Disease and Global Health Governance

This lesson examines how global institutions manage disease, the challenges of pandemic preparedness, and the persistent health inequalities that shape access to healthcare worldwide. You will study the role of the WHO, the impact of COVID-19, and case studies of major diseases including malaria and HIV/AIDS.

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The World Health Organization (WHO)

The World Health Organization was established in 1948 as a specialised agency of the United Nations, headquartered in Geneva, Switzerland. Its mandate is to promote health, keep the world safe, and serve the vulnerable.

Key Functions

Function	Description	Example
Setting norms and standards	Issues guidelines on disease control, air quality, nutrition	WHO Air Quality Guidelines (updated 2021)
Disease surveillance	Monitors global disease outbreaks and declares Public Health Emergencies of International Concern (PHEICs)	COVID-19 PHEIC declared 30 January 2020
Coordinating international response	Mobilises resources, experts, and logistics during health emergencies	Ebola response in West Africa (2014–16)
Technical assistance	Supports countries in strengthening health systems	Training healthcare workers in LICs
Research and innovation	Funds and coordinates global health research	COVAX initiative for equitable vaccine distribution

Evaluation of the WHO

Strengths:

• Coordinated the eradication of smallpox (1980) — the greatest public health achievement in history
• Leads global campaigns against polio (99.9% reduction in cases since 1988), malaria, TB, and HIV
• Provides essential technical guidance to 194 member states
• The Framework Convention on Tobacco Control (FCTC) is the first international public health treaty

Weaknesses:

• Underfunded — annual budget of approximately $6.7 billion (2022–23), less than many large hospitals; heavily dependent on voluntary contributions
• Criticised for slow response to COVID-19 — delayed declaring a PHEIC and was perceived as deferring to China in the early stages
• Limited enforcement power — WHO can recommend but not compel member states to act
• Political interference — member states' geopolitical interests sometimes override public health priorities
• Structural bias towards HICs — decision-making weighted towards major contributors

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Pandemic Preparedness and COVID-19

What is a Pandemic?

Key Definition: A pandemic is an outbreak of disease that occurs across a wide geographic area (typically multiple countries or continents) and affects an exceptionally large proportion of the population.

The COVID-19 Pandemic (2020–2023)

COVID-19, caused by the SARS-CoV-2 virus, was the most significant global health emergency since the 1918 influenza pandemic.

Key Timeline:

• December 2019: First cases identified in Wuhan, China
• January 2020: WHO declared a PHEIC
• March 2020: WHO characterised COVID-19 as a pandemic; most countries implemented lockdowns
• December 2020: First vaccines authorised (Pfizer-BioNTech, AstraZeneca-Oxford)
• May 2023: WHO declared the end of the COVID-19 PHEIC

Global Impact:

Indicator	Data
Confirmed cases	Over 770 million (WHO, 2023)
Confirmed deaths	Over 7 million; excess mortality estimated at 14.9 million (WHO)
Vaccines administered	Over 13.5 billion doses
Economic cost	Estimated $12.5 trillion in global GDP losses (2020–2022)

Health Inequalities Exposed by COVID-19

The pandemic starkly revealed and worsened existing health inequalities:

Dimension of Inequality	Evidence
Within countries	In the UK, COVID-19 mortality was highest in the most deprived areas and among Black and South Asian communities (PHE, 2020)
Between countries	By late 2021, over 80% of people in HICs had received at least one vaccine dose; in LICs, it was below 10%
Vaccine inequality	COVAX (the global vaccine-sharing initiative) fell far short of its target — HICs hoarded supplies through bilateral deals
Economic impact	LICs and MICs lacked fiscal capacity for furlough schemes and social protection; informal workers were worst affected
Gender	Women disproportionately bore the burden of increased care work, domestic violence, and job losses in service sectors

Exam Tip: COVID-19 is an excellent case study for demonstrating how health outcomes are shaped by socio-economic factors, governance, and global inequality. Use specific data (mortality rates by deprivation decile, vaccination rates by income group) to support your arguments.

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Major Global Diseases

Malaria

• Caused by Plasmodium parasites, transmitted by Anopheles mosquitoes
• 247 million cases and 619,000 deaths in 2021 (WHO World Malaria Report 2022)
• Approximately 96% of deaths occur in sub-Saharan Africa; 80% of deaths are children under 5
• Interventions: insecticide-treated nets (ITNs), indoor residual spraying (IRS), rapid diagnostic tests (RDTs), artemisinin-based combination therapy (ACT)
• Progress: malaria deaths fell from approximately 896,000 (2000) to 619,000 (2021), but progress has stalled since 2015
• Challenges: insecticide resistance, drug resistance, funding gaps, weak health systems, climate change expanding transmission areas

HIV/AIDS