Among the many victims of Haiti's deadly cholera outbreak may be an unexpected casualty: the World Health Organization. As the epidemic broke out on the island, spreading quickly from rural areas to the capital, Port-au-Prince, the World Health Organization (WHO) and its regional division, the Pan American Health Organization (PAHO), sent expert teams, mapping the epidemic and advising the government on how to best defeat the outbreak. Relief workers hustled to contain the disease in rural areas before it spread to the capital, where living spaces are more compact, sanitation systems are overwhelmed with raw sewage, and more than a million earthquake survivors are still huddled in tent camps. But reach Port-au-Prince it did, and today at least 1,800 Haitians have fallen victim. Cholera, like most any outbreak, demands a nimble, fast-moving, and adaptive response. Unfortunately, that's just about everything the WHO is not. The 11 months since Haiti's earthquake, coupled with the relentless rise of pandemics in impoverished countries in recent years, have made painfully clear that the agency can no longer adequately perform the job of being the world's chief defender against disease.
The WHO -- for 62 years the world's go-to agency on all public health matters -- is today outmoded, underfunded, and overly politicized. In a world of rapid technological change, travel, and trade, the WHO moves with a bureaucracy's speed. Its advice to health officials is too often muddied by the need for consensus. Regional leadership posts are pursued as political prizes. Underfunded and over strapped, the organization has come under attack for being too easily swayed by big pharma. In a world where foundations, NGOs, and the private sector are transforming global health, the WHO has simply not adapted. This isn't just about the WHO losing its edge. Taken together, these myriad dysfunctions are rendering the WHO closer and closer to irrelevancy in the world of global health.
How did it get so bad? When the WHO was created as a U.N. technical agency shortly after World War II, governments' health ministries were the predominant global health authorities. The new U.N. body was meant to serve as a reservoir of expertise and knowledge at the service of countries needing a hand. The WHO essentially became a health consultancy to developing countries, supplying advice, analyses, and best practices, though stopping short of directly implementing health programs. That was an invaluable service at the time. But today, its mission and operations remain largely unchanged.
The WHO's stagnation is juxtaposed with a world of public health that is changing more and more quickly than ever. Legions of new drugs, vaccines, and diagnostics have fortified the medical profession. Governments are no longer the sole stewards of public health; new players are entering the field, both public and private. The eight-year-old Global Fund to Fight AIDS, Tuberculosis and Malaria, for example, is now the go-to coordinator for international funding to combat these diseases. The Bill and Melinda Gates Foundation has revolutionized global health, investing $13 billion in health grants in everything from research into malaria vaccines to treatment of tuberculosis to HIV/AIDS programs on the ground. Even the U.S. government has gotten in on the world of change, forcefully responding to HIV/AIDS in Africa with a $25 billion program that has put some 3.2 million people in treatment in just half a decade. What differentiates these pioneering efforts from the WHO is that they are nimble, well-funded, and less encumbered by red tape. It's hard to see how the WHO can compete.
In fact, in this new atmosphere, where organizations are taking health into their own hands, it's unclear exactly what role the WHO should even play anymore. Offering up its expertise is not as straight forward as it once was; the biggest players in global health aren't asking for assistance as governments once did. Nor can the WHO set its own advising priorities, since its funding comes from donors, primarily national governments. In recent years, the agency's $2.3 billion annual budget has been increasingly divvied up before it ever reaches the WHO, earmarked by donors for their favored causes, be they specific diseases or treatments to fight them. With its limited resources, the WHO is caught in a trap, appealing to donors' interests in fighting specific diseases such as polio, HIV/AIDS, or malaria, while giving broader health priorities -- notably, the development of basic health-care infrastructure -- short shrift. The WHO is no longer setting the agenda of global health; it's struggling to keep up.