Who Begins: Transfer and Transformation of Administrative Culture From the League of Nations to the World Health Organization

“The League of Nations is dead, long live the United Nations!” – This manifesto-like statement by Lord Cecil, closing the League’s last Assembly in April 1946, signaled the symbolic passing of duties between these two organizations and a nearly generational transition from the interwar’s first experiment at world organization¹ to postwar internationalism.

Cecil underlined the symbolism of the League’s metaphorical cessation, thus singling the historical momentum of the presumed naissance for the UN. Just like the League itself only two generations before, this new international body became the focal point of the hope for perpetual peace and lasting international collaboration. The mystique of a new start addressed these projected hopes at the cost of unavoidably and incorrectly designating the League’s role as an overall failure. The narrative of the League as a failure also suggested a programmatic rupture in organizational structures and administrative cultures between these two bodies. Both assumptions, of failure and of the zero hour, persisted in the public and scholarly imagination for several decades. However, a more recent interest in the League and its effects upon international order and its successor organization, the UN, has manifested in the newer scholarship of the last decade, returning alongside the programmatic text “Back to the League of Nations”.² With this recent scholarship reevaluating the League’s effort, impact, and legacy, the last two decades saw a consistent rise in research and publication on various aspects of the twentieth century’s internationalism, convincingly undermining both the failure and zero hour tropes.

The League’s success and shaping impact is best traceable through the history of its technical and semi-autonomous associate organizations, for example in Natali Stegmann’s research on ILO’s involvement with social politics in the interwar Central Europe³ or Heidi Tworek’s illuminating account of the complex interplay between the national and international, while a robust and lasting system of medical intelligence and epidemic control was built up via the telegraph network across the globe.⁴ The thriving scholarship here also touched on thematic fields such as crime and security,⁵ intellectual cooperation,⁶ and the League’s attempts to address the issues of minority rights.⁷ All of these issues largely continued into the immediate aftermath of World War II, with lasting impact from the interwar period, and further undermined the UN zero hour – and the League as a failure – narratives.

The continuity appears particularly stark in the case of public health involvement: the League of Nations’ Health Organization was arguably one of the strongest and most impactful creations produced by the interwar iteration of internationalism. The research in this sphere is rich and leans on a longer tradition of studies of medical cooperation during the interwar period: from Susan Gross Solomon’s studies of Soviet attempts to rejoin the revolution-severed networks⁸ and Iris Borowy’s studies of the League’s engagement in stemming healthcare and epidemic control systems in the Far East and especially in China,⁹ to studies of individual actors inhabiting and acting in the spaces between the local, the national, and the international (e.g. Ludwik Rajchman in Katja Castryck-Naumann’s and Andrija Štampar in Sara Silverstein’s contribution to a larger collection spotlighting the Central European impact on interwar internationalism by Becker & Wheatley¹⁰) and, finally, to macro-scaled overview works like Thomas Zimmer’s Welt ohne Krankheit,¹¹ Iris Borowy’s Coming to Terms with World Health,¹² Josef Barona’s Health Policies in interwar Europe¹³ or Andrew Denning & Heidi Tworek’s The Interwar World.¹⁴ The continuity thesis, though never the primary focus of inquiry, is also addressed in Klaas Dykmann’s Internationale Organisationen und ihre Zivilisierungsbestrebungen¹⁵ and, last but not least, in Cueto, Brown & Fee’s The World Health Organization, A History.¹⁶ This article builds upon this currently vibrant rediscovery of the continuities that transposed several methodological approaches and epistemic assumptions, best-approved practices and, generally, the “civilizing worldview”¹⁷ of international officers in public health, from their first large institutional success with the League of Nations to the establishment of the currently active World Health Organization.

All this being said, it would be naïve to entirely deny the immediate aftermath of World War II and its momentum the power to rearrange the international order of public health and re-assemble it from an array of best-approved practices in administering medicine as exercised and tested in the interwar period.

Thus, this article debates the continuity in the transfer and transformation of administrative culture from the League of Nations to the World Health Organization. In pinpointing this volatile combination of the well-used and rearrangement of the pre-given, I argue for a more balanced approach that complicates the two extremes: the one that pledges a new start, which glosses over the highly interesting and practical replication of administrative structures, carry-over of personnel and in part political tensions and managerial animosities; and the other, which fully rejects the zero hour idea and thus misses the transformational impact of this historical moment.

