Intended for healthcare professionals


Global rules for global health: why we need an independent, impartial WHO

BMJ 2014; 348 doi: (Published 18 June 2014) Cite this as: BMJ 2014;348:g3841
  1. Devi Sridhar, senior lecturer12,
  2. J Frenk, dean3,
  3. L Gostin, professor4,
  4. S Moon, lecturer3
  1. 1Centre for Population Health Sciences, Edinburgh University, Edinburgh EH8 9LD, UK
  2. 2Blavatnik School of Government, University of Oxford, Oxford, UK
  3. 3Harvard Global Health Institute, Harvard School of Public Health, Boston, MA, USA
  4. 4O’Neill Institute for Global and National Health Law, Georgetown University, Washington, DC, USA
  1. Correspondence to: D Sridhar devi.sridhar{at}

Devi Sridhar and colleagues argue that WHO’s unique political legitimacy makes it essential to achieving international action on global health and call for governments to re-establish guaranteed core funding

Over the past few years the World Health Organization (WHO) has been undergoing substantial reform. The immediate trigger was a budget crisis in 2010 that spurred massive staff cuts. But at a more fundamental level, deeper systematic changes in global health governance have made reform imperative.1 Though WHO reform draws relatively little attention outside diplomatic circles in Geneva, at stake are critical concerns that will affect public health everywhere.

The essential role of WHO is most often appreciated when outbreaks of infectious disease cross borders, such as the newly identified Middle East respiratory syndrome (MERS) coronavirus, which has infected 636 people since 2012 and has a death rate of about one in three.2 With an increasing number of cases being reported, fears exist that it could infect thousands of people, similar to the SARS (severe acute respiratory syndrome) coronavirus in 2002-03.3

The international response to MERS has been more rapid than to SARS at least partly because of global structures that have facilitated epidemiological assessment, international information sharing, and the development of potential treatments. In an increasingly interconnected and interdependent world, global rules negotiated among governments are crucial for facilitating international cooperation and for protecting the health of the world’s population. Sometimes adhering to these rules requires governments to forgo some of their sovereignty and to trust an international organisation to act impartially and independently for the common good. One of the fundamental reasons for the creation of WHO in 1948 was to ensure that governments would “compromise their short-term differences in order to attain the long-run advantages of regularized collaboration on health matters.”4

Although many global …

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