New ICLE Issue Brief Warns Global Health Governance Lacks Democratic Accountability
PORTLAND, Ore. (April 8, 2026) — Global health governance has shifted away from democratic accountability and toward a system in which a small number of powerful actors exert outsized influence over policy, a new issue brief from the International Center for Law & Economics (ICLE) finds.
Authored by ICLE Senior Scholar Julian Morris, Nonresident Scholar Roger Bate and Christopher Snowdon, head of lifestyle economics at the Institute of Economic Affairs, the brief examines the evolving role of the World Health Organization (WHO) and its relationship with philanthropic foundations, nongovernmental organizations, and private-sector stakeholders.
The authors describe an ecosystem of “Democratically Deficient Organizations” (DoDOs), in which policymaking authority increasingly rests with entities that operate outside traditional mechanisms of public accountability. They argue that the WHO’s reliance on voluntary, earmarked funding has weakened the link between its priorities and the will of member states.
“This circuit operates with minimal external constraint,” they write. “At no point does meaningful democratic accountability enter the process. Research circulates within a closed funding network.”
The brief highlights tobacco control and pandemic governance as case studies. It finds that the WHO’s Framework Convention on Tobacco Control has not accelerated global declines in smoking, while discouraging harm-reduction approaches that have proven effective in some countries. It also warns that proposed expansions of WHO authority risk reinforcing existing institutional weaknesses.
The authors call for reforms to restore democratic oversight, including rebalancing WHO funding toward assessed contributions, strengthening transparency and conflict-of-interest safeguards, opening governance processes, and reaffirming the role of domestic institutions in health policymaking.
To arrange an interview with the authors, contact Jim Fellinger at [email protected]. Download the full report here.
About ICLE
The International Center for Law & Economics is a nonprofit, nonpartisan research center working with a roster of more than one-hundred academic affiliates and research centers from around the globe. ICLE scholars promote the use of law and economics methodologies to inform public policy debates.