Being an international organisation whose aim is to advise all the countries in the world is very difficult. But, as I suggested on Monday, this is what the WHO is trying to do for health and health care – and it’s truly hard. But if many of those countries have a very different understanding of what they mean by health – it becomes harder still.
For some countries in the world, health care is exemplified by some of the highest of high-tech. For nearly 10 weeks the Covid crisis was represented by the media as being about wards full of high-tech equipment helping very sick people stay alive. Other countries had similar experiences of anxiously counting their ventilators and feeling that technology was the front line against Covid.
By contrast the other front line against Covid consisted of human behaviour and decidedly low tech. Washing hands, simple masks, keeping 2 metres apart from non-household people and staying indoors. The reason the high-tech wasn’t overwhelmed was that millions of people engaged, as a normal part of their everyday lives, with new behaviours and low tech solutions .
Most people in the UK see the NHS as being about the first of these two scenarios. But even with all that high technology, the Covid crisis has shown that most health care is about low tech human behaviour.
It is the job of the WHO to try and organise these very different views of what counts as health care into one international organisation. WHO creates one vision from completely different national views of what counts as health and health care.
BOTH of these – low and high-tech – are very important. In Sierra Leone’s Ebola crisis, important high-tech diagnostic labs were vital. But the roads over which the tests were carried to the labs were so bad that many of the test tubes broke and the tests could not happen. High-tech labs were vital, but without a road system to get the samples to the labs they weren’t much use.
I make these points to underline how difficult it is for a single international organisation to bring all these things together into one vision. When confronted by a major health problem such as Covid, those of us in the developed world look to a magic high-tech solution to get us out of it. A new vaccine. A new therapeutic drug. These expectations are understandable in a world where cancer is being beaten back with ever more effective high-tech interventions.
But we also live in world where, despite cancer being beaten by miracle tech, people still smoke and many of us are still overweight. But that’s not what we see as health care.
WHO covers all of that and more. And the 2020 WHO that is finding its way through this crisis is different from what existed previously . The current Director General, Dr Tedros Adhanom Ghebreyesus, is different from his predecessors in a number of ways. He is the first black director general; he is not a medical doctor, and he is the first African Director General. A few days ago[1] he drew 5 lessons from the crisis,
“Although a vaccine will be an important long-term tool for controlling COVID-19 there are five priorities that every single country must focus on now to save lives now.
First, empower communities. Every individual must understand that they are not helpless. There are things everyone should do to protect themselves and others. Your health is in your hands. That includes physical distancing, hand hygiene, covering coughs, staying home if you feel sick, wearing masks when appropriate and only sharing information from reliable sources.
Second, suppress transmission. The single most important intervention for breaking chains of transmission is not necessarily high-tech and can be carried out by a broad range of professionals. It’s tracing and quarantining contacts. Many countries actually have used non-health- professionals to do contact tracing.
Third, save lives. Early identification and clinical care saves lives. Paying special attention to high-risk groups including elderly people in long-term care facilities saves lives.
Japan has done this. It has one of the highest populations of elderly people but its death rate is low and the reason is what we just said. Many countries can do that; they can save lives.
Fourth, accelerate research.
Fifth, political leadership; as we have said repeatedly, national unity and global solidarity are essential to implementing a comprehensive strategy to suppress transmission, save lives and minimise the social and economic impact of the virus. No matter what stage a country is at these five priorities, if acted on consistently and coherently, can turn the tide.”
Having written a large number of posts about the Covid crisis, I find it completely humbling to think how difficult it must be to craft a message for every government in the world, advising them on what to do. To talk at the same time to Botswana, Belgium and Bangladesh and to say something that is sensible to each. That’s hard.
And I also think you have to recognise that some governments will just not listen. A number of leaders have found the Covid crisis all so difficult that they are desperate for this to be over. They wanted it over in late March. So every few weeks you hear them say “we are over the worst”. I don’t see many of them learning any lessons from the WHO about what to do now.
For many other governments the notion of really ‘empowering communities’ mentioned above is anathema to the way in which they see the relationship between their government and the people.
Many other countries genuinely think they have done these things – for example they may think they have “put a protective ring around residential homes” as is suggested above – but the death rates show they haven’t.
Once more we are back to the political fact that national governments have the power to ignore what international governance advise them to do.
But as a result of the Covid crisis, in many of the countries where leaders can ignore what the WHO says there are many more people who feel that it makes more sense than their national government.
For three months WHO representatives have been talking a lot of sense about what to do on national news. Very often there’s has been some distance between what they have been advising and what national Governments have done.
Looking back we could have organised a clear platform to argue for the WHO position. Looking back that could have been organised across a number of countries.
Looking forward we all need to start to think about how to do this in the future.
I don’t think that there will be a dramatic increase in the number of national governments taking advice from an international organisation such as the WHO. But that doesn’t mean there should not be a series of national movements within (and between) countries that take its advice seriously and represent that health position against reluctant national governments.
So next time this disaster strikes I’d recommend a series of national civil society organisations under the banner of “What would WHO do?” Their job will, in the absence of sensible government action, be to argue for actions based on the WHO advice and to stand up for better, more honest interventions.
Not so much a new WHO but a recognition that national movements may have much more chance of influencing national governments than an international governance organisation itself.