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Comment — WHO is badly in need of reform, but it cannot replace NGOs like our own
  1. Joanne Liu
  1. International President, Medecins Sans Frontieres/Doctors Without Borders, Geneva, Switzerland
  1. Correspondence to Dr Joanne Liu; joanne.liu{at}

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The authors of the report ‘Outsourcing: how to reform WHO for the 21st century’, published in BMJ Global Health, recommend outsourcing some key WHO responsibilities to other organisations, including Médecins Sans Frontières (MSF). We agree that the WHO is badly in need of reform, but caution against thinking that non-governmental organisations like our own can replace the WHO's own critical role in the response to epidemics.

Ultimately, it is not the response of international medical experts that can make the crucial difference to an epidemic response. Instead, it is the way that governments themselves respond and their willingness to seize the nettle and make prompt, effective decisions that put the health of the population first, above economic or political concerns. The WHO has to play a vital role here, and must be able and willing to speak truth to power and, where necessary, confront governments—in the affected areas and farther afield—when there are serious medical gaps and outbreaks of disease. This is made more difficult by the appointment of the WHO country representatives often on the basis of political considerations instead of competency. This must change in favour of expertise with clear accountability and responsibility.

At present, one of the biggest failings in the system is that governments are positively disincentivised from declaring an outbreak for fear of disrupting the functioning of the country and driving away visitors and investors. States should be able to count on international solidarity in the face of overwhelming epidemics and the world needs a strong WHO with political courage that can support national authorities in making clear decisions on setting priorities, attributing roles and responsibilities, ensuring accountability for the quality of activities, and mobilising the necessary resources.

Yes, private international organisations like ours will continue to provide staff and patient care to support an epidemic response when patients are suffering. However, the really important national and international political will has to be galvanised by the WHO. In addition, the critical infrastructure and technical investments which underpin an effective epidemic response, such as the development of proper laboratory facilities and sentinel surveillance systems, badly need the support of a strong and empowered WHO.

Rather than cutting away at the WHO's responsibilities, we need to ensure that it is stronger, braver and enabled to call a spade a spade in a timely fashion. Since the ultimate goal is saving lives.


  • Twitter Follow Joanne Liu @JoanneLiu_MSF

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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