It is likely that WHO will experience four major threats to its effectiveness:

Finance: With significant fixed costs, the effects of inflation and a static budget, it is difficult to increase both efficiency and effectiveness without any reduction in the tasks being undertaken. Dependence on specified voluntary contributions is inevitable, though it is important to ensure that these do not encourage the Organization to pursue activities that might be better carried out by others or that divert resources from higher priority activities that are less well-funded. The financing reforms initiated by the current administration, which focus on alignment, transparency and impact, are moving in the right direction and should be sustained.

Locating and employing strategic leaders: WHO continues to depend on its human resources – maintaining a diverse pools of highly skilled and experienced experts who have the skills needed to work effectively with Member States. Volatile voluntary funding inevitably leads to widespread use of short-term hiring arrangements: this makes it difficult for managers to maintain these pools. Innovative means for accessing experts from national institutions (with appropriate geographical balance and diversity) should be sustained, with care to ensure they function within the WHO culture, norms and operating procedures. Being a WHO staff member needs to be synonymous with both technical excellence and the ability to work effectively with national authorities.

Maintaining space for interaction, handling multiple interests and sustaining integrity: Multiple stakeholders are involved in global health. They include civil society networks, individual NGOs at international, national and community level, professional associations, the media, think tanks, national and transnational corporations. They also now include articulate individuals and informal communities of advocates with strong voices and novel influence thanks to information technology, social media and organizational skills. While this is a welcome development, this multiplicity of actors engage with WHO because they seek to influence decision making. This can be challenging both for WHO’s Member States and for the Secretariat.

Governance: It is important to ensure the primacy of WHO’s governors, the Member States, when policy decisions are made. It is also important to ensure that the expertise and independence of the Secretariat are protected when standard setting work is undertaken. And, given the increasing significance of multi-stakeholder working, it is important that safe spaces exist for all parties to interact. These spaces should enable the inclusion of those who might lack the power they need to ensure their voices are heard and presence is felt. I have substantial experience in partnering and fostering movements and appreciate the careful balance that is required to benefit from the work of multiple stakeholders, while maintaining the independence of the technical and normative functions that need to be undertaken from within the UN system.

Novel threats: The global health community has learnt to anticipate unexpected threats - whatever the cause. The transformation of WHO’s work in outbreaks and emergencies will lead to a more predictable, agile, and effective capacity for action. This will always involve WHO working with other entities in ways that reflect comparative advantages. When an incident occurs and a response is triggered, pre-planned procedures should engage a broad range of operational entities, strategic partners and international political actors at the highest level. It is now well-recognized that simulations involving critical experts from within government, UN, NGOs, scientists, business and media are invaluable. Results must be shared with world leaders at regular intervals so that they can appreciate states of readiness and institute necessary system changes to ensure that they are able to contain extreme threats to people’s health and global stability.