For more than a year many anti-lockdown campaigners have been scaremongering about a World Health Organisation power-grab entailing new draconian measures in the event of another pandemic. With news that the WHO’s revised International Health Regulations will be much less intrusive than feared, Lee Jones and Shahar Hameiri argue that framing the WHO as the primary threat to democracy and national sovereignty misunderstands the nature of global governance, and misdirects valid criticisms towards intergovernmental organisations – when they should be focused on the catastrophic failings of the governments that shape them.
For the past year and a half there has been a mounting flow of alarmist commentary on the World Health Organization (WHO) from both left- and right-wing critics of lockdown. This was provoked by negotiations to revise the International Health Regulations (IHRs) – which specify how governments should prepare for and react to public health emergencies – and to conclude a ‘pandemic treaty’ designed to avoid a repeat of COVID-19. A year ago, a group of Conservative MPs warned of the WHO’s “ambition… to transition from an advisory organisation to a controlling international authority” that could impose lockdowns on countries. ‘Real Left’ (formerly Left Lockdown Sceptics) likewise accused the WHO of wanting to become “a global monopolistic health authority that wants to override national governments, undermine democratic principles of participation and the people’s mandate”. Campaigners have launched several petitions to parliament to refuse to sign the pandemic treaty unless it is subjected to a referendum, or even to quit the WHO, the latter attracting over 100,000 signatures.
Concerns about the WHO are understandable, in light of its poor record and remote, intergovernmental mode of operation. They resonate with a wider audience concerned with the rise of ‘globalism’ and ‘supranationalism’, often connected with the idea that elites have established some kind of global executive in the form of the World Economic Forum (WEF). Considering how many people experienced the response to COVID-19, this is hardly surprising. Democratic rule was indeed formally suspended in the UK and many other countries. Draconian measures were introduced with exclusive reference to unelected ‘experts’, ‘The Science’ and, occasionally, the WHO. Individuals accountable to no one seemed either to exercise enormous influence over global policymaking (Bill Gates) or to be exploiting the crisis to propose dramatic societal transformations without any popular sanction (Klaus Schwab). With academics, journalists and social media oligarchs overwhelmingly closing ranks with the state, silencing any debate, it is easy to see why many people – understandably baffled, fearful and angry – concluded that lockdown and the coercive campaign to vaccinate the world was some kind of globalist conspiracy.
The truth, however, is rather different. As our research shows, the WHO is actually a rather weak body, hobbled by powerful member-states’ reluctance to fund it adequately and – crucially – governments’ unwillingness to make the public healthcare provisions necessary to protect populations from infectious disease. It played only a marginal role in COVID-19, as states largely ignored its guidance and advice, plunging their societies into lockdowns out of desperate panic, not a coordinated conspiracy. These failings result from domestic governance problems, and it is only by addressing these domestic problems that they will be resolved. Governments and critics alike are aiming at the wrong target when looking for solutions and villains at the global level.
What the WHO is, and what it isn’t
The WHO is an intergovernmental body. It can only do what its member-states let it do – particularly those richer states who provide the vast bulk of its funding through voluntary contributions, thereby dictating its agenda. The WHO is not, therefore, a ‘supranational’ body, i.e. sitting ‘above’ nations and dictating to them. It is a forum in which governments themselves (some of them elected) make global regulations in discussion with each other, rather than in national parliaments, through dialogue among citizens’ representatives. They are supported by a relatively small WHO staff – about 9,000 – who organise meetings and provide technical expertise and advice. In 2019/20, the year COVID-19 broke out, the WHO’s total budget was just $4.8bn, smaller than that of many American hospitals, and less than 40% of the US Centers for Disease Control, for example. The WHO’s 2018/19 budget for emergency response was a meagre $154m. The idea that the WHO can currently compel member-states to do anything, let alone be an embryonic ‘global dictatorship which overrides national sovereignty’ is therefore fanciful.
The basic model of global health governance – like global governance more generally – is not about empowering a supranational authority to ‘lord over states’, but about governments coming together to agree global regulations that they are then supposed to cascade downwards into their domestic settings. The 2005 IHRs are essentially an internationally agreed policy template for domestic public health policies and instruments. They empowered the WHO to conduct disease surveillance, and to declare a ‘public health emergency of international concern’ (PHEIC), which was meant to alert states to activate their domestic agencies to contain disease outbreaks – but that was all. Member-states approved the rules, and it was member-states that were meant to develop the domestic capabilities to detect and contain pandemic diseases to protect their populations – not the WHO.