The fact that the UNO and its agencies, the WHO being my selected example, survived the political tensions of the postwar era while the LON and its LNHO did not survive the interwar period is regularly attributed, among many other factors, to the drastically different way the USA engaged with internationalism during these two epochs. This argument is not untrue by any means, and it is largely correct that, for example, Thomas Zimmer ties the postwar success story to an increased and perpetual American involvement. My article does not so much counter this view¹⁸ – although I spotlight the largely “European”, LNHO-related continuities in the birth moment and administrative culture of the early WHO. Rather, I argue for a more complex view of the turning point in the 1940s. Just as it was not only US participation but a combination of many congruent developments in the postwar decades that made the UN stand out as a success, the “zero hour” assumption demands a more holistic and systemic view to be properly understood. It was largely a congruity of transfer and transformation, of both a deliberate perpetuation and change in administrative culture, and this is precisely the starting point of my article.

This text is dedicated to international public health officers, the carriers, interpreters, and transposers of continuity in administrative culture from the interwar to the postwar periods. In their complex role, the fine polysemic German word Übersetzer(*innen) perfectly describes their major function in the transition process. The article first reconstructs the foundational activities undertaken by selected top-level international public health officials and representatives of their governments, who were all familiar with each other from multiple previous cooperations within the League. While molding the WHO, they relied on their interwar background in navigating the multi-faceted and conflicted landscape of international public health and thus intelligently (occasionally almost too intelligently for their good) strategized about how to maintain the productive practices of administering their field. At the same time, they got rid of institutions and, apparently, players, with whom they grew to associate strongly.

The second part of the article focuses on the tacit carry-over of the League’s established and functioning mechanisms and networks, exemplified by staff pooling and overwhelming continuity of personnel-related politics. Here, a very pragmatic decision was made to overtake as many of the functional structures and people as possible, such that a question must be raised as to how far the WHO was a novelty at all but rather a proclamation of such endowed with a better budget. Fully aware that my modest approach does not compare to the research tool on the LNHO staff “Visual League,”¹⁹ recently released by Haakon Ikonomou’s research group, but is rather a sign of collegiate admiration, I provide a rough calculation on geographic distribution and thus diversity as done by the LNHO and then the early WHO in its first staff pooling. Both my calculations on the LNHO – and Visual League’s data on the LNHO – strongly support Dykmann’s argument for the League’s carefully selected, West-centered internationalism of the interwar period.²⁰ Adding up the early WHO sample is particularly telling from the viewpoint of continuity in the backend logic and mindset of administrative culture, with occasional small adjustments due to upscaling or minor improvements for officers themselves.

Among many other specialized agencies, the UN’s Health Organization was also at its naissance, cradled first within discussions of the UN’s Economic and Social Council (ECOSOC) and subsequently in two specialized launch platforms: The Technical Preparatory Committee and the Interim Commission. In two years, between February 1946 and June 1948, the two bodies drafted the cornerstone structures, statutes, play rules, and payrolls of the Health Organization to be officially signed off at the First World Health Assembly 1948. While doing so, officers sometimes created but often transformed and transferred the pre-existing procedures, instruments, and infrastructures previously run by the League’s Health Organization (LNHO). Several of these constituting experts also marveled at a professional track with various international bodies of the League and, thus, further contributed to the continuation and slow, mildly progressive transformation of administrative cultures between the two global public health organizations.

If we approach the WHO’s history from memoirs of some of its “founding fathers”, we easily come across an insightful and entertaining account by Sze Szeming, who will accompany us throughout this first section of the article. A Chinese expert with a remarkable domestic and international career in public health administration, then aiding the diplomatic services in the USA while working with the UNRRA during World War II, Sze joined his country’s delegation to the UN-establishing San Francisco conference. As a representative of this internationally trained and modernizing young experts’ cohort in the Chiang Kai-shek Republic, Sze wrote his diary in a mixture of Chinese and English, meticulously noting his encounters, negotiations and observations at the conference and afterwards, his observations as an eye-witness to all WHO-establishing momenta: to the preliminary council of the UN Economic and Social Council in February 1946, the Technical Preparatory Committee, and then the Interim Commission.

