (H1N1) outbreak in 2009; in response to the reversal of progress towards polio eradication in 2014; in the midst of the 2014 Ebola outbreak in West Africa; during the 2016 Zika virus outbreak in the Americas; when the ongoing Ebola outbreak reached the city of Goma in the Democratic Republic of Congo in 2019; and amid the global outbreak of the novel coronavirus in 2020. Many critics have accused the WHO of slow and poorly coordinated responses to outbreaks. This includes the 2014 Ebola outbreak, where it waited five months before declaring a PHEIC, despite calls from groups like Médecins Sans Frontières. In response to these criticisms, the organization introduced several reforms to improve its responses, including the creation of a reserve force of public health workers and a $100 million emergency fund. WHO has also added an incident management system that allows it to immediately place medical staff, equipment and supplies such as medicines on the ground while coordinating a broader response. The organization also serves as an organizer and host for international meetings and discussions on health issues. Although WHO is not generally a direct donor of health services and programmes in countries, it provides relief supplies and other support in emergencies and manages donor-funded programmes. In contrast, voluntary contributions to specific projects or activities varied to reflect changing U.S. priorities and/or support during international crises. Over the past decade, U.S. voluntary contributions have ranged from a low of $102 million in FY2014 to a peak of $402 million in FY2017.
Higher amounts of voluntary contributions may be due to increased U.S. support for certain WHO activities, such as emergency response. United States voluntary contributions also support a number of other WHO activities, such as polio eradication; maternal, newborn and child health programmes; Food security; and regulatory oversight of drugs. As in previous health crises, WHO provided medical and technical advice to investigate the virus, particularly new variants, and coordinated national responses with world leaders. It has also distributed essential relief supplies to Member States, including millions of diagnostic tests and personal protective equipment for medical personnel. WHO has partnered with the Coalition for Epidemic Preparedness Innovations (CEPI) and Gavi, the Vaccine Alliance, to launch COVAX, a global initiative to ensure equal access to COVID-19 vaccines. By mid-2022, COVAX had delivered about 1.5 billion doses, missing its goal of distributing 2 billion by the end of 2021. Finally, the IHR introduce important safeguards to protect the rights of travellers and other individuals with regard to the processing of personal data, informed consent and non-discrimination in the application of health measures provided for in the regulations. “Advocacy for strengthening WHO remains important,” writes David P. Fidler of CFR for Think Global Health. “However, this goal faces serious obstacles,” Fidler said, namely opposition from China, Russia`s war in Ukraine and the lack of strong U.S. support to expand the agency`s authority and funding.
WHO relies on contributions from Member States and private organizations to implement its budget and workplan. WHO`s biennial budget for 2022–2023 was set at $6.12 billion (a 5% increase from the $5.84 billion budgeted for the previous biennium 2020–20219). WHO`s actual income and expenditure may differ from budgeted amounts, for example when additional resources are received and allocated in response to health emergencies, including COVID-19. WHO has its headquarters in Geneva, Switzerland, six semi-autonomous regional offices that monitor activities in each region, and a network of country offices and representatives around the world. It is headed by a Director General (DG), currently Dr Tedros Adhanom Ghebreyesus, who was first appointed in 2017 and is expected to be reappointed for a second five-year term in May 2022. In addition to coordinating the ongoing response to COVID-19, Dr Tedros noted that strengthening WHO in terms of funding, staff and response is a priority of his mandate, and proposed a more robust role for WHO in preparing for and responding to future pandemics in light of the challenges posed by COVID-19.4 At the same time, the IHR require countries to designate a national IHR focal point to communicate with WHO. Strengthen and maintain core surveillance and response capacity, including at designated ports of entry. Additional provisions concern the areas of international travel and transport, such as medical documents required for international transport.
WHO`s overarching mission is “to achieve the highest attainable standard of health for all people”. 1 It supports its mission through, inter alia: WHO`s overall goal for its activities in 2019–2023 was to “ensure healthy lives and promote well-being for all at all ages”. To achieve this goal, it focuses on three strategic priorities (the “triple trillion goals”): 3 White House, “Letter to His Excellency António Guterres,” correspondence from President Biden, January 20, 2021, www.whitehouse.gov/briefing-room/statements-releases/2021/01/20/letter-his-excellency-antonio-guterres/; Associated Press. “Biden`s U.S. revives support for WHO and cancels Trump`s withdrawal.” January 2021. apnews.com/article/us-who-support-006ed181e016afa55d4cea30af236227; HHS, “Dr. Anthony S. Fauci Remarks at the meeting of the Executive Committee of the World Health Organization,” Jan. 21, 2021, www.hhs.gov/about/news/2021/01/21/dr-anthony-s-fauci-remarks-world-health-organization-executive-board-meeting.html. These and other challenges were particularly evident during and after the Agency`s perceived failures to respond to the Ebola outbreak in West Africa (2014-2015), prompting the Agency to adopt a number of reforms, including revamping its approach to health emergencies19 and establishing specific new emergency funding mechanisms such as the Emergency Emergency Fund.20 Since 2020, WHO faced one of its biggest challenges to date: coordinating a global response to the COVID-19 pandemic. Many Member States, including the United States, have criticized WHO for its management of the COVID-19 response and called for further reforms of the organization, while acknowledging WHO`s continued importance in the global health system. The World Health Assembly (WHA), composed of representatives of WHO`s 194 Member States, is the organization`s highest decision-making body and meets annually.
It is responsible for selecting the Director-General, setting priorities and approving WHO`s budget and activities. Every six years, the World Health Assembly negotiates and approves a work plan for WHO (the most recent plan, known as the General Programme of Work, covers the period 2019–2023)5 and every two years it approves a biennial budget for the workplan (the current budget is for 2022–2023).