Global health governance: we need innovation not renovation

Correspondence to Professor Richard Smith; [email protected] 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. Despite the Director-General admitting that ‘WHO was overwhelmed’ 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 creation of an alternative remain fraught with difficult questions requiring imagination, an agreed vision and political consensus. In their absence, the tinkering continues and, with a few exceptions, most commentators cling to renovation (‘reform’), rather than innovation.