In his interview with the WHO’s World Health in 1989,²¹ his memoirs²² and his private diary of 1945, Sze consistently recreates a story, according to which two elder colleagues from Norwegian and Brazilian delegations approached him at lunch in San Francisco.²³ They expressed their concern that the term “health” was never on the agendas of the UN, nor was there any visible effort on behalf of the US and UK delegations to enhance the creation of any comprehensive international health agency. The three set off to negotiate and suggested that a new International Health Organization be created, which was then finally sealed by the decision of the Economic and Social Council in February 1946 and began the broadscale work on drafting the WHO. Thus, very much in line with the aforementioned narrative of 1945 being a starting point for the whole UN, and perhaps in line with his own conviction if not with the real state of affairs, decades later, Sze revoked that the World Health Organization came into being largely by this accidental meeting of him and two other colleagues.²⁴

Of course, a closer look at the founding years of the WHO reveals a far more intricate picture. Health in its broadest definition and the international governance of it never vanished from the agendas. Neither did the awareness of a need for a large and universally representative international organization to deal with short-and long-term agendas of public health. Though severely aggravated through the war, the cooperation of medical research and public health never ceased entirely, nor did the drafting of the postwar design of international public health.

The most prominent international organization in the field, the League’s Health Section, was, indeed, financially starved, drained of personnel and either scattered across its many fragmented exiled wartime offices or largely isolated within the neutral and occupied Switzerland. Nevertheless, as far as the scarce resources and sheer enthusiasm of the remaining staff allowed, the LNHO remained active and productive.²⁵ The travel activity and correspondence of the Section’s wartime director, Raymond Gautier,²⁶ gives an insight into the most tedious efforts international experts made to maintain the best possible circulation of epidemiological data,²⁷ to keep in touch with their colleagues in countries occupied by the Reich,²⁸ to enforce the standardization of medicines²⁹ and testing of vaccines,³⁰ and to draft the future design of one International Health Organization as soon after the end of the war. Additionally, some of the functions of the LNHO (and those of the Office International, which we will consider later on) were overtaken by the UNRRA, 1943-born United Nations Relief and Reconstruction Administration, with which Sze was also affiliated. UNRRA could operate broadly during wartime, thanks to US involvement and generous budgeting, but it was still a temporary solution for the postwar period.³¹

Thus, it is most unlikely that health went missing or was forgotten or neglected in the afterwar re-draft of international order. What is noticeable, however, is that players who were quite renowned and had a consistent track record for administering public health transnationally in the interwar period. The Norwegian Karl Evang and the Brazilian Gerald de Paula Souza apparently had no knowledge of how the victorious powers of the World War II would approach and handle their area of expertise. While in Evang’s case the slight lack of information might be attributed to the general disruption of knowledge networks in the chaos of war, Souza was well entangled within the Pan-American Sanitary Bureau, and Sze spent the war years working for the UNRRA in the USA.

Sze’s feverish attempts to make contact with Thomas Parran, the US Surgeon General, introduced the Chinese expert to perplexities of transatlantic rivalry and the collective will of many central players to tread softly in order to avoid any collaboration with French colleagues (which we shall discuss later on). These attempts and the lack of pre-conference knowledge on plans for global public health reveal a remarkably uneven distribution of information, even among well-connected players. This brings to mind the polyphony of governing public health in the interwar period, with many overlapping networks and organizations only partially working with each other despite them often sharing top-level experts. The most prominent example here was, of course, the one rivaling international health agency – l’Office International d’Hygiène Publique, established before the League and its Health Section and never integrated into the League, maintaining close bonds with the French government, which became fatal to l’Office’s reputation after the fall of France in 1940.

Renowned officers’ lack of information on how health would be approached and treated in a postWorld War II design also hints at another unbroken structural continuity in managing international public health. Along the lines of Dykmann’s argument, there were carefully orchestrated West-dominated forms of organizing and running international organizations while players considered less central (even if they were strictly speaking European, like Karl Evang) had much less access to the level of discussing, designing, and decision-making. Finally, the apparent laissez-faire approach to managing international health, as apparently adopted by the US, the UK, and a few other central-enough players, bears a striking resemblance to a similar constituting phase of the League itself, with the Health Section coming to life in most vague a formulation, the most “unbureaucratic” manner possible.³² Let us briefly consider this omission as a strategy.

Unlike Sze, Evang, and Souza, LNHO officers, though absent from San Francisco, had a good enough knowledge of the health agenda missing from the program.³³ Thus, we might ask if the intent to (re-) establish a large international body to deal with public health was truly forgotten or if it was missing from San Francisco for strategic purposes.