Critics of the WHO are therefore making the same mistake as Eurosceptics did over the European Union – seeing the EU as a supranational nanny-state, an unelected ‘Brussels bureaucracy’ imposing its rules on hapless member-states. As explained in Taking Control, the book written by the co-editors of The Northern Star, this was simply untrue. The EU was the way that national elites made policy over the heads of citizens, drawing legitimacy and policy direction from their European counterparts, rather than their own peoples, in a post-democratic, neoliberal era. But, as we shall see, in the case of the WHO that did not, in fact, lead to a robust ‘globalist’ policy being implemented domestically. On the contrary, as policymakers drifted away from accountability to their own electors, they failed to develop the capacities mandated by the rules they made through the WHO.
The WHO and COVID-19
Is there any threat that the WHO might evolve into a ‘global dictatorship’, through revised IHRs and a new pandemic treaty? And, if not, what are these developments actually about? To grasp what is happening at the WHO today, we have to understand the limits to the kind of intergovernmental global governance, which were brutally exposed during the COVID-19 pandemic.
Put simply, most states completely failed to develop the capacities necessary to contain and respond to a new pandemic. That is, they declined to implement the rules to which they had ostensibly agreed in 2005. This was well known way before COVID-19. A WHO survey in 2017 – five years after full compliance with the IHRs was required – found that only a tiny handful of states were ‘fully’ compliant. In 2018, another WHO report warned that only a third had the required capabilities. Even this was dubious, since the states ostensibly ‘best prepared’, like the UK and US, were exposed as grossly under-prepared when COVID-19 eventually struck. Sure, there were plenty of strategy documents, policy papers, technocratic benchmarking exercises, and so on. But beneath the façade, decades of neoliberal policy had hollowed-out state capacities. Public health laboratories had been ‘rationalised’, hospital capacity stripped back, and even pandemic equipment stockpiles had been privatised, with crucial items left to expire on warehouse shelves. The WHO had been warning member-states about under-preparedness for years, but was essentially ignored.
Indeed, states continued to ignore the WHO all the way through the pandemic. The 2005 IHRs forbade border closures until a PHEIC is declared, but many states did it anyway. WHO guidance on pandemics also never advocated whole-of-population lockdowns, because the harms of this intervention were (rightly) anticipated to outweigh any putative benefits. Member-states had based their domestic policies off WHO templates, but within weeks of SARS-CoV-2 disease arriving on their shores, most had plunged their countries into lockdowns. Member-states did not even notify the WHO when deviating from the IHRs, which they were also mandated to do.
The truth is that, by the time COVID-19 had spread beyond China, the WHO had no real control over the management of the disease. All expert observers of the WHO agree that global health governance rapidly collapsed into an array of fragmented – and often zero-sum – national responses, exactly what the WHO was designed to avoid. This is precisely why these experts advocated toughened IHRs, in an attempt to force member-states to develop the healthcare capacities that they should have had in the first place. But, as we shall see later, even this has failed.
What about lockdowns?
Now, the sceptics will say: what about the WHO’s endorsements of lockdown? What about its tendency to bad-mouth possible existing treatments while favouring mass vaccination? Insofar as these accusations are true, these are also signs of the WHO’s weakness vis-à-vis member-states.
Most damningly, it is indeed true that the WHO essentially endorsed lockdown, as part of its generally sycophantic praise of the Chinese government. Through December 2019 and January 2020 – while China was still jailing whistleblowers and insisting that there was no evidence of people-to-people transmission – WHO officials were praising China’s ‘transparent’ conduct as ‘very impressive’, ‘incredible’, ‘beyond words’ and ‘setting a new standard for disease response’. The WHO delayed recommendations for airport screening and border closures long beyond when they might have been useful. In late February 2020, the WHO celebrated ‘China’s bold approach’ (to locking-down Wuhan), claiming it had ‘changed the course of a pandemic’ and urged other states to take ‘urgent and aggressive actions’, too. Only in October 2020 did the WHO’s COVID-19 special envoy tell states directly to ‘stop using lockdown as your primary control method’. Even then, most member-states simply ignored the WHO’s recommendation and continued to lock down their populations.
Why did the WHO effectively endorse lockdown – actions that were absolutely not part of the IHRs or any previous WHO policy recommendations? This was not an expression of its strength, but rather of its weakness, especially relative to a now-powerful member-state: China. In 2003, during the outbreak of the Severe Acute Respiratory Syndrome (SARS) epidemic, the WHO was intensely critical of China’s secretive approach. By 2020, a considerably wealthier China was now a major WHO funder and, with President Trump’s suspension of WHO funding, became its single larger financier as President Xi Jinping provided an extra $2bn.
