Contestation Within the World Health Organization: Tensions Between Reciprocation and Redistribution

The constitution of the World Health Organization (WHO) stipulates the organization’s aim: attaining all-around wellbeing for every person on the planet. This is significantly different from the aim of the WHO’s predecessors, for while pre-1940s international health governance was guided by reciprocation (every party gives and gets), the WHO’s aim involves redistribution (the haves give to the have-nots). This puts the WHO in a difficult spot: redistribution is regularly advocated by individuals and governments on the political “Left” but is often considered anathema to individuals and governments on the political “Right.” Thus, the WHO’s broader social purpose is up for debate, because while the organization’s aim is clearly specified in its founding document, the organization’s member-states do not have a shared understanding and set of expectations about how to pursue that aim. To explore this contestation among WHO member-states and to envision what it means for the WHO’s future, the paper proceeds in three parts. Part I provides an overview of reciprocation and redistribution, showing that both have played important roles in international affairs but are in tension with one another. Part II examines reciprocation and redistribution within the World Health Organization and its predecessors, demonstrating that the WHO’s embrace of redistribution has varied, partly as a result of contestation by member-states. Then Part III briefly notes that because the organization is caught between the “have” member-states controlling material resources and the “have-not” member-states controlling voting, the lack of a single agreed social purpose is likely to pose problems for future endeavors such as the 2025 pandemic treaty, with its prominent provisions for redistribution.