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Global Health Governance post-COVID-19: Maintaining Social Distance or Closing the Gap?

WHO_Seventy-fifth World Health Assembly
Photo: WHO / Pierre Albouy - Seventy-fifth World Health Assembly, Geneva, Switzerland, 22-28 May 2022.

Three years into the pandemic, it is time to close the 'social distance' gap in global health governance structures and come together to secure a way forward for a governance model that can deliver and respond to future health crises.


[Trupti Kulkarni is currently studying for the Master of Global Health at ISGlobal. She has over 10 years of experience in the non-profit sector, most recently with an INGO, designing and implementing public health programmes in several countries in Africa and Asia. Her interests include public health policy and advocacy, and the intersection of technology and healthcare for equitable access to health.]


664,618,938 and 6,722,949 - no, these are not the numbers of the latest Powerball lottery, but the millions of the shocking number of cases and deaths caused by COVID-19. Much like the odds of winning the Powerball, the chances of a pandemic devastating the global order and disrupting its operations were thought to be slim, given the smörgåsbord of international organisations (42,000), their robust governance and collective expertise. But in the first half of 2020, the world ground to a halt. A period of widespread human suffering caused by unprepared health systems, nationalistic governments and weak international organisations. Three years into the pandemic, it is time to close the 'social distance' gap in global health governance structures and come together to secure a way forward for a governance model that can deliver and respond to future health crises.

Global Health Governance – the Good, the Bad, and the Ugly

The good

Since its creation in 1948, the WHO has (co-)led the way in addressing pressing health issues, mobilised expertise in coordinating health efforts, and provided technical expertise on various topics that directly or indirectly impact health. Its many strengths include the 2005 Framework Convention on Tobacco Control, and galvanising an international movement to ensure access to HIV-AIDS medicines in low- and middle-income countries.

The bad

One of WHO's weaknesses is its huge structure; with more than 26 functions and 150 offices, delivery on various health issues is mired in bureaucracy. Striking a balance between disease-specific programmes or ‘health for all’ mandate is tricky, with funders pooling their money into new initiatives such as the Joint United Nations Programme on HIV/AIDS, Global Alliance on Vaccines and Immunization, etc. Currently, more than 80% of WHO's budget comes from voluntary contributions, which are controlled by donors and can fluctuate greatly.


Figure 1: Top Funders of the WHO for the period 2020-21. Source: WHO


The ugly

The impact of these weaknesses in WHO’s governance and failure to enforce the International Health Regulations was reflected in governments’ unwillingness to report disease events during the early onset of the COVID-19 pandemic and their adoption of a ‘me-first’ attitude by hoarding personal protective equipment and test kits, and monopolising vaccine production and distribution. This unequal access to COVID-19 vaccination is illustrated in Figure 2. This has also created a “pandemic paradox”; according to a UN report, 40 million children are vulnerable to measles because ofto missed vaccination campaigns. The aftershocks are also being felt in non-health sectors too; a report by says that in Kenya, 16% of girls did not return to school in 2021, and 328,000 teenage pregnancies were recorded.

Figure 2: Share of World Population Fully Vaccinated Against COVID-19. Source: The New York Times.


Accelerating the ‘Go’ in Governance of Global Health

The pandemic is a wake-up call to rethink governance and pandemic preparedness. The World Health Assembly session in November 2021 kickstarted the process of drafting an international treaty on pandemic prevention and preparedness to respond to future health crises. At its heart will be ensuring equity and continued access to health care. It is expected to be presented at the 77th World Health Assembly in May 2024, and the zero-draft was already completed in December 2022! This FAQ uncovers exciting aspects of this development.

In terms of redesigning governance, the WHO needs to be revamped. First, its constitution should be strengthened to give it the legal authority to enforce regulations. Second, its technical expertise and operational know-how, which are crucial in low- and middle-income countries, should be further strengthened with adequate financial and resource support from high-income countries and other private organisations. Third, WHO should reinvent its organisational structure, eliminating multi-layered departments and unnecessary bureaucracy to make it more agile.

The time is NOW to accelerate the 'go' in global health governance!

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