To the Editor:
Right now, in any low to middle income country (LMIC), a child has developed postinfectious life-threatening hydrocephalus or a mother has suffered a brain bleed after a motor vehicle collision. Their lives could be saved by neurosurgical procedures such as shunting, third ventriculostomies, or burr holes. In the poor countries of the world, these conditions are incredibly common and result in significant morbidity and mortality while taking a tremendous toll on national economies. The Lancet Commission on Global Surgery clearly demonstrated the utility in ensuring access to life-saving surgical interventions such as these.1 However, the efforts to help vulnerable people lead full and productive lives are now at profound risk due to the unfortunate decision by the United States to withdraw funding from the World Health Organization (WHO).
On July 7, 2020, the United States announced its withdrawal of large financial support to WHO due to concerns surrounding the agency’s coronavirus response. Global efforts in infectious disease control, nutrition, and education will certainly be impacted by this decision, but so will global neurosurgery. Defunding WHO could have a profound impact on the gains made in capacity-building efforts and improving access to neurosurgical care.
Global neurosurgery is the public health and clinical care of neurosurgical patients with the primary purpose of ensuring timely, safe, and affordable neurosurgical care to all who need it.2 The Lancet Commission on Global Surgery incorporates all surgical disciplines, including global neurosurgery. The release of the Commission sounded the alarm on the investment of interdependent components of a surgical system such as anesthesia staff, nurses, operating rooms, critical care services, and biomedical engineers.3 With better capacity comes better neurosurgery and consequently improved treatment of the millions of patients every year with life-altering neurosurgical disease.
So where does WHO fit in? The United Nations (UN) has outlined its Sustainable Developmental Goals, which are to be reached by 2030. Global neurosurgery is related to targets #3 and #17—the promotion of healthy lives and global partnerships, respectively.4 WHO is the coordinating authority regarding health within the UN.
WHO is mandated to implement the health priorities set by its member states (MSs). In 2015, the members of WHO unanimously passed a resolution calling for “Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage.” The United States was a cosponsor of this historic resolution. Today, with the help of WHO and its key partners, more than 40 LMICs are currently in various stages of implementing the mandates of this resolution. Subspecialists such as neurosurgeons are transforming the profession by integrating the principle of health equity with WHO’s support. For example, WHO has partnered with the World Federation of Neurosurgical Societies (WFNS), the largest professional society within neurosurgery, to better understand the global neurosurgical disease burden and workforce deficits. This partnership also permits better access to local stakeholders to continue important advocacy efforts. Individual LMICs, under the WFNS-WHO partnership, can effectively push the agenda of improved neurosurgical care that is nationally or regionally specific.
At the World Health Assembly meeting in 2018, it was clear that WHO was increasing collaboration and communication between neurosurgical systems around the world.5 As Rosseau describes, neurosurgeons convened with health ministries and other key players to commit to “…sharing training, equipment, and other resources with the rest of the global surgery community.” Neurosurgeons seated at the table with WHO was a significant step in the right direction.
Finally, it is well known that WHO is one of the most significant champions of Universal Health Coverage (UHC). Neurosurgical care is part of UHC and thus needs to be protected at all costs. In a country like Uganda, where the average person makes $2280 USD/yr and may spend up to $1220 USD for a neurosurgical procedure, the economic burden on patients can be devastating.6 WHO encourages governments to strategically partner with the public and private sectors to ensure that all health needs, including neurosurgical ones, are economically met with the best quality of medicine available.
The global neurosurgery movement, as part of the broader global surgery movement, would not have been possible without WHO. The key stakeholders respect and depend on WHO to set global priorities and support the MS implementation of their mandates. Yes, WHO can improve. But the United States will be far more effective in driving the improvement as an MS. The consequences of withdrawal of funding from WHO are devastating and will adversely affect millions of people around the world and, in particular, neurosurgical patients.