Rx for an Ailing Health Agency

After the World Health Organization eradicated smallpox in 1980 with an intensive vaccination campaign, the way seemed clear for the U.N. agency to rid the world of most major contagions. The agency, however, stumbled badly. Today, infectious diseases kill more than 17 million people a year and WHO finds itself under a barrage of criticism.

WHO’s biggest donor, the United States, has not paid its 1997 allotment and still owes money from 1996. Even WHO’s most loyal supporters recently cut their subsidies drastically.

The agency’s 191 member nations are justifiably incensed by its slow response to grave health problems. Its director general, Hiroshi Nakajima, had to be pushed for three years before he agreed in 1995 to start WHO’s division of emerging and communicable diseases. By then, new diseases like Ebola and Lassa fever were well established in some regions.

The WHO delegates are now meeting in Geneva to choose Nakajima’s successor and chart new priorities for the 50-year-old organization. The effectiveness and perhaps survival of the health agency depends on the course they choose.

The delegates’ first task should be installing more critical oversight within the agency. Britain’s National Audit Office concluded in 1995 that bookkeeping in WHO’s Africa operations was so sloppy that “fraudulent transactions [could remain] undetected over long periods.” Another embarrassment is WHO Deputy Director Fernando Antezana, whose claims of holding graduate degrees from Harvard and Stanford were recently exposed as false on television’s “60 Minutes.”

Delegates could help restore WHO’s credibility by selecting former Norwegian Prime Minister Gro Harlem Brundtland as director general in an election to be held Tuesday. Brundtland, a skilled politician with the requisite expertise, hails from outside the U.N. bureaucracy. With strong support from the United Nations’ leadership, she might actually be able to clean house.

WHO’s next director should focus the agency’s limited resources where they are needed most: the developing world. Part of the problem is that developed nations like the United States earmark WHO contributions for diseases they are familiar with, such as AIDS, and give short shrift to malaria. AIDS has claimed an estimated 3.5 million lives over 10 years, but malaria takes 2.7 million lives every year.

WHO, its core budget frozen for the past 15 years, cannot fight all disease everywhere. But it has the budget and basic expertise to challenge rapidly spreading infectious diseases and other health threats in the developing world. Free trade now allows disease organisms to travel swiftly among countries, and the infections of the developing world are often the potential problems of us all.