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We are pleased to see that our article has incited debate and discussion. While the responses reflect a wide range of perspectives, what is clear is that there is a need for fundamental reform in how WHO is organised and functions. And, while we offer thoughts on how this could be carried out, we are less inclined to ‘sell a solution’ than we are to ‘solve a problem.’ Any approach to WHO reform will undoubtedly entail imperfect trade-offs which can best be understood and navigated for the overall greatest good through critical discussion from a wide range of perspectives as offered by the respondents.
Each response offers important insights and criticisms that serve to further and deepen the discussion along the key considerations that must be weighted: accountability and ownership, sovereignty and collective action, practicality and efficacy. Liu's call for a stronger WHO that can assert global political leadership in instances of health crises, such as epidemics, is exactly the type of role we feel it should be positioned to serve while being able to coordinate other agents as well as its own personnel for action. Ideally, WHO can both provide the leadership and action directly but the former is where its unique positioning and voice is needed most. As Liu points out, the ultimate goal should be to build strong national health systems that can lead and act nationally and locally with WHO supporting countries in performing both of these roles. Efforts to build adequate health systems in developing countries must—finally and actually—be funded, supported and realised.
Sharma and colleagues delve into a number of practical challenges associated with outsourcing. We agree that, under the proposed model, managing accountability and the increased complexity of contracts and responsibilities will be difficult. Their point about strengthening the capacity of institutions from the Global South to compete for such contracts, is well taken and one that we would support. Requirements around equity or capacity building should be added into such contracts. While the ‘gaming’ of an outsourcing model is an inherent risk, we would like to see further conversation on what may be ‘lesser of evils’ options given the inefficacy of current approaches.
The People's Health Movement (PHM) emphasises the need for WHO to remain neutral and accountable. We support the values they assert, but are more cynical about the likelihood to realise them at least in the short-term given the current political economy surrounding WHO and global health more generally. Similar to Liu's call for WHO to have the latitude and positioning to exert political leadership, we agree with PHM's call for it to be protected and positioned to assert moral leadership, too. Strengthening its ability to carry out these functions, such as treaty negotiation, may require it to prioritise away from technocratic tasks such as data collection or drug registration. At the end of the day, WHO must prioritise its roles and then be positioned and supported to execute effectively.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
Data sharing statement No additional data are available.
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