More importantly in the early days of the pandemic, the WHO wanted to avoid alienating China in order to maintain its cooperation. This was precisely because of the WHO’s lack of supranational authority. The WHO has no power to compel member-states to surrender information, to forcibly gather data or inspect facilities, to coerce governments into preparing well for a pandemic, or to compel them to activate those contingencies. The WHO is entirely reliant on member-states’ goodwill to achieve any of this. It lauded China publicly and delayed triggering tougher restrictions in order to maintain and enhance WHO teams’ access to the country. It praised China’s lockdown in order to jolt other, apparently complacent, member-states into taking the situation seriously and activating their emergency systems.
What we subsequently discovered, however, is that those emergency systems largely existed on paper, if at all. The collapse into lockdown primarily occurred not because the WHO commended it, but because most states had failed to build the capacities that would have allowed them to track and contain the disease using less drastic measures. In short, the resort to lockdown was an expression of state failure, coupled with mass and elite panic, not of an over-mighty WHO pressing hapless member-states to lock down against their will. The tiny number of states that had developed better disease surveillance and response systems, like South Korea, were able to avoid lockdown and maintain more of a semblance of normal life. Even some states that were neither so well-prepared nor particularly powerful, like Sweden, demonstrated that it was entirely possible – albeit difficult – to defy the ‘international community’ and chart out one’s own national course.
Hitting the wrong target
Critics of the WHO are therefore looking in the wrong place to vent their (entirely justified) frustration at the appalling mismanagement of the COVID-19 pandemic. The WHO is hardly blameless, but it played at most a minor part throughout. It was not the WHO that was responsible for agreeing the IHRs, then not implementing them, then plunging societies into prolonged and harmful national lockdowns. It was the WHO’s member-states.
For the same reason, those who advocated revisions to the IHR to empower the WHO to compel states to do better in future were also misguided. Their hope – as is typically the case with all advocates of global governance – is that they could empower expert advisors and supranational bodies in order to drive political changes that they otherwise cannot deliver through domestic means. (This is why the moribund British left favoured continued EU membership, for example, seeing it as the only safeguard for workers’ rights, doubting their own capacity to defend them domestically.) Given WHO member-states’ failure to adhere to the old IHRs, global governance advocates believe the WHO should be given ‘enforcement’ powers to push them to comply in future. It is this that gave lockdown opponents conniptions.
However, this quest was always doomed to fail, not least because member-states simply will not give the WHO such powers. If a state wants to enact the IHRs, it will do so without any compulsion, though it may see the case for coercing others – particularly since pandemics are seen to require a coordinated international response to be effective. However, if a state does not want to implement the IHRs – or, more commonly, if it lacks the resources to do so, or there are competing priorities – it will not want to empower a supranational body to force it to do this against its will. Given how few states actually implemented the IHRs, it stands to reason that the appetite for supranational coercion is low; and, since states are legally sovereign and cannot be compelled to sign any international treaty against their wishes, it is highly unlikely that even a bare majority would agree to such changes.
It is arguable that, if richer states were willing to back the ‘stick’ of coercion with the ‘carrot’ of extensive international aid to help build poorer countries’ domestic healthcare capacities, more states could be persuaded. But that is precisely what was never on offer in the negotiations over the IHR revisions or the pandemic treaty. Both sets of negotiations were riven by concerns over ‘equity’, as developing countries – many still reeling from the disastrous economic effects of lockdowns – demanded greater resource transfers from the global north, including aid to build-up healthcare facilities and greater sharing of vaccines and remedies. But wealthy states resolutely stuck to the same neoliberal policy set that they pursued for decades in the run-up to COVID, when they pushed privatisation and offered ‘expertise’ and ‘best practice’ templates rather than supporting the material development of domestic public healthcare, as developing countries had demanded since the 1970s. They refused to commit more resources, rejected proposals to earmark medical supplies for poorer countries or otherwise interfere in global supply chains, and resisted any weakening of intellectual property rights that could allow poorer states to manufacture their own vaccines. Northern states are still defending private property rights as sacred, as if the last four years never happened.
The result is a set of revisions to the IHR which are substantially more modest than WHO critics had imagined. Some present this as a win for their campaigning, but in reality the WHO’s member-states were never going to produce what they imagined. The IHR remain what they always were: a set of mutually-agreed instructions for states to follow, not backed by the resources needed to follow them. Because most of the contentious ‘equity’ concerns were moved out of the ‘technical’ IHR talks into negotiations for the pandemic treaty, that is likely to be an even damper squib. It looks unlikely that the mooted May deadline will be met and negotiations could even collapse in acrimony.
