The 75th Birthday of the World Health Organisation – and World Health Day 2023 ('Health for All')
On April 7th, 1948, the World Health Organisation was officially formed as a specialist agency of the recently formed United Nations. Today, April 7th 2023, is also World Health Day which is observed every year to mark the foundation of the WHO, founded ‘ to promote health, keep the world safe and serve the vulnerable’.
'Serving the vulnerable' and the original priorities
We believe that the WHO’s own summary in the image above (that it initially had a strong focus on TB, malaria, yaws [a nasty tropical disease], syphilis, smallpox and leprosy) is actually slightly inaccurate because the original priority focus in 1948 was as follows: “Malaria, maternal and child health, tuberculosis, venereal disease, nutrition and environmental sanitation”[i]. In other words, the three infectious scourges originally focused on by the agency were specifically malaria, tuberculosis and syphilis and only a couple of years later, by 1950, the first antibiotics were being rolled out offering treatments which should really have massively reduced the latter two infections that were bacterial (albeit that it was soon after recognised that TB required a multi-drug treatment to better guarantee success). It’s true that TB continued to decline in richer countries in the following years, but progress remained negligible in what is now called the (TB endemic) Global South.
1993 and the first (and only) ‘Official Global Emergency’ declared by the WHO
Fast forward 45 years to April 1993 when the World Health Assembly (the governing arm of the WHO) officially declared TB to be a ‘Global Emergency’.
Be in no doubt that this was not just a reflection on how little progress had been made, because there is good evidence that reports of rising rates of infection in richer countries were what had refocused the agency towards TB. Be that as it may, this Declaration was also the first of its kind in the agency’s history, and, as far as we know, remains the only one. Other global issues since (ebola, swine flu, zika, and COVID-19) have been differently defined as ‘public health emergencies of international concern’ (PHEIC). As far as we know therefore, given that it has never subsequently been 'undeclared', TB remains a Global Emergency (since it has never been redeclared as a PHEIC, and because it was estimated in 1991 that 8 million new cases were arising each year, and the most recent official estimates for 2021, thirty years later, is that this number is 25% higher at 10 million and probably still rising).
So is a Global Emergency considered more serious than a PHEIC? Your guess is as good as ours, but based on available evidence it really doesn't seem to be...
So where is the appropriate response, and why does this lethal disease attract such a persistently low priority?
The first of WHO’s annual Global TB Reports (of 1994)
‘TB is a Low Priority’ – this must have been seen at the time as being so significant that it was actually headlined on the cover of the 1994 Report. Reviewing its contents today makes for thought-provoking and pretty depressing reading given the story of the last thirty years.
First of all, the annual official estimated death toll from TB in 1993 was put at 1.9 million. That number has barely declined in the last thirty years (and actually we fear may even really be higher today).
Moreover, MDR-TB was already identified as a problem that year – identified in the Report as potentially becoming ‘an incurable disease for future generations’. Thirty years later, and that threat still festers (albeit almost invisibly), the number of drug-resistant cases is still growing, and no appropriate response to this threat has yet been mobilised. The 1994 Report further identified that ‘inadequate or incomplete TB treatment’ was providing ‘virtual breeding grounds’ for MDR-TB – another situation that persists today, with far too few MDR cases still being found and far too much incomplete or inadequate treatment available.
But it is Dr Arata Kochi’s 30-year-old Forward to this TB Report that is perhaps the most tragic, ironic and thought-provoking part of all of it.
Dr Kochi was the WHO’s TB Program Manager at the time. He had already published something of a ground-breaking paper in 1991 entitled ‘The global tuberculosis situation and the new control strategy of the World Health Organization’ which had particularly identified ‘inadequate treatment services, high rates of treatment failure and a worldwide absence of adequate surveillance and monitoring’ as the key issues behind the awful infection and death rates. (All three of these factors remain the key issues behind the invisible and undeclared global emergency that is MDR-TB today, by the way).
In a few brief paragraphs Dr Kochi succinctly shared some of his thoughts in his Forward – and they deserve a revisit today, thirty years later on the WHO’s 75th birthday.
Despite the WHO’s original 1948 focus on tuberculosis, he identified how TB had suffered so much from being a low priority on the world’s health agenda. He further described how every day he wondered how this could still be allowed to continue. How was it possible, for instance, to ignore a germ that had already infected and lurked in the lungs of a third of humanity? (Thirty years later the proportion of humanity that harbours a latent TB infection is reckoned to have reduced slightly to a quarter but numerically, because of the increase in global population, the total number of infections is actually probably even higher).
Dr Kochi's ’magnitude of injustice’
We believe that Dr Kochi is still alive, so we can only guess as to what his daily wonderings might be today, a further 30 years later. Back in 1994 he described how he considered it beyond belief that millions of people were still dying from TB each year when inexpensive treatment was already available. He added that he simply couldn’t measure the ‘magnitude of this injustice’ Surely his outrage must have magnified with each passing year?
What was needed then, he reckoned, (and most definitely still is the case now) was ‘co-ordinated responsible action from people in governments, foundations, multilateral organisations, corporations and NGOs’.
In 2008, the New York Times described Dr Kochi as “an openly undiplomatic official”: he’d won admiration for re-organising the fight against tuberculosis but was later ousted from that job partly because he'd offended donors like the Rockefeller and Gates Foundations.
On this 75th birthday of the wonderful WHO, the UN agency that is entrusted with so much responsibility for the health of the most vulnerable members of our human family, we can't but ask – given the appalling record of global TB control, where exactly is the likes of Dr Kochi in the WHO today?
Happy Birthday, World Health Organisation.