The WHO Can No Longer be the Vanguard of Public Health

Much criticism has been levied against the WHO for the “egregious failure” that was their handling of the Ebola epidemic in Africa. Many experts have since claimed the WHO’s follow up response to Zika in Brazil represents the realization and swift change the WHO took to better handle international medical crises. However, both experiences demonstrate the same level of member state politics that cannot be allowed to determine international public safety. The WHO should not be considered the vanguard of public health, and more authority and funding should be placed in the hands of humanitarian NGOs on the ground, with the WHO acting as an international liaison and support structure.

To claim that the WHO has taken lessons learned from the Ebola outbreak and applied them to the Zika outbreak is misguided; the issues are so completely different it is wrong to compare them. Those affected with Ebola immediately begin experiencing violent flu like symptoms with a high mortality rate. Zika on the other hand, presents with relatively mild symptoms and has a very low mortality rate. In some ways, this makes Zika more insidious, as the infection can spread far and wide without raising any alarm. Ebola on the other hand, has a tendency to burn itself out historically, due to the rapid death toll decimating populations before it can spread far. Medically, they are two completely different monsters, and comparing them is fruitless.

The other issue, even if they were medically comparable, the autonomy granted to regional WHO offices means it is no surprise there was a very different response in Africa and South America. The way the local WHO offices operate is strikingly different, and is not representative of any major institutional changes to the WHO on global scale. Epidemics are not just medical events, but also political events. As an international organization made up of member states, the WHO is subject to politically based funding issues and organizational pressures. When an outbreak happens, the location (rural area in poor state vs. urban area in wealthy state) as well as the medical perception (violent symptoms killing young adults vs. quiet symptoms maiming the elderly) factor into the political response of the world community and member states. A political organization can not respond to a politicized event in an unbiased professional manner, expecting that is idealistic.

The fact that so many died in Africa until Ebola cropped up in western countries before a world response was initiated, but when a few died of Zika in Brazil where the wealthy of the world would soon gather for the Olympics garnered immediate international attention, demonstrates just how determined by politics any response by international organizations made up of member states is. Alternatively, Médecins Sans Frontières, a humanitarian NGO, responded to Ebola with immediate action and attempted to alert the international community long before the crisis reached its peak. Removing politics from world health emergencies allows for a much more level-headed response that isn’t bogged down by bureaucracy.

It is unlikely the WHO will be able to restructure itself in a manner that it can respond much more appropriately to medical emergencies any time soon. One of the biggest impediments to this is the “vicious cycle” the WHO is trapped within, where it receives very little funding due to a lack of confidence from member states, and it cannot regain the confidence of said states without a massive increase in funding and autonomy. Even if the WHO does manage to secure the necessary funding, restructure its organization and operational responses, and successfully respond apolitically to a future public health emergency, there is no guarantee it will continue to in the future. The nature of any international organization that is made up of member states that must continuously approve the budget, provide funding, and resist the temptation to interfere politically, will go through cycles of excellence and ineptitude. There have been many other successes and failures by the WHO in the past, the recent Ebola and Zika issues are nothing new.

Expecting a politicized international organization to be the vanguard of public health the world over is setting the international community up for disaster. Humanitarian organizations like Médecins Sans Frontières have shown that it is possible for an international organization to respond effectively and appropriately; their inability to combat Ebola was because they had to rely on the WHO to sound the alarm and secure international support. These humanitarian organization need to be given much more credence and authority, as well as secured more funding. The WHO can play an important role in coordinating different NGOs and acting as a liaison between them and the international community, providing resources, information, and funding. It is unwise to put all of humanities eggs in one basket, expecting the WHO to always be there to step in and save the day.

Considering the ICC and R2P in the Long Run

It’s easy to criticize the International Criminal Court (ICC) and the doctrine of The Responsibility to Protect (R2P). They have each been heralded as a transformation in the international community on behalf of human rights. They have each fallen short of their enormous expectations. It’s important however, that we consider their place in the long run, their utility for gradually changing norms, and the foundation they have set for the distant future.

Despite the ICC being created as the first permanent international criminal court “participating in the global fight to end impunity” it has investigated and prosecuted cases almost exclusively in Africa, accused of ignoring individuals committing crimes against humanity in other regions of the world. David Bosco argues that this is not so much a bias against Africa, but a fear of entering into geopolitical quagmires that may provoke the US, China, or Russia. Regardless, the ICC has been called out as a tool of Western neocolonialism in Africa, and member states have begun the process of pulling out of the ICC. In response, the ICC has attempted to extract itself from trying cases in Africa referred to it by nation states, and has begun to engage with violations of human rights outside of war on behalf of victim groups, such as the land-grabbing in Cambodia that has resulted in forced relocation, illegal imprisonment, and murder.

Many fear that this is a mistake, and will only increasingly antagonize the global south and reduce state membership. David Bosco writes regarding the ICC once again, that the ICC may be “crumbling before our eyes” and worries that the withdrawal of some prominent members such as South Africa will leave the court a shell of its form self. He’s hopeful that the ICC will remain an institution, but that it will have a “much more limited role in international politics than its founder has imagined.” However, should the goal of the court be engaged in international politics? A judicial branch of government is typically expected to be as apolitical as possible, deriving its authority from law, accepting cases from lower courts, not states and politicians.

Kirsten Ainley of the London School of Economics sees this as the best opportunity for the ICC to grow and evolve into an independent institution. If the UN Security Council provided more cases and support for the ICC, it would constantly be dragged into political nightmares and inevitably be used as a tool by those states in power. Instead, it now has the opportunity to refocus its efforts, such as on “building and policing national justice systems” which will have a greater and more lasting impact than targeting politically controversial individuals. By working with national courts through council and support, and acting as an advocate for victims, the ICC will shape international norms and extend the rule of law. These norms have already begun to take hold, as states threatening to exit the ICC have faced massive backlash both domestically and from organizations such as Human Rights Watch lambasting these efforts in South Africa and Burundi.

The R2P is discussed disproportionately in light of its failures rather than its effect on international norms, expectations, and discussions as well. Some claim outright that R2P has completely failed as a result of its reliance on the UNSC for being enacted. Others have gone so far as to call R2P a threat to the international system’s legitimacy predicting its final death after the invasion in Libya. Alex Bellamy, Director of the Asia Pacific Centre for the Responsibility to Protect, insists that despite past invasions in the Middle East that have only made things worse, efforts to enact R2P in Syria against the Islamic State should be redoubled. He goes onto say later that R2P has not failed, but that the international community itself has failed to commit to “a disarmingly simple principle.”

Kirsten Ainley instead argues that “there are at present no feasible pathways to reform” and efforts to strengthen or clarify will only antagonize states opposed to its interventionist nature and its threats towards national sovereignty. She hopes that the ICC and R2P as complementary systems will be allowed to change slowly and gradually, not forced to fix the world’s problems in their infancy.

Both the ICC and the R2P are completely reshaping the way states, international organizations, transnational corporations, and individual actors are discussing issues of human rights. Even in their failures they have given us a vocabulary with which to wrestle with these ideas, and expectations for the direction the international community is heading towards. Instead of discussing whether the ICC and R2P have failed, we should appreciate their subtle and steady influence, and imagine how they will shape the distant future, when they may have a very different presence in the world.