For the League’s players, the fact that a health agency was not explicitly set up right away in San Francisco did not speak for a lack of interest in managing international public health but rather for a US/British strategy that they might have known about from how their own body, the LNHO, came into being one generation prior. The idea in both cases was very much the same: first, install the general scaffold of the larger mother organization, then specify and design narrower sub-bodies according to the current agenda and necessity.³⁴

One of the immediate benefits of keeping their cards concealed was a very deliberate attempt to evade any negotiation with French representatives, who were at the very least actively engaged with hosting foundational conferences, if not a whole new public health organization in Paris. They were also largely expected to intervene on behalf of the Paris-based l’Office International d’Hygiène Publique.³⁵

The interwar time here had been largely shaped by the duality of the League’s Health Committee and the Office, which no effort of the League managed to merge so that only one agency would be coherently responsible for policing global public health.³⁶ As we learn from Sze’s detailed diaries, French experts were in the running early on to host both the ECOSOC meeting and any other preparatory bodies to follow. By the time the ECOSOC approved the Technical Preparatory Committee to convene in late March 1946, there was – among another four – a French draft submitted by high officials from the Health Ministry on how they envisioned a future agency to function. Much of the effort was thus spent on securing that the multifocality and concurrence of coexistent health authorities from the interwar were not replicated into the postwar time regardless of draft authorship, and a merge was enforced for the Office.

However, another possible interpretation of the reservations on behalf of the French comes from the pre-war switch of administrative leadership and the figure of Joseph Avenol, the Secretary-General from 1933. Avenol’s years saw an internal structural reform of the League’s workflows.³⁷ Strategically, this meant switching to a deliberately apolitical and appeasing stance that made the League tolerate Italian and NS-German expansionism and ended with the SecretaryGeneral co-opting with the Nazi regime after the war broke out.³⁸ Whether it was the well-hidden Anglo-American aversion toward the structural change in the League that Avenol introduced or the Nazi-cooptation, which was traceable in the wartime politics of the Paris-based Office, the somewhat irrational secretiveness of the US-American fraction becomes more understandable.³⁹ With the narrative of a new start, the legacy of the League’s final years under Avenol might have triggered such heavy momentum that it cast a shade of general suspicion on a whole French crew and agency. As we will soon see, this anxiety was inherent to all participating fractions. It led, in part, to redundant over-cautiousness that slowed down rather than sped up the establishment of the new international public health agency.

Let us now have a closer look at these drafts, the actors and agendas behind them, and how all these largely carried on from the League, seeking to make good use of the epoch’s momentum to reshuffle the old suboptimum of internationally governed public health.

When the Technical Preparatory Committee met in Paris in late February 1946, four drafts and one memorandum were provided. The authors submitting these documents were all but one representative of whole groupings of actors, be they from the same country or organization, and each envisioning the future Health Organization in their own way. These documents were, as per the submitting author, drafts by André Cavaillon and Xavier Lenclainche (France), by Thomas Parran (US),⁴⁰ by William Jameson (UK),⁴¹ and finally, a draft by Andrija Štampar (Yugoslavia)⁴² and a memorandum by Ludwik Rajchman.⁴³

There was a lot of adjustment to the League’s Health Organization due to quite a different constellation of powers supporting and explicitly willing their people to engage with the activities of UN-led internationalism and with public health in particular. Whereas the League was largely drafted by the Big Three of the time, Britain, France, and the US, with the US very soon withdrawing from officially manifested cooperation and other great powers of the time, including Russia, Germany and Japan, entirely missing, the new zero hour 1945 offered a chance for a more productive reshuffle.

A general consensus in scholarship ties the success of the UN system and its postwar internationalism to the new reality after 1945, in which the USA abandoned its previous isolationist position and delved actively into the redesigning of the world. This is to a large extent true, although I would prefer a somewhat milder formulation of the authorship behind the success story to at least a collective understanding and interest in continuing a worldwide organizational body as shared by the wartime Allied forces, as Sayward puts it.⁴⁴ With the USA swiftly positioning itself as one of the two superpowers of the postwar world order, this newly discovered active engagement, or in Wertheim’s apt description⁴⁵ an instrumental internationalism, threw additional revenue of reputational gain at the unraveling political competition with the USSR, a rivalry that shaped but also boosted global interrelations in the second half of the century.⁴⁶

The UN project was largely carried out by the Big Five of the postwar period, i.e. the US, the UK, the USSR, France, and China. In the case of the WHO, it meant a very early upscaling and codification of proposed play rules. Unlike in 1919, drafting experts now had to consider rather divergent political vectors among the involved powers, with the Cold War unraveling almost in parallel to the UN agencies being launched and the Chinese revolution to follow.

