It’s time to rethink who represents the US at the WHO

In June 1948, Congress enacted a joint resolution authorizing U.S. participation in the World Health Organization. In addition to outlining the rules for ending membership in the WHO — language which became relevant to President Trump’s intended withdrawal in July 2020 — Public Law 80-643 also dictates the qualifications of the individual selected to represent the United States at the WHO executive board. 

The WHO Constitution notes that the representative to the executive board must be technically trained in health. The U.S. 1948 resolution interpreted this requirement to mandate that whomever represents the United States be a graduate of a recognized medical school and have no less than three years of experience practicing medicine or surgery. 

This rule has stood for 73 years. It is time to change the rule.

Every year, the executive board of  the WHO meets to review the most important topics in global health, set the agenda for the World Health Assembly, and guide the management of the WHO secretariat. The 34 Members of the executive board hail from every region of the world, including six representatives from the Americas. Members serve on a rotating basis, but the United States has held a seat at the table almost every year possible. (After three year cycles, members rotate off of the executive board for a minimum of one year.)

The issues debated at the WHO executive board are diverse and complex.  In January 2021, there were 47 agenda items. These ranged from discussion on budget and organizational structure of the international organization, to reform agendas, universal health coverage, patient safety, and not least of all, governing the multi-sectoral response to the COVID-19 pandemic, which has to date impacted over 235 million people and been responsible for over 4.8 million deaths worldwide. 

The United States has been privileged to have had many excellent representatives to the WHO executive board over the past 70 years. Some have been exceptional diplomats, others have successfully negotiated reforms, and all have worked with global partners in a highly politicized organization to try to improve population health around the world. But it is safe to assume that it was not their training to perform surgical procedures or high marks in anatomy class that qualified them for success. 

A lot has changed since 1948. Medical doctors are not the only professionals working in global health, so what does it now mean to be “technically qualified in the field of health?” Thousands of people every year are graduating from schools of public health with advanced degrees, including in epidemiology. Lawyers are navigating complex international law impacting global governance of disease. Veterinarians, disease ecologists, environmental health experts, medical anthropologists, data scientists, communications experts, modelers, sociologists, virologists, microbiologists, biochemists, economists, political scientists and diplomats — from the local to the global level — are the face of global health professionals in our century. 

The current director general of the WHO is not a physician. Dr. Tedros Adhanom Ghebreyesus holds an undergraduate degree in biology, a masters of science in immunology of infectious diseases, and a PhD in community health. Over a third of the representatives on the executive board from other nations have non-medical degrees. There are epidemiologists, economists, lawyers,  philosophers, pharmacists and sociologists.   

In the U.S. government today, the people in executive branch leadership positions who would be excellent candidates to be the representative to the executive board have a range of expertise. There are trained clinicians, but also public health experts, epidemiologists,  life science researchers, diplomats, crisis management experts, lawyers and journalists. 

The challenges facing the WHO are vast. Global health — global health security in particular — is a complex transnational concern. Our representatives need to navigate a myriad of issues, while engaging in diplomatic maneuvers to effectively advocate for U.S. positions. 

It is time to finally get rid of the rule that limits the representative to only those that are medically qualified and include the range of experts who are technically qualified in the field of health. 

Rebecca Katz, PhD MPH, is a professor and director of the Center for Global Health Science and Security at Georgetown University. Andrea Cano, Matthew Carvhelo and Emily Woodrow provided research assistance for this piece.