For over 75 years, the World Health Organisation (WHO) has been instrumental in the delivery of healthcare globally, supporting governments and aid groups to provide lifesaving care. From vaccines to quick response and containment of health crises, our world would look very different without its interventions.

However, for some time now, the organisation has been in turmoil as decision-making becomes increasingly fraught and internal tensions have reached a boiling point.

Issues have bubbled away under the surface for years, with concerns over the growing centralisation of the organisation. Whilst many have dismissed these problems as internal politics, given the importance of the WHO in the global healthcare ecosystem, when decision making breaks down, it puts people’s lives at stake.

In January of this year, reports of mass firings first began to circulate. The election of Donald Trump – who has a noted dislike of WHO Director-General Dr Tedros Adhanom Ghebreyesus – meant the organisation  had to contend with a sudden and massive budgetary shortfall. Under Trump’s leadership, the US withdrew over one billion in funding for the WHO, and by July, the organisation was planning to cut 20% of its workforce.

This has left staff in uproar as junior members have borne the brunt of cuts, leading to accusations that the layoffs have focused less on costs and more on those furthest from the centre of power. There have been numerous stories of people being reassigned or simply cut out without any explanation or clear alternative pathway or job role. Reports from inside the organisation say this has led to an increasingly toxic culture, as people are having to fight to keep their jobs. In a letter shared with Health Policy Watch and directed to Dr Tedros, he was warned that “‘This isn’t about efficiency, it’s about who is shielded and who is sacrificed.’”

It’s a telling accusation and one which undergrids a worrying reality that at its heart, the organisation is less a merit-based coalition of selfless, capable leaders than an exclusionary hierarchy where power and relevance are directly tied to status and job title.

Now, over 800 staff have submitted a motion of no confidence in the process of downsizing and are calling for an independent review of the process. Dr Tedros will have to tread carefully. Continued alienation of staff risks turning a global health agency, whose primary mission is on collaborative and coordinated delivery of health outcomes, into a fundamentally toxic environment where employees are forced to defend their livelihoods however they can.

Whilst this would be an issue regardless of timing, it’s happening at a time when global medical misinformation is on the rise; from Donald Trump’s widely debunked claim that paracetamol leads to autism and vaccine uptake at record lows the world over, the steady hand of WHO’s  leadership has never been more important.

It’s unfortunate then that staff have not been motivated to collaborate and innovate so they can  continue delivering vital support the world over. As the saying goes, rot starts at the head and for the WHO to successfully steer through this change, new leadership could not only make all the difference – it could be crucial.