Reporting on the ECOSOC Council meeting to launch the TPC in February 1946, Sze showed his excessive dissatisfaction with the fact that the designated Chairman, Andrija Štampar, was “bowing to Russian wishes on every occasion”, which in Sze’s eyes resulted in confusion and an unnecessary and irritating delay in setting up the future WHO almost there and then, that is at the latest after the TPC convention a month after the described moment.⁴⁷ It was not only the solo effort of Štampar to take the Soviets into account but rather a new postwar reality, as well as the LNHO’s unique experience of comparatively successful cooperation with the USSR before it became mainstream, to which the far more experienced expert knew to abide better than Sze.

The delay in establishing the WHO might have been somewhat unnerving for the younger Chinese official, yet it also aided in providing a clearer structure for the new health authority. The organizational structure of the LNHO grew largely out of everyday practice. Bodies and positions were gradually created when the need arose through a simple shift of responsibilities, shortterm contracts or lending staff from other offices of the League (we will return to this issue later), which for the time being remained the mother body of the LNHO. This provided the LNHO with legitimacy and prestige but also translated major political tensions from other areas into the health sector.

In this regard, the four mentioned drafts that were suggested to the TPC included a certain variation on how the future public health body should attach to the UN as a whole, whether it should function as a separate agency in close alliance with the UN or within the UN as one of its departments. The Parran-draft, to which Sze attended meticulously, was aiming for the largest amount of autonomy straight away, with membership to the future WHO being decided on its own terms, thus not automatically carrying over the list of all UN member states but rather deciding on practices of in-and exclusion autonomously. At the same time, autonomy came at the risk of being disposed of and replaced by the UN should the WHO fail. In contrast, such a step would be impossible if the organization decided to operate as a constituent part of the UN. The Štampar draft, attributable to the LNHO group, for this reason (and perhaps because the League operated similarly, and the draft came from the League officers proper) largely sought to underline the close bond with the UN. Correspondence between the actors in this cluster supports the claim that they largely sympathized with the fully embedded solution.

In the long run, the decision on this issue was postponed at the ECOSOC and then repeatedly adjourned at the TPC to be decided in the IC – in favor of an agency autonomous but underlining its proximity to the UN as much as possible. All in all, the delay was legitimately well used to coordinate a clear basic set of play rules and a scaffold of organizational structure, which, at least in the early days of the WHO, was astonishingly readable compared to the all-flexible, overlapping and over-entangled composition of the LNHO.

The drafts also provide valuable insight into the intricacy of administrative consideration across different national and institutional schools of public health as well as into the nuanced entanglement of players largely familiar with each other and thus acting in a way that is indicant of attempts to precipitate responses of each group.

The already mentioned Sze was present at the TPC meetings in Paris. Since the San Francisco conference in 1945, he joined the group of younger US-American experts. Another (and perhaps far more prominent) member of this group was Surgeon General Thomas Parran, the supreme chief of public health services in the USA. If we trust Sze’s private diary accounts, this fraction established vivid communication with some British colleagues. Parran also introduced his Chinese peer into intercontinental rivalry with no the more closely defined but collective “French”: Sze’s diary entries feature numerous comments about not letting the French host the Preparatory Committee in Paris, for they might also want to overtake the Interim Commission.⁴⁸ Although Sze never explicitly mentions it, it is highly probable that the lion’s share of this effort – which, as we shall see shortly, occasionally led to unnecessary mistrust toward experts from Continental Europe en masse – was due to the prominent aspiration to eliminate l’Office.

At a certain point during the San Francisco conference, Sze also approached no other than Ludwik Rajchman – the first Director of the League’s Health Section who, upon fleeing to the USA from the Nazis, now cooperated with the UNRRA.⁴⁹ Sze sought cooperation and support in building up his, or his group’s, vision of a new health organization, and the idea to contact Rajchman was quite logical given the group’s antiFrench sentiment and Rajchman’s departure from the League with the start of the Avenol era.