The beam in our own eye
While the WHO negotiations have shown that wealthy states remain disinterested in helping poorer ones develop their substantive healthcare capacities, what COVID-19 primarily revealed is that they cannot apparently be bothered to develop their own healthcare capacities sufficiently – and that has not changed, either. Leading experts tend to agree that Britain is no better prepared to fight a pandemic today than it was in 2020. If anything, it is weaker, since the enormous costs of lockdown – in terms of direct healthcare impacts and the consequences of delayed treatment – have crippled the National Health Service, while massive subsidies to businesses and households – compounded by the costs of the war in Ukraine – have left public finances enduringly weakened.
The controversy around the IHRs and the pandemic treaty ought instead to be controversies about our own states’ internal governance. We ought to be asking ourselves the following questions: Why has healthcare policy increasingly been made through remote, intergovernmental forums like the WHO? Why has the drafting of international and domestic strategies, policy templates and bureaucratic guidelines been substituted for the development of substantive healthcare capacity? Why has existing capacity been steadily hollowed-out, even as our societies age, develop more complex healthcare needs, and become wealthier? Why were our states so complacent in the face of the well-known risks of a pandemic? Which particular capacities did we fail to develop, and why? Why did we fail to hold state officials to account for these failures in the many years prior to the pandemic? What failures of democratic involvement and oversight in policy-making and implementation does this suggest? How can we, above all else, strengthen democratic control over healthcare policy, such that it reflects our interests and priorities, and to ensure that, when officials say they are preparing the state for the worst, they are actually doing it? What kinds of trade-offs are we really willing to accept between the goals of individual, group- and population-level health, and other kinds of societal values, such as freedom of individual choice, civil liberties, and prosperity? What is the material basis of good health, and what fundamental social, political and economic changes are required to improve citizens’ wellbeing?
None of these questions are being addressed by current negotiations at the WHO, because its member-states are still locked into the old way of ‘solving’ global problems – or rather, appearing to solve them – through global governance. What is needed, above all else, is a refocusing of attention to the national level, since it is there that our most important problems lie. It might be tempting to think that withdrawing from the WHO would achieve this. But as Brexit showed, withdrawing from intergovernmental organisations does not automatically lead to the revitalisation of democratic self-government. The WHO is an infinitely weaker constraint on democracy than the European Union, and, unlike the EU, is not a substantial barrier to addressing our own internal failures.
To be sure, there are few signs of hard questions being asked at present. In the UK, the COVID-19 public inquiry has fixated on the shortcomings of then-Prime Minister Boris Johnson, and who said what to whom on WhatsApp, rather than evaluating the wisdom of the policies actually pursued. The establishment prefers to focus on the decision-making or malfeasance of this or that minister, rather than asking more fundamental political questions, or even documenting the harms of lockdown policies. The result is likely to be a mash-up of sordid ‘revelations’ that our political elite are not very good at their jobs, coupled with a ream of technocratic ‘lessons learned’ – a Butler Review redux. Still, why would we expect anything more from a public inquiry operating within the same state system that has so disastrously failed its citizens? Any effort to address the questions highlighted above will necessarily have to come from outside of that system.
The technocrats supporting global governance have been telling us for decades that the challenges we face are beyond individual states’ capacities to address; they require global solutions. In turn, this requires issues to be de-politicised to get around tetchy inter-state disagreements: turn them into technical issues so that networked experts can determine the correct policy responses, which states should then quietly enact at home, bypassing political controversies. This is indeed a de-democratised vision of technocratic dictatorship. But it is not the world that we truly inhabit.
Ruling over the ‘void’ of de-democratised polities, elites have indeed flirted with regulatory forms of global governance for decades. But they have never been entirely willing or able to walk the walk. The result has been the worst of both worlds: the elitist, technocratic, de-democratised shell of global governance, with actual implementation left to hollowed-out nation states which lack the authority, capacity and resources needed to carry through effective policy. The proponents of global governance, and its critics, both share the same fantasy that it could be otherwise – they merely differ in their judgements. Proponents dream of a world where state sovereignty can be bypassed and ‘best practice’ imposed on states, refusing to face up to the systemic failure of this approach. Anti-‘globalists’ think that this world of top-down control already exists. They see a disempowering conspiracy, coherence and coordination at work where, in truth, chaos, evasion and decay prevail – a void of authority, not its excess, ripe for the exertion of democratic control, if only citizens themselves cease to evade the real situation and find a way to organise themselves politically. Currently, all sides are taking flight from reality, and from the hard task of building democratic states responsive to the needs of their peoples – in healthcare, and much else besides.
The Northern Star 
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