Trump's WHO threat sparks debate on the efficiency of global health governance

News reports about Donald Trump’s transition team working towards pulling the US out of the World Health Organisation has again put the spotlight on the WHO. In 2020 Trump initiated the process to leave the WHO alleging the organization’s deference to China, but the process was not finished as his successor Joe Biden restarted relations with the agency. Over the decades, the WHO’s remit has expanded from its original focus on women’s and children’s health, nutrition, sanitation, and fighting malaria and tuberculosis. Today, the WHO monitors and coordinates activities concerning many health-related issues, including genetically modified foods, climate change, tobacco and drug use, and road safety. 

The UN agency has garnered criticism for its response to international public health crises, including the COVID-19 pandemic. International committees found the inefficiency of WHO in declaring Covid as a Public Health Emergency of International Concern (PHEIC) for months, which led to a hefty toll worldwide in terms of mortality and morbidity. The WHO also failed to ensure travel bans and enforcement of International Health Regulations to contain COVID-19 worldwide. 

Global tobacco use is another healthcare crisis that has not seen a solution in over two decades. The prescribed approach by the WHO has not been successful in achieving the cessation rates that were envisioned while drafting the WHO’s Framework Convention on Tobacco Control (FCTC). Experts argue that harm reduction is the missing piece in WHO’s approach to tobacco control. 

In an article published by the Lancet, former WHO Directors Robert Beaglehole and Ruth Bonita said, “Harm reduction is a successful public health strategy for global tobacco control efforts. It should be a central strategy in FCTC. WHO's lack of endorsement of tobacco harm reduction strategies limits healthier choices for the 1.3 billion people globally who smoke and who are at an increased risk of early death. There is no scientific justification for WHO’s position that less harmful alternatives should be treated the same way as tobacco products, ignoring a risk-proportionate approach”.

While the WHO FCTC has been influential in encouraging a global response to tobacco control, it does not include any safer alternatives to tobacco, overlooking reduced risk solutions. It leaves it up to countries to decide how to regulate e-cigarettes and novel nicotine alternatives.

It has also been challenging to show a strong and consistent association between implementation of FCTC measures and smoking prevalence. On the contrary, the US FDA approves certain categories of safer alternatives based on scientific data. In countries like New Zealand, the prevalence of adult daily smoking plummeted from 13.3 per cent in 2017-18 to 6.8% in 2022-23 after e-cigarettes became widely available, a 49% decline in 5 years. The substantial decline in smoking consumption in Japan is associated with the rapid uptake of products that heat, rather than burn tobacco. WHO’s lack of endorsement for tobacco harm reduction is limiting healthier choices for the 1.3 billion people who smoke annually and are at an increased risk of early death. 

The objectives of WHO must be redefined to match the aspirations of global citizens, which is essential to make life better across countries. Further, the organisation must tackle the issues of politics and economics to implement various health programs as per the scientific requirement for health and well-being.