Working with the WHO in Geneva
The World Health Organization has 7,000 staff in 150 countries. It works with 194 member states. And some of the most important decisions get made during coffee breaks. That is one of the many things David Ho learned during his time working with the WHO in Geneva.
This is part of my retelling of “50 Years of Singapore and the United Nations” (Tommy Koh, Li Lin Chang, Joanna Koh, 2015, ISBN: 978-9814713030).
Chapter 32 is written by David Ho, who served as First Secretary for Health at Singapore’s Permanent Mission to the UN in Geneva from 2012 to 2014. Unlike Vernon Lee in the previous chapter, David is not a doctor. He has a history degree. His perspective on the WHO is less about science and more about how diplomacy and politics shape global health. And honestly, that perspective might be even more interesting.
Singapore and the WHO: From Beginner to Partner
Singapore joined the WHO in 1966, one year after independence. Back then, Singapore was a developing country. Young medical officers from Singapore received WHO Fellowships to train overseas. The WHO Fellowship Programme was one of the first things the WHO created when it was founded in 1948. It was designed specifically for developing countries to build their medical capacity.
Singapore has come a long way since then. Many of those early fellowship recipients built entire careers in public health. They went on to serve on WHO Expert Working Groups. And Singapore returned the favor. Its healthcare institutions started hosting and training overseas WHO Fellows. By the time of writing, the WHO had designated ten Singapore institutions as WHO Collaborating Centres. That is one of the highest numbers in the entire Asia-Pacific region.
SARS Changed Everything
The 2003 SARS outbreak was a turning point. Not just for public health, but for Singapore’s relationship with the WHO. SARS showed how important international cooperation and transparency are when a new disease hits. It also made clear that Singapore needed to be more plugged into global health decision-making.
After SARS, Singapore ran for a seat on the WHO Executive Board for the first time. They won in 2006. The Executive Board is the body that shapes the decisions and policies that go before the World Health Assembly. It has 34 elected members, each serving three-year terms.
Singapore was represented by Dr. Balaji Sadasivan, then Senior Minister of State for Foreign Affairs. In 2007, Dr. Balaji was elected Chairman of the Executive Board. That was the first time a Singaporean held a leadership role at the WHO.
The Story Behind Dr. Balaji
David Ho shares a personal detail about Dr. Balaji that most people do not know. Before entering politics, Dr. Balaji was a well-known neurosurgeon. But his career path was shaped, indirectly, by the WHO.
As a young medical student, Dr. Balaji won an international essay contest organized by the WHO. The topic was environmental issues. The prize was a trip to Minamata, Japan, for a neurological seminar. Minamata was the site of a mercury poisoning disaster that caused severe neurological damage in the local population. That experience influenced Dr. Balaji’s decision to go into neurosurgery.
As Chairman of the Executive Board, Dr. Balaji guided the WHO through major work on pandemic preparedness and non-communicable diseases. The landmark achievement during his tenure was the passing of the 2005 revision of the International Health Regulations. This created a more solid framework for reporting and responding to epidemics and pandemics worldwide.
Dr. Balaji continued attending WHO meetings even as his own health declined. He led Singapore’s delegation to the 63rd World Health Assembly in May 2010. He passed away four months later.
The Coffee Break That Changed David’s Mind
This is my favorite part of the chapter. It is a perfect example of why you should never assume your own perspective is the only one that matters.
David was in a WHO meeting about tracking non-communicable diseases. The WHO kept asking countries to submit data. David thought this was a waste of time. The data was not always useful. The collection process was tedious. Like a typical efficiency-minded Singaporean, he figured the time could be better spent on other things. He said so in the meeting.
During the coffee break, a delegate from a developing country came up to him. The delegate explained, with real passion, why that data was critical to his country. His government was not convinced of the need to invest in healthcare to prepare for non-communicable diseases. The only way to make the case was to show them hard numbers from a credible organization like the WHO. Data showing exactly how far behind they were compared to international standards. Without that data, nothing would change back home.
David realized he had been looking at the situation only through Singapore’s lens. For a developed country with good healthcare, the data collection was just paperwork. For a developing country, it was the difference between action and inaction. He withdrew his objections unconditionally.
That is a lesson that applies far beyond global health.
Why Coffee Breaks Are Not Accidental
David noticed something else about that coffee break exchange. The sensitive conversation did not happen at the meeting table. It happened informally, during the break. He learned this was not accidental.
