The WHO: guardian of global health

On 20 May 2025, the World Health Assembly adopted the WHO Pandemic Agreement, the first global treaty on pandemic prevention in the organisation's 77-year history, with 124 countries voting in favour and none against. Days earlier, the same organisation had been confronting its gravest funding crisis: the United States, its largest donor, was walking out. The WHO, the World Health Organization, is the United Nations specialised agency for health, directing the global response to everything from polio to pandemics for 194 member states. For UPSC, it is a high-yield institution: its mandate, its emergency powers, its treaty-making and India's deep partnership with it all feature regularly in prelims and mains.

What the WHO is

The WHO is the United Nations specialised agency for health, established on 7 April 1948 when its constitution came into force, and headquartered in Geneva, Switzerland. Its membership is near-universal: 194 member states, every country except Liechtenstein (and observers like the Holy See and Palestine). World Health Day is observed every 7 April to mark its founding. The Director-General, the organisation's chief executive, is Tedros Adhanom Ghebreyesus of Ethiopia, in office since 2017 and re-elected for a second term in 2022.

The WHO's constitutional definition of its objective is worth quoting exactly, because examiners love it: "the attainment by all peoples of the highest possible level of health." Health itself is defined in the constitution's preamble as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity", a definition that deliberately reaches beyond hospitals into the social determinants of health.

What the WHO actually does

The WHO's work falls into three baskets. The normative basket is its most powerful: it sets the global standards everyone else follows. The International Classification of Diseases (ICD), now in its 11th revision, is the diagnostic language of world medicine; the Model List of Essential Medicines guides procurement in developing countries; and the Framework Convention on Tobacco Control (FCTC, 2003) was the WHO's first global treaty, binding 183 parties to tobacco-control measures. The technical basket is country support: guidelines, training, and help building health systems. The emergency basket is outbreak response: surveillance, field teams, and the emergency-declaration power described below.

A useful exam frame is that the WHO is not a global health ministry. It cannot order lockdowns, close borders or compel vaccination; it advises, coordinates and standardises, while sovereign states decide. Much criticism of the WHO during COVID-19 flowed from expecting powers it was never given.

The IHR and the PHEIC mechanism

The International Health Regulations (2005), in force since 2007 and binding on all 194 members, are the legal backbone of global health security. They require countries to maintain core surveillance and response capacities and to notify the WHO of events that may constitute international emergencies. The Regulations' sharpest instrument is the Public Health Emergency of International Concern (PHEIC): a formal declaration by the Director-General, on the advice of an Emergency Committee, that an outbreak poses international risk and needs a coordinated response. A PHEIC unlocks emergency funding, travel and trade guidance, and research coordination.

Amendments to the IHR adopted in May 2024 strengthened the framework: a new definition of a "pandemic emergency" as the highest alert level, stronger equity provisions, and a compliance committee. The amendments enter into force for states that do not opt out, and they were the companion reform to the Pandemic Agreement.

The eradication record: the WHO's greatest hits

Before judging the WHO by its controversies, examiners expect the success story. In 1980, the World Health Assembly declared smallpox eradicated, the only human disease ever wiped out, after a WHO-coordinated global vaccination campaign. It remains the organisation's signature achievement and the proof that coordinated global health action can work.

Polio is the unfinished sequel: cases have fallen by over 99 per cent since 1988, and the WHO certified India polio-free in 2014, but Afghanistan and Pakistan remain endemic pockets. Guinea-worm disease has been driven from millions of cases to near-zero, and the Expanded Programme on Immunization (1974) built the childhood-vaccination infrastructure most countries still use. The pattern across these campaigns is the WHO's comparative advantage: no single country can eradicate a disease alone, so the organisation's coordination role, weak in enforcement, is decisive in eradication.

COVID-19: the WHO's trial by fire

The WHO declared COVID-19 a PHEIC on 30 January 2020 and characterised it as a pandemic on 11 March 2020. Its record since is contested in opposite directions. Defenders credit the organisation with early technical guidance, the ACT-Accelerator for vaccines and therapeutics, and the largest emergency operation in its history. Critics argue it was slow to declare the emergency, deferential to China in the early weeks, and late on airborne transmission and travel guidance.

For mains answers, the balanced line is institutional: the WHO performed the coordination role it was designed for but was exposed by the advisory role it was confined to. It could recommend against travel bans but not stop them; it could declare a PHEIC but not enforce quarantines. The Pandemic Agreement and the IHR amendments are the system's attempt to fix the gaps the pandemic revealed, particularly on equity: the bitter lesson that vaccines reached rich countries first.

The Pandemic Agreement (2025)

After three years of negotiation, the WHO Pandemic Agreement was adopted on 20 May 2025 at the 78th World Health Assembly: 124 votes in favour, 11 abstentions, none against. It is only the WHO's second global treaty after the tobacco convention. Its core bargain links access and benefit-sharing: countries and companies share pathogen samples and genomic data rapidly, and in return a new Pathogen Access and Benefit-Sharing (PABS) system reserves for the WHO 20 per cent of pandemic-related products (vaccines, therapeutics, diagnostics) for equitable allocation, half donated and half at affordable prices.

Two caveats matter. The PABS annex, which contains the operational detail, was still being negotiated when the Agreement was adopted; the treaty will open for signature only after it is finalised. And the Agreement creates no WHO enforcement power: implementation rests with national governments, and several major states entered interpretive understandings. The United States, having initiated withdrawal, will not be bound by it.

