Thursday, 25 February, 2021

How does the World Health Organization work?

At the WHO press conference on January 22. – Salvatore Di Nolfi / AP / SIPA

  • Several thousand people infected, soon 200 deaths but no global health emergency triggered by WHO against the new coronavirus.
  • Some see it as a political reason. If they are not inexistent, the specialists interviewed by 20 minutes explain that technique prevails.
  • How does this UN organization work in the spotlight in times of crisis?

In times of health crisis, eyes turn to the World Health Organization, WHO. And, this is the season. For the moment, the UN institution which brings together 194 countries has not launched the famous “international health emergency” concerning the new
coronaviruses. What some people criticize, suspecting political intrigue with the
China. This Thursday evening, WHO will take a new step forward and possibly revise its position. Before that, 20 minutes is trying to explain to you how WHO works.

How it works ?

The World Health Organization, created in the wake of the UN, on which it depends, in 1948, is based in Geneva. This is where its central office is located, on the border with France. There are also six regional offices and thematic departments. “Until then, WHO was organized in a staircase between the different offices and services, which was complex and slowed down decision-making,” explains to 20 minutes Anne Sénéquier, co-director of the World Health Observatory at Iris.

This complex architecture is being reformed. “The organization now has more money and is more operational. The alerts also go up faster. The WHO has regained a lack of credibility since the SARS crises and more recently with Ebola, “added the one who was humanitarian on the ground at the time of the Ebola crisis in 2014.

“WHO is an international organization, not a supranational one,” said Antoien Flahault, director of the Geneva Institute of Global Health, straight away. He is not a gendarme. It is an organization that is there to serve the member states. They don’t ask to be targeted. Clearly: it is not a kind of European Union whose decisions are binding on the member states.

How are decisions made?

In the case, for example, of the outbreak or not of an international health emergency, it is a committee ad hoc, “Emergency comity”, which rules. It is not a permanent body. “It meets at the request of the Director General of WHO and is made up of subject experts (because we are talking about a virus but it may be an environmental or nuclear problem, for example), come from several countries and several disciplines. It must include specialists from the country of origin of the problem, “explains Anne Sénéquier.

In this case, by nature, the health emergency was not triggered for the new coronavirus at the start of the week after a close vote. “Opinions can be divided or consensual and inform the decision of the CEO. That there is pressure and controversy is also part of the epidemic emergence. There is nothing very surprising or very abnormal, says Antoine Flahault. It turns out that the country affected by this possible public health emergency is a powerful country in the world since it is China. Maybe his voice will be heard more. “

Are WHO decisions tainted by diplomacy?

Antoine Flahault insists with 20 minutes on the eminently political character of any international institution. Who does not seem to him illegitimate: “The consequences of a public health emergency of international scope are significant and go beyond health. The countries concerned by the application of this instrument of international health regulations make their arguments heard. “

And alliance systems exist, confirms the Geneva university: “There is the Commonwealth which is an alliance, La Francophonie is another, there are also the countries aligned with the United States, NATO, the countries of the former Eastern bloc are also sometimes organized … Linguistic alliances are important: like russophonie. But China also clearly has a pool of influence. “

Without completely denying that there are power relations within the organization, Anne Sénéquier judges that these questions do not interfere with decisions “at this level and under these conditions”. “There are undoubtedly things to improve on transparency for example, but we are talking about experts in the field, scientists. It is in China’s interest to cooperate and indeed it does. “Today’s questions are more technical and scientific than political,” says Antoine Flahault, who fully understands WHO’s current choice.

Concretely, what does this mean, a global health emergency?

It’s a fairly new mechanism. Which is included in one of the rare international treaties on health: the International health regulation, which dates from 2005. “It was after the episode of SARS that it was deemed necessary to change methods, recalls Anne Sénéquier. It was first established in 2009 for the H1N1 epidemic. It was also for Ebola, the last time in 2018 in the Democratic Republic of the Congo. “

“It gives WHO the opportunity to edit recommendations,” explains Antoine Flahault. But these are not binding international laws. However, but everyone knows that it’s difficult not to follow them. The WHO is not going to nail the planes to the ground, it is going to say “we recommend not to leave this or that place any more”. These recommendations will have a strong impact because the treaty on international health regulations is still binding: the signatory countries are committed to respecting them. But therefore, they can violate it and when that is the case the WHO can say “this country has not followed our recommendations”. “

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