“The World Health Organization (WHO) is facing an unprecedented crisis that threatens its position as the premier international health agency. To ensure its leading role, it must rethink its internal governance and revamp its financing mechanisms,” Tikki Pang, a visiting professor at the National University of Singapore and former director of research policy and cooperation at the WHO, and Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations, write in this Nature Medicine opinion piece. They note that the WHO “was born in the bifurcated Cold War world in 1948, and every aspect of its charter, mission and organizational structure was molded by diplomatic tensions between NATO and the USSR,” but “with the collapse of the Soviet Union and the rise of the new emerging market superpowers, the WHO finds itself trying to straddle a global dynamic for which it was not designed.”

They continue, “A recent dialogue on WHO reform that we participated in, held by the Council on Foreign Relations in New York in February, identified several key challenges that should be addressed by the agency.” They go on to discuss these challenges, which include refocusing “its original aim of being primarily a ‘knowledge broker’ that gives advice and information about best practices but stops short of directly implementing programs”; convening “negotiations resulting in internationally binding legal agreements and monitor[ing] their implementation”; overhauling its website so it is easier to navigate; “enhanc[ing] the relationship between its Geneva headquarters and its powerful regional offices”; improving financing through currency hedging; and increasing institutional resilience. They conclude, “Governance and the setting of normative standards cannot be accomplished with a slew of loosely connected health initiatives, nongovernmental organizations and bilateral programs. The only entity with a charter, a legislative body and a mandate to fill that role is the WHO, and it must do so decisively” (5/4).