WHO

1. Mandate, evolution and institutional architecture

WHO emerged from the recognition that epidemics do not respect political boundaries and that international cooperation is necessary for improving population health. Its Constitution was adopted in 1946 and entered into force in 1948. As the directing and coordinating authority for international health work, WHO combines technical expertise, standard-setting, surveillance and operational support. Its agenda extends beyond infectious diseases to maternal health, nutrition, non-communicable diseases, mental health, environmental risks and health-system strengthening.

The World Health Assembly (WHA), attended by delegations of Member States, determines policies, approves the programme budget and appoints the Director-General on the Executive Board’s nomination. Each Member State has one vote, although many decisions are adopted by consensus. The Executive Board prepares the Assembly’s agenda and helps implement its decisions. The Secretariat, led by the Director-General, operates through headquarters, regional offices and country offices.

WHO’s decentralised structure helps adapt programmes to different epidemiological and administrative conditions. However, it can also create coordination problems between headquarters and regional structures. WHO is not a global health ministry: it cannot ordinarily compel governments to change domestic policies, grant investigators unrestricted access or implement its recommendations.

• Normative role: develops technical guidelines, disease classifications and standards for medicines, vaccines and diagnostics.
• Knowledge role: compiles health statistics, assesses risks and supports evidence-informed policymaking.
• Coordinating role: convenes governments, researchers, donors and humanitarian partners during health emergencies.

2. Legal instruments and emergency governance

WHO’s Constitution provides different routes for international health governance. Article 19 enables the Health Assembly to adopt conventions or agreements, which bind states through their acceptance procedures. Article 21 permits regulations on specified subjects, with an opt-out framework under Article 22. Article 23 enables recommendations. Distinguishing these instruments is important: a technical recommendation does not have the same legal status as a treaty obligation.

The International Health Regulations (2005), or IHR, are a legally binding framework for preventing and responding to the international spread of disease while avoiding unnecessary interference with international traffic and trade. They require surveillance and response capacities, designated national contact arrangements and notification to WHO of events that may constitute an international emergency. States must assess events using the IHR decision instrument and notify qualifying events within 24 hours of assessment.

The Director-General determines whether an event constitutes a Public Health Emergency of International Concern (PHEIC), considering available evidence and Emergency Committee advice. Temporary recommendations can address surveillance, clinical management, travel and other measures, but are not themselves legally binding. A PHEIC is a legal category under the IHR; describing an outbreak as a pandemic concerns its epidemiological spread and is not an identical designation.

In June 2024, the WHA adopted amendments to the IHR, including a pandemic emergency category, stronger provisions on equity and a coordinating financial mechanism. In May 2025, the WHA adopted the WHO Pandemic Agreement under Article 19. Adoption did not itself make the agreement operational: further work on its Pathogen Access and Benefit-Sharing annex and subsequent treaty procedures were required. These developments should therefore not be confused with universal ratification or automatic domestic implementation.

• The WHO Framework Convention on Tobacco Control, adopted in 2003 and effective from 2005, illustrates WHO’s treaty-making role.
• An emergency declaration mobilises attention and coordination; it does not authorise WHO to impose national lockdowns or vaccination mandates.

3. Contributions to global health and development

WHO’s major achievements demonstrate the value of sustained cooperation. Smallpox eradication, certified by the WHA in 1980, combined surveillance, vaccination and international coordination. WHO also works with governments and partners on polio eradication, malaria control, tuberculosis, HIV and neglected tropical diseases. Such programmes require domestic implementation: international guidance cannot substitute for functioning laboratories, trained workers and community trust.

WHO supports Sustainable Development Goal 3, including universal health coverage (UHC). UHC means that people receive needed quality health services without financial hardship. It requires attention to primary healthcare, referral systems, essential medicines and financial protection, rather than merely expanding insurance enrolment. WHO’s work on non-communicable diseases links health with tobacco regulation, food environments, air pollution and urban planning.

