Angela Merkel, the G-7, and an Uncertain Moment for WHO

May 27, 2015

By: J. Stephen Morrison & Seth Gannon

Opening the World Health Assembly (WHA) in Geneva last week, German Chancellor Angela Merkel reaffirmed the centrality of the World Health Organization (WHO) while calling for serious reform in the aftermath of the Ebola crisis. She emphasized that at the G-7 summit in the first week of June, which she will chair, three global health issues will receive serious attention: WHO reform; poverty-related tropical diseases; and antibiotic resistance. She has also committed to Jim Kim, head of the World Bank, to weigh his proposal that the Bank create an emergency pandemic response financing facility. No doubt the Iran nuclear deal, evolving crises in eastern Ukraine, Yemen, Syria, and Libya, and climate change will dominate G-7 discussions. Nonetheless, Merkel’s speech reaffirms that global health now occupies a significant place at the G-7 table.

The G-7 agenda reflects a larger trend that has Merkel stepping forward as a leading voice in global health. Thanks to Germany’s comparative economic vitality, her own political strength atop a large Bundestag majority, and her increasing influence internationally (as described in George Packer’s compelling portrait in The New Yorker), Merkel is well-positioned to tackle pressing global issues and pursue partnerships with global health leaders. In January in Berlin, Merkel hosted the successful five-year replenishment for Gavi, the Vaccine Alliance, to advance affordable access to new and underutilized vaccines in the world's low-income countries. Due in part to her leadership and advocacy, the gathering came in over its ambitious $7.5 billion target, with significant contributions from the Bill & Melinda Gates Foundation, Germany, the United States, the United Kingdom, Norway, and Canada. 

And Merkel’s WHA keynote did more than preview the G-7 agenda. It signaled that WHO is under the scrutiny of world leaders dismayed by the late and chaotic international response to Ebola. The crisis in West Africa produced serious skepticism that, when the next unforeseen threat emerges, WHO will reliably and competently sound the alarm, assess the risks, rally quick responses, and coordinate action. Weak, vulnerable states, fearful that declaring a public health emergency will gravely disrupt trade and transportation, will reflexively resist. After describing WHO's decentralized structure and rightly characterizing it as the “only international organization that enjoys universal political legitimacy on global health matters,” Merkel came to her point: “But let’s be honest. Decentralized structures can also impede decision-making and hinder good functioning.” Though she offered no specifics, Merkel called for “clear hierarchies, so that ultimately everyone knows who has the say in any given situation, who has reporting obligations and who has to carry out the work.”

In April, partly at Merkel’s request, UN Secretary General Ban Ki Moon announced the creation of a High-Level Panel on the Global Response to Health Crises, chaired by Tanzanian President Jakaya Mrisho Kikwete. The Kikwete panel has a broad remit and the potential to put forceful recommendations in front of world leaders, particularly helping clarify the roles and responsibilities of different UN agencies in crisis. But it has just begun its work and is unlikely to return its report before the start of 2016. 

WHO Director General Margaret Chan is pursuing a set of internal reforms to better address future emergencies, as detailed by CSIS Senior Fellow Nellie Bristol. If these reforms move conspicuously beyond business as usual, and if they are implemented quickly even in the lame-duck period of Chan’s final two years, they may dampen external criticism and calls for deeper structural change. But Merkel’s speech makes clear that, at least in the near term, WHO reform is an issue on the higher stages of world politics, starting with next month’s G-7 meeting.

What Merkel’s speech did not do, in its broad outline of the G-7 agenda, is indicate what specific reform measures she supports. That appears to be an open question, perhaps to be answered, at least in part, in June. In light of her political and diplomatic stature, her increasing global health activism, and with Germany in the G-7 presidency, Merkel’s active engagement could have considerable sway – next week and beyond – as the debate unfolds over what essential changes in WHO are required, post-Ebola.

Blog image © WHO/Violaine Martin Used with permission