Public health organisations fail, because they spread themselves too thinly over too many activities

If, like me, you celebrated the downfall of the useless, bossy quango Public Health England, you may be unable to shake the fear that it is a pyrrhic victory. Its replacement, the National Institute for Health Protection, might make a better stab at tackling the next viral outbreak, but there is a danger that PHE’s nanny state personnel will reassemble under a different logo and make a nuisance of themselves once more. Perhaps the best we can hope for is a slight improvement.

The institutional failure of public health agencies does not easily lend itself to free market solutions. Most classical liberals would agree that infectious diseases and environmental hazards require collective action which, in practice, usually means government action. However, funding for public health agencies does not have to come from the state and there is room for an element of competition. This is particularly true of the other multi-billion-pound agency that failed us so badly on Covid-19: the World Health Organization (WHO).

Like Public Health England, the WHO has spread itself too thinly over too many issues, campaigning on universal healthcare, housing, climate change and gender equality while obsessing over fizzy drinks, salt and alcohol, to name but a few. When the coronavirus test came, it dropped the ball, just as it had when Ebola appeared in 2014.

And Donald Trump has a point when he accuses the WHO of being pro-China. As I show in my new IEA report You Had One Job, the WHO seemed wilfully naive in its dealings with the Chinese government in the early months of 2020, understating the risk of Covid-19 and parroting implausible claims from Beijing. It was too slow to admit that there was human-to-human transmission and too slow to declare a pandemic. It repeatedly discouraged governments from imposing travel bans that could have saved many lives and it sidelined Taiwan, in accordance with China’s wishes.

In an ideal world, member states would do to the WHO what Matt Hancock has done to PHE and replace it with a streamlined agency that focuses only on infectious disease. In practice, this would be extremely difficult to do in one fell sweep. A more realistic proposal has been put forward by David Cameron who agrees that the WHO is beyond reform, but cannot be replaced overnight. Instead, he suggests creating a new organisation to deal with new disease surveillance and information-sharing, two areas where the WHO has fallen fatally short. He would like to see a “new, nimble, global, open, independent organisation” called the Global Virus Surveillance Organisation. This is an idea worth exploring, although it should be expanded to include infectious bacterial disease. Alternatively, an existing organisation, such as the Coalition for Epidemic Preparedness Innovations, could be beefed up to fill the role of global pandemic watchdog-cum-whistleblower.

This might involve some duplication of work in the first instance, but having another pair of eyeballs on emerging viral threats would be no bad thing. If the new agency proved itself more capable than the WHO then so much the better. If the arrival of competition incentivises the WHO to raise its game, that would also be a win.

This could be achieved if governments, philanthropists and corporate donors diverted funds away from the WHO and towards the new organisation. The USA has already taken steps in this direction. Under Trump, it has defunded the WHO, withdrawing its $450 million a year contribution with a view to “redirecting those funds to other worldwide and deserving, urgent global public health needs”.

The UK is also well placed to take the lead. With the USA out of the picture, Britain is the WHO’s biggest donor and yet we have failed to make use of the ‘soft power’ that our largesse supposedly buys. The UK is by far the biggest contributor to the WHO’s ‘tobacco control’ projects, for example, and yet the WHO’s position on vaping is diametrically opposed to that of the UK; even during the pandemic, the WHO was tweeting unscientific rubbish about vaping causing heart disease and e-cigarette fluid burning skin. Money talks at the World Health Organization and if Britain cannot make itself heard despite dishing out over $200 million a year, it should think seriously about reducing its contribution.

The corruption and incompetence at the WHO run deep. Serious reform is probably impossible, and abolition is not feasible in the short term, but diverting money from this ailing organisation and putting it towards a politically neutral global disease watchdog would be a good start.  


This article was first published on CapX

Read Christopher Snowdon’s new paper “You Had One Job” here.

Head of Lifestyle Economics, IEA

Christopher Snowdon is the Head of Lifestyle Economics at the IEA. He is the author of The Art of Suppression, The Spirit Level Delusion and Velvet Glove; Iron Fist. His work focuses on pleasure, prohibition and dodgy statistics. He has authored a number of papers, including "Sock Puppets", "Euro Puppets", "The Proof of the Pudding", "The Crack Cocaine of Gambling" and "Free Market Solutions in Health".

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