by David Bell and Toby Green
The World Health Organization (WHO) emerged from the ashes of World War II as a global institution which aimed to provide access to good health for all, regardless of socioeconomic status. This understanding of health was holistic, and included physical, mental and social well-being. The Alma Ata Declaration of 1978 reaffirmed these principles, enshrining community-based healthcare as at the core of decision-making.
Since 2000, however, WHO [AA1] has become increasingly dependent on private foundations and pharmaceutical companies for funding. As their influence has grown, the balance of power has shifted away from populations, represented by nation states.
This has coincided with a growing reliance on vaccine-based strategies to treat viral outbreaks, as seen in 2005, 2009, and most radically in 2020 with SARS-CoV-2. WHO amended definition of pandemics in 2009, enabling the promulgation of top-down policies including lockdowns in early 2020, contrary to its own guidelines published just months earlier. Unprecedented mass vaccination programmes followed, facilitated by an arbitrary change in the definition of ‘herd immunity’ that contradicted accepted immunological principles.
This top-down approach represents an abandonment of the community-based healthcare principles enshrined in the Alma Ata Declaration and in the founding charter of WHO. History has come full circle, with the current approach to global health resembling the sanitation measures of the 19th century, which were designed to protect the rich in the ‘Global North’ at the expense of populations elsewhere. We are witnessing a return to the inequalities of the colonialist approach that the post-war charter of WHO had sought to extinguish. COVID-19 has brought the growing contradictions within WHO to a head. Will global health policy continue to be controlled by a small cabal of wealthy countries, corporations and individuals, or will the principles of equality and personal autonomy prevail, returning power to the hands of the populations whom WHO was established to serve? The health of most of humanity – mental, physical and social – will depend on the outcome.
David is a clinical and public health physician with a PhD in population health and background in internal medicine, modelling and epidemiology of infectious disease. He was Director of the Global Health Technologies at Intellectual Ventures Global Good Fund in the USA, Program Head for Malaria and Acute Febrile Disease at FIND in Geneva, and coordinated malaria diagnostics strategy with the WHO.
Toby Green is a professor of African History at King’s College, London. His 2019 book A Fistful of Shells won a number of international literary awards. He is the author of The Covid Consensus: The New Politics of Global Inequality (Hurst & Co/OUP).
COVAX looks set to continue the remarkable spate of destruction to livelihoods, human rights and future health prospects resulting from lockdowns against COVID-19 across much of the globe.