WHO: the world’s most powerful international organisation? Lai-Ha Chan In light of the outbreaks of Severe Acute Respiratory Syndrome (SARS) in 2003 and the recent A/H1N1(swine influenza), this article argues that the World Health Organization (WHO) is growing to be the most powerful international organisationd even more influential than the United Nations (UN) Security Council. ‘Power ’ here is defined as the ability to perform and act effectively to get a desired outcome. THE ABILITY TO PERFORM: WHO VERSUS UN SECURITY COUNCIL The WHO has myriad functions. One of them is on providing advice on health policy to its member states. Although the UN is the largest intergovernmental organisation and serves as the progenitor of most UN agencies, the veto power vested in the five permanent members of its Security Council often hinders its decision-making. In contrast, no country can veto the WHO’s decisions to issue health advisories. Even UN Security Council permanent members bow to pressure from the WHO as soon as it issues emergency travel advisories. China’s evolving relationship with the WHO provides an instructive example. In the first several months of the SARS outbreak, China denied and downplayed the severity of the disease. In early 2003, it even obstructed the entry of the WHO assess- ment teams into the country for investi- gation of the source of the virus. As soon as evidence mounted that SARS was spreading to various areas around the world, the Beijing Office of the WHO informed the Chinese government on 1 April 2003 that it would issue that day a travel advisory against unnecessary travel to its southern province of Guangdong. This was the first time that China experienced the prowess of this health organisation. Without China’s prior consent, the organisation announced travel advisory and the finger was pointing directly at China. Once China was put under the global spotlight, it swiftly altered its stance on the outbreak. Not only did it grant the WHO delegation entry into Beijing for investigation but also become more cooperative and transparent in releasing information about the disease in the country. This example shows that the WHO does have the ability to act effectively in pushing its member states to comply with the International Health Regulations, even if that very same country has veto power in the UN Security Council. THE DEGREE OF INFLUENCE: THE POWER OF WHO’S ADVISORIES The WHO’s advisories have proved to be remarkably influential during the SARS and the recent A/H1N1 outbreaks. As soon as the WHO declares a disease to be a global pandemic or having the potential to become a global pandemic, member countries strive hard to follow its directives. In the SARS outbreak, China was ostracised by the international community as a result of the WHO’s advisories. Chinese citizens, including Hong Kong residents, were barred from entering several countries or were forcibly quarantined for days upon arrival. 1 In some cases, governments even overreacted to the WHO’s advice and took extreme measures to prevent an outbreak in their countries. Examples include Egypt’s mass slaughter of pigs at the beginning of the A/H1N1 outbreak; Singapore, Hong Kong and China took a similar isolation strategy to quarantine anyone tested positive with the virus or had close contact with those affected. 2 3 Even the mayor of New Orleans, USA, Ray Nagin, his wife and their security guard, who showed little symptoms of the disease, were also under quarantine on 7 June 2009 after one of the passengers in their flight from New Jersey to Shanghai was diagnosed with swine flu. 45 Perhaps the dreadful effect the SARS outbreak created 6 years ago taught the world a lesson that no countries would ever forget. They now tend to follow closely WHO advices. There are a number of concurrent factors that are contributing to the WHO’s remarkable and rising international influence. First, unlike the International Monetary Fund, World Bank, World Trade Organization and G8, the WHO does not suffer any legitimacy crisis. Between 1994 when the IMF and World Bank celebrated their 50 th anniversary and 2001 when a G8 meeting was held in Genoa, Italy, several large-scale international anti-globalisation protests were held at the scenes of the meetings. In contrast, the holding of annual World Health Assembly which governs the WHO has not been mired in anti-neoliberalism movement. Second, as a functional organisation that can avoid complex, competing political matters, the WHO has the power to issue advisories on the basis of available scientific data. Third, unlike the Security Council, it is not required to enforce its decisions rigorously, but instead uses shaming tactics to prompt self-regulation among states. Fourth, glob- alisation, which promotes transnational movement of goods and people, continues apace, states are presented with a new agenda of non-traditional security threats which they cannot, however, successfully address unilaterally. Pandemics are a typical example of these non-traditional security threats. It has now become a global norm that all states are obliged to cooperate with each other under a global institution to prevent the global spread of contagious diseases. The regional or global outbreaks of new and deadly viruses such as SARS, H5N1 and A/H1N1 in recent years, to which many humans do not have immunity, enhance the authority of the WHO, as it becomes a global hub of infor- mation and advices and of coordinating medical research. In the internet age, any attempts to hide outbreaks of infectious diseases from the public not only prove futile but are also bound to backfire. The fear of being isolated by other countries and the desire to protect well-earned or newly established international reputation induce all states to comply with the International Health Regulations. 6 While the global discourse on disease transmission makes states no longer afford to evade WHO advices, a new challenge is that some states tend to over-react to WHO directives when confronted with an uncertain, but poten- tially virulent, virus, believing that it would be better to err on the side of caution. Competing interests None. Provenance and peer review Not commissioned; externally peer reviewed. J Epidemiol Community Health 2010;64:97e98. doi:10.1136/jech.2009.094862 Correspondence to Dr Lai-Ha Chan, Postdoctoral Research Fellow, China Research Centre, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia; Lai-Ha.Chan@uts.edu.au J Epidemiol Community Health February 2010 Vol 64 No 2 97 Editorial