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Although the global health community widely accepts that WHO, as currently configured, is no longer fit-for-purpose, commentators cling to renovation (‘reform’), rather than innovation, at the expense of a global health governance system that reflects the needs of a very changed world.
Collective action in a globalised world requires institutions that look very different from what we currently have. Rather than the renovation of outdated institutional forms—which are closed, territorially fixed and hierarchical—we need to harness innovations such as social networks, open-source systems and the sharing economy.
One of the biggest forms of institutional innovation more broadly is ‘network governance’, by which collective action is achieved through interconnected institutions spanning government, business and civil society.
Introduction
In 1948, my (RS) grandfather bought a car; a Morris Minor. It was slow, cramped and unreliable. Yet, as his needs changed over the years, he did not buy another car because ‘it was too difficult’ to decide. Today, he does not own a car. He can use community transport, Uber drivers and car sharing schemes. Transport has evolved remarkably since 1948, driven by technological innovation, but also institutional innovation in how we mobilise new technologies. Unlike transport, global health governance has not seen such institutional innovation, even though diseases have globalised and health emergencies become more complex.
Historically, global health governance has rested with the WHO. Criticisms of WHO have become frustratingly familiar—weak internal coordination, cumbersome bureaucracy, political appointments and ineffective leadership. The Ebola outbreak prompted some to describe it as facing a ‘do or die’ moment.1
Despite the Director-General admitting that ‘WHO was overwhelmed’2 by the outbreak, WHO has not ‘done’, in the sense of fundamental reform to address criticisms, but nor has it ‘died’. Although the global health community widely accepts that WHO is no longer fit-for-purpose, the design and …