The WHO in the limelight: squaring a triangle of science, politics and policy in global health emergencies by Dr Cleo Davies

WHO logo on their Geneva HQ
photo by Mattia Panciroli

After the SARS outbreak in 2002-2004, the 2009 flu pandemic, and Ebola in 2014-2016, the World Health Organization (WHO) is back in the limelight due to Covid-19. The organization and its work in coordinating global health policies and emergencies is being called into question. At the heart of these challenges are controversies between science and politics and a debate on how to ensure that the organization’s decisions and policy responses are informed by scientific evidence, not political considerations. The current controversy around the WHO is an illustrative example of the role of national and international expert organisations in relation to ‘evidence-based policy’. Whose evidence is drawn on?  How?  Why?  And what are the consequences?

Calls for reforming the WHO

On the 15th of May, the Wall Street Journal (WSJ) online editorial went some way in endorsing the Trump administration’s line for limiting the role of the WHO. It argued for making it a “a lean and effective agency”. It even suggested to create a new one on the model of Interpol if reforms fail. At the other end of the debate, Professor Jennifer Prah Ruger, Amartya Sen professor of health equity, economics and policy at the University of Pennsylvania, argues for strengthening the WHO by increasing its independence from its member states. In an opinion piece published in the Financial Times (FT) on the 6th of May, she calls for “bigger and more sustainable funding” and, rather enigmatically, an “uncoupling of science and politics… to restore the WHO’s scientific credibility”.

A third position is articulated by Dr Ike Anya of EpiAfric and Nigeria HealthWatch in his response letter in the FT on 10th May to Professor Prah Ruger’s opinion piece. He points out that the WHO is in a Catch-22 position: “it derives its powers and funding from member states even as it is supposed to independently assess their actions and inactions”. He suggests we learn to live with what it can deliver in a form of pragmatic status-quo. This rather sobering observation does seem to resonate with the complexities and contradictions of organizational action. There may be no silver bullets. International organizations and what they do are only one part of “what makes the world hand together” to borrow John Ruggie’s turn of phrase to describe theorists’ endeavours to qualify international relations.

But status-quo is politically difficult, even untenable – decision-makers world-wide are under pressure to be seen to be taking action. And they are turning to the WHO for scientific guidance on the policy directions to take. Furthermore, transboundary crises require new forms of governance management, in which the WHO has an essential role to play.

Power-maximizing mandarins or a compromised organization?

The views expressed in the FT and WSJ are concerned with how politics shape the WHO’s actions. They put forward different and opposing ways to increase efficiency and insulate the organization from (illegitimate) political interference: the first by curbing the political ambitions of the “WHO mandarins who naturally try to expand their writ” and making it focus on the tasks assigned by its member states; and the second by elevating it further to independence, transforming it into a paragon of scientifically driven decision-making.

Both positions are reflected in two of the main approaches to studying international organizations in international relations: principal-agent approaches to delegation (Hawkins et al. 2006) on the one hand; and approaches that view international organizations as normative powers that derive legitimate authority from their embodiment of rational-legal norms and expertise (Barnett and Finnemore 2004).

There is empirical evidence of mission creep, of organizations expanding into remits that were not originally their brief. But reducing international organizations to bureaucrats seeking to expand their power is, at best, only a partial story of what they do. And this view doesn’t attend to the much wider accountability networks in which they operate.

Turning to the second line of reasoning, Professor Prah Ruger writes that the “WHO today is a compromised institution… but the world needs a reformed WHO, that puts science before politics.” This resonates with the more normative stance that runs through assumptions about the role and legitimacy basis of international organizations. If behaviour deviates from norms of neutrality and expertise, organizations are considered pathological or hypocritical (Weaver 2008). This literature does attend to the normative powers of international organizations; but it tends to downplay the vulnerability of organizations such as the WHO. Their legitimacy and actions are persistently called into question, whether from the perspective of member states or on a normative basis.

The emerging public administration scholarship on international organizations offers some conceptual insights into how these organizations are characterized by inbuilt tensions, acting according to different behavioural roles (Trondal et al. 2010). They derive legitimacy from being accountable to the member states as well as being neutral expert organizations. These tensions play out in the internal policy-making and decision-making processes, and notably in distinguishing the scientific from the political.

Can science and politics really be uncoupled in policy?

Scholarship on the WHO and pandemics has highlighted how scientific uncertainty is integral to the experience of infectious disease and their management. Indeed, declaring a pandemic has become a political exercise in itself, with the WHO potentially adjusting its behaviour as much to political reactions to its management of previous global health emergencies or to the need to be seen to be taking action in a context of uncertain knowledge. Furthermore, translating science and expertise into policy is not a straightforward process; it is mediated by the practices and cultures in which it is produced (Littoz-Monnet 2017). And decision-making inherently entails a political dimension not only because science can be uncertain, but also because crisis response measures invariably have distributional consequences.

The debate about reforms to the WHO is set to continue

Back in 2016, an independent panel report on the WHO’s response to the Ebola crisis concluded that “the WHO does not currently possess the capacity or organizational culture to deliver a full emergency public health response.” Not only did this point to budgetary and institutional capacity, it also highlighted the limitations of the WHO bureaucratic culture. Covid-19 puts the issue of WHO reform back in the limelight.

Any reforms to the WHO will involve the member states and discussions on the objectives, mandate and the budget of the organization. But analysing the WHO as a site of production of science and expertise should feed into internal reviews and independent panels on assessing the processes and procedures to support improved decision-making and policy-making.

Furthermore, as reforms are devised and rolled-out in the WHO, properly understanding its specific organizational characteristics and cultures is surely needed to for any reflection on potential uptake of reforms. This points to the growing scholarship on international organizations that draws from public administration and organizational studies. It calls for work on how the WHO makes sense of the different and often conflicting role expectations that pervade its environment.

Dr Cleo Davies can be found on Twitter as: @CleoDavies2