Queen bee in a beehive: WHO as meta-governor in global health governance

Correspondence to Dr. Sara Van Belle; svanbelle@ itg. be In this journal, Lee and Smith lament the lack of institutional innovation in the WHO, arguably the crux of global health governance (GHG). They contend that WHO can only regain its leadership role if it focuses on ‘enabling consensus in a nimble and timely manner’ and foremost, if it supports ‘mechanisms to facilitate the formation of networks, sharing of resources, generation of ideas and enabling of decision-making across constituencies that are not confined to states alone’. Like Mackey, they argue for a radical, innovative shift in GHG as complex global health challenges can no longer be borne by WHO alone. Lee and Smith rightly consider network governance as the leading institutional design to guide 21st century GHG. In the light of events related to WHO’s reform of the past year, we would like to focus on what this networked model-WHO looks like and specifically of how WHO could play the meta-governor role. Democratic networked or interactive governance has been advanced as the ‘best fit model’ for both national governments and the international order to face current complex realities. A recent addition to network governance as a model for global health governance is Anne-Marie Slaughter’s work, which urges us to move from the 19th century ‘chessboard game’ thinking to the ‘web’. Margetts et al describe our age as one of ‘chaotic pluralism’, an era where a hodgepodge of different forms of more or less durable organisations, of tight or loosely coupled networks, webs and individuals, of half-truths and the negation of the value of expertise, all vie for our attention. Social media mushroomed to the extent that it is now affecting social change and indeed altering global collective action. To assert its leadership, WHO must transform into a queen bee reigning over a beehive of chaotic pluralism. What does ‘chaotic pluralism’ mean for WHO reform? We argue that in this densely networked global health world, WHO needs first to keep at its role of enabling consensus among actors and issuing evidence-based guidelines. It should thus renew its claim to authority and legitimacy in global health governance, reclaiming guidance in global health learning and expertise. In an inherently unstable multipolar world, there is some merit in continued collaboration and sharing responsibilities on guaranteeing global public goods such as on global health, climate change mitigation and the Sustainable Development Agenda. WHO remains, unless its member states and key funders decide otherwise, a main diplomatic platform to guide the global health agenda. Meaningful (re-)connecting to a broad range of actors would allow the organisation to respond to the increasing complexity of the global demos. Intergovernmental membership organisations such as WHO should open up to innovative ways of decision-making and institutional engagement with a wide array of actors, with transparent rules for their representation in an accountable manner. This requires a major overhaul Summary box