WHO and UN meetings always have generous time set aside for coffee breaks. It is deliberate. Yes, caffeine helps people survive long negotiations. But the real purpose is to give delegates space to talk informally about positions they cannot share openly in a formal setting.
Most major breakthroughs at the WHO happen over coffee or during informal consultations. The WHO is a consensus-based organization. All major decisions are made by the membership as a whole, usually by health ministers at the annual World Health Assembly in May. Since voting is rare and consensus is the norm, those informal side conversations are essential to bringing 194 countries to agreement.
The Singing Director-General
David shares a wonderful story about the WHO Director-General at the time, Dr. Margaret Chan.
Dr. Chan was known inside health circles as the “singing DG.” When discussions got too heated, and they often did because health is an emotional subject, she would start singing. Her favorite song was “Getting to Know You” from the musical “Anna and the King.”
Imagine a room full of delegates from around the world, hopelessly divided on some policy issue. Then the Director-General starts singing. And then the whole room sings along.
It sounds funny. But it worked. It broke the tension. It reminded everyone in the room that they were all human beings trying to figure things out together. After the song, people could get back to the hard work of building consensus.
David’s takeaway: there are many different ways to communicate effectively. Singing is one of them.
Regional Coordinator for 37 Countries
One of David’s proudest achievements was being nominated by his peers to serve as Regional Coordinator for the Western Pacific Region. The WHO divides the world into six regions. Singapore and 37 other countries belong to the Western Pacific region.
As coordinator, David was the point person making sure all 37 countries stayed informed about WHO issues and had a voice in deliberations. He also represented the region’s positions in global health governance negotiations.
Coordinating 37 countries is hard. Each has its own interests, culture, and style. David’s approach was simple: meet people in person, usually over coffee or a casual meal. He found face-to-face conversations much more productive than emails. Discussions are more fluid and less guarded when you are sitting across a table from someone.
After two years of building those relationships, many of his working colleagues became friends. Even after everyone returned to their home countries, they kept in touch. The practical benefit: if you need information urgently, you can pick up the phone instead of navigating layers of bureaucracy.
Getting ASEAN a Voice at the WHO
Here is a piece of quiet diplomacy that David is clearly proud of.
The ten ASEAN countries, despite being geographically close, were split across two different WHO regions: Western Pacific and Southeast Asia. This meant ASEAN had almost no influence as a bloc at the World Health Assembly, even though they coordinated well at their own ASEAN Health Ministers Meetings.
David had an idea. What if ASEAN delivered a joint statement at the WHA? That would raise ASEAN’s profile as a credible group in international health.
But he also knew that it would look better if the idea came from the right place. Thailand was chairing the ASEAN Health Ministers Meeting at the time. So David used his personal relationship with the Thai delegation to suggest the idea to them. They agreed it was good, pushed for ASEAN’s endorsement, and it happened.
In 2013, Thailand took the floor at the 66th World Health Assembly on behalf of ASEAN to deliver its very first statement. The practice continued in 2014 and became a permanent part of the WHA calendar.
David’s lesson: as a small country, Singapore works best when it works quietly behind the scenes. He calls it “soft diplomacy.” You provide the idea and the value. You let others carry the flag when that makes the outcome more likely to succeed.
From Grateful Beginner to Global Contributor
David ends the chapter with a big-picture reflection. Singapore went from being a grateful recipient of WHO fellowships in the 1960s to having one of the best healthcare systems in the world. Along the way, Singaporeans have sat on steering committees for global health initiatives, participated in countless expert working groups, and been seconded to WHO offices around the world.
The future has challenges. Singapore’s population is aging. Global threats keep emerging. But David’s message is clear: the only way forward is to build a collective community of practice where expertise is shared and common goals are set together. Singapore will keep contributing. And it will keep learning from countries that have more experience in areas where Singapore does not.
That is the pattern this book describes again and again. Give and take. Learn and teach. Start small and keep building.
About the Author
David Ho graduated from the National University of Singapore in 2007 with a Honours degree in History. He started his career at the Ministry of Health in the International Cooperation Branch. He took on the Ministry’s WHO portfolio in 2010. From 2012 to 2014, he was seconded to Singapore’s Permanent Mission to the United Nations in Geneva, serving as First Secretary for Health. In Geneva, he was nominated by his international peers to serve as Regional Coordinator for the Western Pacific Region, representing 37 member states and areas for a two-year term.
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