Money: the WHO's structural weakness

The WHO's chronic vulnerability is its funding model. Assessed contributions, the mandatory dues, account for under 20 per cent of the budget; the rest is voluntary contributions, mostly earmarked by donors for their preferred programmes. The result is an organisation that is simultaneously well-funded and broke: flush with money for donor-chosen priorities, starved of flexible funds for its core mandate. The United States was historically the largest contributor (roughly a fifth of the budget), so its withdrawal opened a hole no other donor quickly filled. A 2022 funding reform raised assessed contributions toward 50 per cent of the base budget, but the transition was still underway when the American exit hit.

The US withdrawal

On 20 January 2025, the United States notified the WHO of its withdrawal, citing the organisation's handling of COVID-19, its alleged political bias, and disproportionate American payments. Under the terms of the 1948 US joint resolution of membership, withdrawal takes effect one year after notice: 22 January 2026, provided dues for the notice year are paid. The practical effects are threefold: a large budget gap, the loss of American technical personnel seconded to Geneva, and a normative gap, since US non-participation weakens any treaty it refuses to join, including the Pandemic Agreement. The withdrawal also revives the question of alternative health leadership: China, the EU and philanthropies like the Gates Foundation all expanded their health funding as Washington stepped back.

The Director-General: how the WHO picks its chief

The Director-General is nominated by the Executive Board and appointed by the World Health Assembly for a five-year term, renewable once. Tedros Adhanom Ghebreyesus, Ethiopia's former health and foreign minister, took office in 2017 as the first African DG and was re-elected in 2022. The election is intensely political: regional blocs bargain over candidates, and the DG's nationality is read as a signal of the organisation's direction. Tedros's tenure has spanned COVID-19, the Pandemic Agreement negotiations and now the American withdrawal, making the DG's office the public face of both the WHO's authority and its constraints.

How the WHO is governed

Authority flows from the World Health Assembly (WHA), the annual meeting (every May in Geneva) of all 194 members, which sets policy, approves the budget and adopts treaties. The Executive Board (34 members serving three-year terms) prepares the Assembly's agenda and executes its decisions. The Director-General leads the Secretariat of roughly 8,000 staff. Work is decentralised through six regional offices, each with its own regional committee: AFRO (Brazzaville), AMRO/PAHO (Washington), EMRO (Cairo), EURO (Copenhagen), SEARO (New Delhi) and WPRO (Manila). The regional layer explains why the New Delhi office matters so much to India.

India and the WHO

India's WHO relationship is among the deepest of any member state. New Delhi hosts the South-East Asia Regional Office (SEARO), one of the six regional headquarters, giving India unusual institutional proximity. In 2022 India established the WHO Global Centre for Traditional Medicine in Jamnagar, Gujarat, the organisation's first outposted office for traditional medicine, aligning with India's advocacy of Ayurveda and traditional systems in global health.

The partnership's substance spans decades: the WHO certified India polio-free in 2014 after the massive Pulse Polio campaign; it supports India's End TB strategy, HIV and malaria programmes, and the Ayushman Bharat health-protection scheme is studied globally as a universal-coverage model. During COVID-19, India supplied vaccines to dozens of countries while running the CoWIN digital platform, now offered as a global public good. The WHO's 13th General Programme of Work set "triple billion" targets (one billion more people with universal health coverage, better protected in emergencies, and enjoying better health), and India is central to all three counts.

The criticisms, fairly stated

WHO critics make four arguments. One, donor capture: earmarked voluntary funding lets rich donors steer the agenda. Two, slowness: the PHEIC process and consensus culture delay decisive action. Three, politicisation: Taiwan's exclusion from the WHA at China's insistence is the standing example. Four, enforcement deficit: the IHR and the Pandemic Agreement rely on self-reporting and goodwill. The organisation's defenders reply that these are design features of a member-state body, not bugs: the WHO can only be as strong as its members permit, and the 2024-25 reforms, assessed-contribution increases, IHR amendments and the Pandemic Agreement, are precisely the attempt to permit more.

What examiners keep asking

WHO questions orbit five facts: the founding date and headquarters (7 April 1948, Geneva), the mandate sentence ("the highest possible level of health"), the PHEIC mechanism under the IHR, the Pandemic Agreement (2025) and the US withdrawal timeline. Around these, examiners test the DG's name, the six regional offices (SEARO in New Delhi), the FCTC, and India's traditional-medicine centre at Jamnagar.

Key Terms

• World Health Organization: The UN specialised agency for health, founded 7 April 1948, headquartered in Geneva, with 194 member states.
• World Health Assembly: The WHO's annual decision-making body of all 194 members, meeting every May in Geneva.
• International Health Regulations: The 2005 (in force 2007) legally binding framework for surveillance and emergency response, amended in 2024.
• PHEIC: Public Health Emergency of International Concern, declared by the Director-General under the IHR; COVID-19 was declared on 30 January 2020.
• Pandemic emergency: The highest alert level introduced by the 2024 IHR amendments, above a PHEIC.
• Pandemic Agreement: The WHO's 2025 global treaty on pandemic prevention and response, adopted 124-0 with 11 abstentions at WHA78.
• PABS system: Pathogen Access and Benefit-Sharing, reserving 20 per cent of pandemic products for WHO-coordinated equitable allocation.
• FCTC: Framework Convention on Tobacco Control (2003), the WHO's first global treaty, with 183 parties.
• ICD: International Classification of Diseases, the WHO's global diagnostic standard, now in its 11th revision.
• Assessed contributions: Mandatory member dues, historically under 20 per cent of WHO funding; being raised toward 50 per cent of the base budget.
• SEARO: The WHO South-East Asia Regional Office, headquartered in New Delhi.
• Triple billion targets: The WHO's 13th General Programme of Work goals: one billion more people with UHC, protected in emergencies, and in better health.

Practice questions