WHO's Agenda: Altruism or Elitism?

As I wrote in my previous post, the World Health Organization (WHO) announced in 2021, amidst much fanfare, the successful conclusion of a pilot program for the malaria vaccine developed by GSK and that it was recommending a broad rollout in Africa.

A nurse with the new malaria vaccine. Image courtesy: Gavi

While the decision marked a landmark victory in the fight against malaria, a disease that has plagued humans since the origins of mankind, it was not without criticism, including from the well-respected Bill and Melinda Gates Foundation, which has funded part of the research into the vaccine. 

The vaccine, known as RTS,S and developed by GSK, requires four doses to achieve a rather dismal efficacy of 30%. Despite it not meeting (or even coming close to) WHO's set goal of 75% efficacy, the organization gave the vaccine its full backing and support, even pushing forward with a pilot study in four African countries with nearly a million participants. 

Critics have pointed out the logistical complexity of delivering a four-dose regimen and the high vaccine cost, in addition to the disappointing efficacy and potentially serious side effects. It is because of these challenges and disappointing performance that the Bill and Melinda Foundation decided it will not support the vaccine rollout, going against the WHO. But the main criticism of the WHO pilot program concerns ethical violations. Using participants' presence in the vaccination center as "implied consent," WHO chose to waive the "informed consent" requirement that is standard practice for any vaccination program where parents are given detailed information about the vaccine, including potential threats (increased rates of meningitis and cerebral malaria in the case of this vaccine). Bioethicists have argued that the practice violates the Ottawa Statement, a consensus statement on the ethics of cluster randomized trials. British Medical Journal has accused the WHO of a serious breach of international medical standards. An additional concern regarding the lack of parental consent (and education) is that without a full understanding of the risks and low efficacy of the vaccine, the vaccinated children might be subjected to a reduction in safeguarding efforts (mosquito nets have proven to be highly effective in reducing mosquito bites), and thus more prone to parasite exposure. That, combined with a blatant disregard for parental participation in their children's health, makes WHO guilty of ethical malpractice.

As shocking as the allegations may sound, particularly with the status of the WHO as a trusted and altruistic institution, the corruption of public health efforts by corporate and research greed has been far too common in the past -- take for instance, the development of the BiDil drug for black people and 23&Me using genomic data for research. In the western world, where patient consent and autonomy are valued so dearly, a violation of the sort experienced in Africa would have been crucified. 

Vaccines are by no means bad. They can, and indeed do, save lives. However, we must be careful to blindly trust the seemingly altruistic endeavors of major institutions like the WHO as unbiased and without flaw. Historical ideas of race and western superiority are pervasive in every aspect of our society, including humanitarian efforts in Africa. The same biases surrounding education and intellect that were once used to justify slavery are now being used to encourage researchers to waive consent laws, with WHO complicit in this malpractice. Although the WHO is an international nonpartisan organization, through this malaria vaccine implementation, it has proven itself a courier of deep-rooted western elitism and imperialism.