This is an interesting comment in The Lancet from two global health leaders from the US and China. Citation, extracts and comments from me below.
CITATION: Comment: Volume 407, Issue 10539p1580-1582April 25, 2026
Transforming WHO: incremental reform is no longer sufficient
Shenglan Tanga, Send email to shenglan.tang@duke.edu ∙ Michael Mersona
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00609-4/fulltext
EXTRACTS
WHO was founded in 1948 as the UN agency that connects nations, partners, and people to ensure that everyone, everywhere can attain the highest level of health. As it has taken on more activities and programmes, WHO has grown enormously. Between 2017 to 2024, its workforce increased by 70% and the number of top-ranked directors nearly doubled.1 Successive global health crises, including most recently the COVID-19 pandemic, have exposed long-standing structural weaknesses in WHO's governance, financing, and operational model. Despite repeated calls for reform over more than 30 years, changes in these areas have been largely incremental and insufficient...
First, we believe that WHO should prioritise essential functions that are based on its mandate and strengths and that no other institution can credibly perform on a global scale. Programmes with little comparative value should be eliminated, even if they are supported by donors. This could result in further staff reductions and the elimination of programmes that are costly and often have only a limited impact.5 At its core, we believe WHO's comparative advantage lies not in programme implementation but in provision of global public goods related to disease control and health promotion: normative guidance, surveillance, data governance, emergency coordination, and convening power. WHO should maintain the technical and advisory committees mandated to develop guidance in these areas and re-establish its science division, which brought the organisation much needed scientific rigour.
Second, we suggest that WHO reforms its structural organisation and governance to make it more effective. At present, it functions as a loosely constructed confederation... Although this arrangement respects political diversity and decentralisation, this fragmented authority complicates decision making, delays responses, dilutes responsibility for performance, and produces inconsistent guidance...
Third, WHO's reforms should include a reorganisation of its country presence... We propose a three-tiered model of country engagement to better align WHO's presence with country needs. Full country offices would continue to exist in fragile and low-income countries, focused on technical support to national programmes and projects funded by a broad array of donors, emergency preparedness efforts, and health-system strengthening. Smaller technical liaison offices would cover selected upper-middle-income countries and focus on specific global public goods such as surveillance and pandemic prevention, preparedness, and response. In high-capacity countries, country offices would be replaced by periodic technical missions and structured policy dialogue from the regional offices. Such differentiation would allow WHO to redeploy its scarce resources where its technical and convening roles are most consequential...
Without such reforms, WHO will remain trapped in a cycle of expanding expectations and diminishing capacity. This is an outcome the world can no longer afford.
COMMENT (NPW): Several years ago I was at WHO headquarters and was asked about my views on WHO's role in strengthening the availability and use of reliable healthcare information. My response was twofold. First, that WHO explicitly commits to the goal of universal access to reliable healthcare information (by which we mean that every person has access to the information they need to protect their own health and the health of others), recognising that this can only be achieved by strengthening the global evidence ecosystem. Second, that WHO focuses on those components in the global evidence ecosystem for which it has a unique mandate and strengths. The informal meeting was held with a view to a major reevaluation of WHO's role in healthcare information. The evaluation did not take place.
HIFA and the Global Healthcare Information Network are now in official relations with WHO and our priority this year is to prepare a technical report for WHO by December 2026, with recommendations for the WHO Secretariat to consider. Currently our focus is to implement the central recommendations of the global consultation we undertook in 2023/2024 but I would welcome a wider discussion on HIFA to brainstorm options for WHO's role in the global evidence ecosystem. If you or your oganisation would like to support such a discussion, please contact me: neil@hifa.org
You can read more about our work with WHO here: https://www.hifa.org/projects/hifa-official-relations-who
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org