Its Model List of Essential Medicines and prequalification programme help countries and international purchasers make quality-assured procurement decisions. WHO also supports antimicrobial resistance surveillance through the Global Antimicrobial Resistance and Use Surveillance System. Under the One Health approach, it collaborates with FAO, UNEP and the World Organisation for Animal Health to address connected human, animal and environmental risks.

During COVID-19, WHO coordinated technical guidance, surveillance and research and participated in the Access to COVID-19 Tools Accelerator. COVAX, its vaccine pillar, sought fairer vaccine access through a multi-partner arrangement. Nevertheless, vaccine nationalism, constrained supplies, financing gaps and unequal production capacity exposed the difference between commitments to solidarity and actual distribution.

• WHO’s standards can shape markets and national regulation even where WHO has no direct enforcement power.
• Health security and UHC are complementary: resilient routine services improve emergency detection and response.

4. India–WHO relations: cooperation and strategic interests

India has been a WHO member since 1948 and hosts the South-East Asia Regional Office. Cooperation covers immunisation, disease surveillance, tuberculosis, maternal and child health, neglected tropical diseases and emergency preparedness. India’s last wild poliovirus case was recorded in West Bengal in January 2011; the WHO South-East Asia Region was certified polio-free in March 2014. Maintaining that status still requires vaccination and surveillance against importation.

India’s pharmaceutical and vaccine industries make it central to debates on affordable medicines and diversified manufacturing. Its interests include predictable access to diagnostics, vaccines and therapeutics; technology transfer; sustainable research capacity; and protection of policy space under the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights. WHO contributes technical and normative expertise, but changes to WTO intellectual-property rules are negotiated at the WTO, not by WHO alone.

The WHO Global Traditional Medicine Centre in Jamnagar, Gujarat, was established in 2022 with Indian support. It provides a platform for research, data, sustainability and evidence-based integration of traditional medicine. Engagement should emphasise rigorous evaluation of safety, quality and efficacy; institutional cooperation does not amount to WHO endorsement of every traditional treatment.

India can connect its domestic health priorities with WHO-led cooperation through stronger primary healthcare, antimicrobial stewardship, digital-health interoperability and resilient medical supply chains. Its contribution to the Global Initiative on Digital Health highlights opportunities for international collaboration, provided privacy, cybersecurity and inclusion remain integral to digital public infrastructure.

• Strategic opportunity: act as a bridge between major health-technology producers and countries facing access constraints.
• Domestic imperative: improve public-health capacity and data quality so that international commitments translate into measurable outcomes.

5. Limitations, reform priorities and a balanced assessment

WHO’s financing combines assessed contributions from Member States and voluntary contributions from governments and other partners. Heavy reliance on earmarked voluntary funding can constrain flexibility and align resources more closely with donor preferences than collectively agreed needs. In 2022, Member States agreed to increase assessed contributions towards 50 per cent of the base budget by the 2030–2031 budget cycle at the latest, subject to the agreed reform pathway.

Political tensions also affect investigations, reporting and public confidence. WHO depends substantially on national information and cooperation, while governments may fear economic losses or reputational damage from reporting outbreaks. Criticism of its COVID-19 response and earlier Ebola response revealed concerns about timeliness, communication, emergency capacity and accountability. However, holding WHO responsible for every national policy failure overlooks its limited authority and resources.

Reform should combine predictable financing, transparent decision-making, independent evaluation and stronger country-level capabilities. Reporting incentives must encourage early disclosure rather than punishment through unnecessary trade and travel restrictions. Equitable pathogen sharing should be linked to fair access to resulting medical products. For India, the preferred approach is constructive multilateralism: strengthen WHO’s scientific credibility and representative governance while demanding accountability and resisting politicisation.

• Finance: expand flexible funding and ensure transparent donor engagement.
• Preparedness: invest in laboratories, workforce, surveillance and reliable supply chains.
• Equity: strengthen regional production and access to technology and medical countermeasures.
• Accountability: publish clear evidence, acknowledge uncertainty and evaluate emergency performance.

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