Opinionista Ivo Vegter 31 May 2018

Bring the World Health Organisation to heel

The World Health Organisation has many laudable achievements under its belt. However, it has grown fat, lazy and ineffective. It tries to legislate individual lifestyles, scares people unnecessarily about cancer, and excludes people on political grounds.

If the World Health Organisation (WHO) were a country, it would be the richest per capita in the world. Its most recent financial statements are for 2016 (which is itself worrying for a publicly-funded organisation in mid-2018), but in that year its staff costs amounted to $910-million, or about 37% of its total expenses.

Divvied up among its 7,000 employees, that works out to an average of $130,000 (R1.64-million) per employee, which is more than the per-capita GDP of any country listed by the International Monetary Fund or the World Bank.

It spent about $200-million on travel in 2016, which, according to its biennial project budget, is more than it spends per year on HIV/Aids, hepatitis, malaria and tuberculosis combined. That works out to an average annual travel budget per employee of $28,500 (R360,000). Per employee. Just on travel. And in 2015, it spent even more.

According to reports based on leaked internal documents, former director-general Margaret Chan spent $370,000 flying first class and staying in presidential suites. It won’t come as a surprise to learn that WHO gatherings are frequently held at luxury resorts in exotic locations.

It has become a hive of fat cats, living off the taxpayers of rich countries, trying to impose socialism on the world’s poor. It needs to be brought to heel.

The WHO has its roots in a series of sanitary conventions, held between 1851 and 1938, to develop a joint international response to various communicable diseases, including cholera, plague, typhus and smallpox. After World War II, these efforts were combined under the newly-formed United Nations, in 1948, with a mandate to combat communicable diseases including venereal disease, improve maternal and child health, improve nutrition and improve environmental hygiene.

The benefit of international co-operation in fighting communicable diseases is self-evident. Disease transmission knows no borders, so neither should efforts to fight disease. The success of this approach is demonstrated by the extraordinary successes of the WHO over the years.

Its stand-out achievement was the eradication of smallpox, proposed in 1958 by the USSR, and achieved by 1977, when the last case was reported in Somalia. In 1980, the disease was declared eradicated, and it was recommended that smallpox vaccinations be halted.

Against many other diseases, like yellow fever, syphilis and leprosy, the WHO has been very effective. It has also been instrumental in promoting childhood vaccination against killer diseases such as diphtheria, pertussis, tetanus, measles, poliomyelitis, and tuberculosis, which has resulted in a dramatic decline in the incidence of these diseases worldwide.

However, as its budget ballooned from its original $5-million to $2.2-billion, the organisation has grown sclerotic, and its activities have become ever broader. Its project areas now include noncommunicable diseases, mental health and substance abuse, violence and injuries, disabilities and rehabilitation, ageing, the social determinants of health, equity, gender equality and human rights, national health policies, integrated people-centred health services, and strengthening regulatory capacity.

As its mandate has expanded, its effectiveness has declined. The WHO’s International Agency for Research on Cancer, whose most high-profile work involves evaluating other people’s cancer research, has been emblematic of the problems that beset the organisation.

Its way of determining whether substances are potentially carcinogenic is fundamentally misleading, and entirely unhelpful in the fight against cancer. All it does is encourage ineffective but costly regulatory measures to supposedly “protect” people from risks that often don’t even exist. Of the more than 1,000 substances evaluated, only one emerged in the IARC’s analysis as “probably not carcinogenic”.

The critical flaw in the IARC’s methology is that it merely evaluates whether evidence exists, not what the absolute risk is. For instance, it ruled cellphone radiation to be potentially carcinogenic. Even assuming it was correct, the slightly increased risk of cancer was minuscule. However, that increase was for only one type of cancer. For all other types of cancer, cellphone use actually corresponded to a decreased risk of cancer. Did it say cellphones cure cancer? Of course not.

The IARC relied on a single, terrible study, riddled with flaws, and then cherry-picked the result it wanted. The only possible motivation for such behaviour is to scare people into funding more studies, or increase funding for the WHO itself.

It repeated its fear-mongering with red and processed meats. Citing evidence that it called limited, it blew up a tiny increase in relative cancer risk into an avalanche of sensational media stories, giving ammunition to groups that seek to control our lives and limit our freedoms.

Similar approaches to other substances ensure a steady stream of chemicals to demonise, ensuring that they get regulated, banned or otherwise restricted, with the inevitable result of raising the costs of producing the food, goods and services that we need to live.

Even in its original mandate of combating communicable diseases and health emergencies, the WHO is failing. During the swine flu pandemic of 2009, its role was limited to fear-mongering, and it mobilised the production of hundreds of millions of vaccine doses, the bulk of which were ultimately destroyed. While conspiracy theories about the WHO being in cahoots with vaccine manufacturers are a little far-fetched, an expert panel was none too flattering about the organisation’s response, and said it was unprepared to deal with a genuinely severe pandemic.

Five years later, its late and ineffectual response to the Ebola crisis in West Africa was also widely slammed. Its own assessment found:

At present, WHO does not have the capacity or organisational culture to deliver a full emergency public health response.”

It claims to support openness and transparency, but its leadership elections are held by secret ballot behind closed doors. News reporters and observers have on several occasions been kicked out of supposed “open sessions” at WHO deliberations, most notably at Framework Convention on Tobacco Control conferences. During one such secret confab, it passed what may well be the world’s first global tax.

Despite its high-profile recent failures on the fairly limited mandate of fighting communicable diseases and pandemics, the WHO’s constitution reveals a far grander ambition.

It defines health extremely broadly, not just as the absence of disease and infirmity, but “a state of complete physical, mental and social well-being”. This is also declared to be a fundamental human right, and is “dependent upon the fullest co-operation of individuals and states”.

It needs almost the entire alphabet (a to v) to list its functions. It declares:

Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.”

This gives the WHO a grand, authoritarian vision, with a clearly socialist ideology. It explicitly promotes universal healthcare in all countries, even though this surely is a political decision that each democratic country must make for itself, based on the ideological views of its people and the prosperity of its fiscus.

Noncommunicable diseases are often called “lifestyle diseases”. To combat them, the WHO not only recommends that people improve their lifestyles, but it wants member governments to require it. It strongly promotes heavy-handed legislation, regulation and taxation. It wants governments to control people’s lifestyles, using the excuse that they know what is best for us.

The WHO wants to see stronger states and socialised healthcare, while at the same time strongly criticising the actions of private philantrophists in the health sector. It clearly doesn’t want anyone else treading on its own turf, or the turf of its member governments.

It is time that the WHO gets a radical shake-up. Its ideology should become much less socialist. Instead of trying to implement universal healthcare systems and impose healthy lifestyles upon everyone, its mandate ought to be restricted to eradicating communicable diseases, helping people to respond to global pandemics and health emergencies, and a few other health issues where international co-operation is really useful.

It should be funded, staffed and structured to be effective at this narrow mandate. Some would say that it should be entirely defunded.

At present, the only thing the WHO seems to be really good at is convincing governments to pass draconian lifestyle laws and taxes, while officials party it up at five-star hotels on tropical beaches. This serves the cause of neither health nor liberty. The WHO ought to be brought to heel. DM

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