However, to the disappointment of his younger addressee, Rajchman showed rather little interest in pushing through any resolutions or drafting any new health organizations together; apparently, he had been working on a draft of his own. Though clearly the bearer of the LNHO tradition, Rajchman was no longer attached to the Geneva cluster or in contact with his successor, Gautier. Even more essentially, Rajchman submitted a separate document to the Preparatory Committee;⁵⁰ however, this document was titled a memorandum, not a draft, and Rajchman was neither present at the TPC in Paris nor were his thoughts taken into closer account when comparing drafts for the final version.

Yet another draft came in under the name of a Yugoslav health expert, Andrija Štampar, whom we should remember from Sze’s indignation a few passages above. Štampar would play a crucial role in the early WHO – no less prominent was his deep, decades-long engagement with the LNHO.⁵¹ Prior to the TPC, Štampar chaired the sessions of the ECOSOC; the very fact that this largely international, exceedingly renowned scholar was chosen for the chairmanship seems to effectively negate Sze’s assumption that no one spared a thought about health at the UN level. By the mid-1940s, Štampar, together with Rajchman and perhaps two to three other experts, belonged to the star cohort of the interwar generation in international public health.⁵²

Štampar’s standing, apparently unknown to Sze, was large enough for yet another equally prominent actor with a comparably long League experience, Senior Officer to the British Ministry of Health Melville Mackenzie, to fear Štampar’s dominance at the ECOSOC and then Preparatory Committee. To counter such a chance, Mackenzie maneuvered the ECOSOC to allow each country to assign both delegates and their alternates.⁵³ This resulted in a large presence of US and UK parties in London and Paris.⁵⁴ Mackenzie’s cluster also provided their own draft, envisioning the future of what would become the WHO.⁵⁵

Mackenzie’s wish to hold Štampar in check might have also had a second motivation, as the Croatian scholar was in avid communication with the two aforementioned League health officials of the wartime, Gautier and Biraud. Their correspondence, though not indicative of a clear-cut timestamp, still reveals the three being actively involved in molding their own draft for the constitution of the future health organization.⁵⁶

The League’s immediate officials were rather underrepresented at the Technical Preparatory Committee. Biraud’s pre-TPC correspondence with Gautier, Štampar, the League’s Secretary-General Sean Lester and the UN Economic and Social Council in London reveals feasible anxiety and misapprehension on the Geneva side. Biraud had been initially suggested to become the Technical Preparatory Committee secretary.⁵⁷ For this constellation, Gautier, the current Director of the LNHO, would serve as the representative of the organization, and the French expert Jacques Parisot was foreseen as an alternate; his standing within the French public health sector was considered very profitable for bringing across the League’s legacies.⁵⁸ However, the start date came ever closer while the invitation and all relevant information were missing, such that Biraud had to rearrange and vigorously write correspondences. He wrote to and telegraphed Štampar, ensuring that, in his ECOSOC capacity, Štampar would bring the League’s draft over if no one else should be invited. Biraud also wrote⁵⁹ and then finally telephoned John Tomlinson, the Secretary of the ECOSOC in London, on February 28 and afterwards protocoled that the initial invitation to serve as a secretary had to be withdrawn out of “fear of interorganization jealousy – and of prejudice. The influence at play was not (sic) that of the Office International d’Hygiène”.⁶⁰ For want of any direct proof and based on previously displayed power constellations, this “jealousy” might either be that of Štampar for Mackenzie⁶¹ – or, more probably, that of the US-American cluster for the French predominance. The second can be partially supported because the designated Secretary, Howard Calderwood, belonged to the Parran & Sze US cluster.

Unbeknownst to Tomlinson, the (proper) French person of Health Secretary Cavaillon had approached Biraud well in advance, asking for his assistance in organizing the Committee in Paris. He then joined the event in an official capacity as the LNHO representative. At the same time, Štampar left his League background as unexplained as many other participants’.

While the secretary role fell to a US-American official, the designated chairman yet again maintained a perfect track record with the League’s Health Organization: Belgian Dr René Sand participated in a total of five health-related bodies of the League from 1923 and belonged to the same star league of international public health as Štampar, Rajchman, and (former Surgeon General) Hugh Cumming, representing the Pan-American Sanitary Bureau at the TPC. Like Mackenzie, Cumming also maintained the most vivid correspondence with the League’s core members throughout the war. This exchange included, in both cases, long elaborations on the future of the sector and the prospective change necessary to strengthen the new Health Organization, which was being born at the time.

A closer look at the actor constellation thus unavoidably evokes the sense of a post-graduation class reunion, with more or less popular students forming new roles and alliances. Some new participants, for example the Parran and Sze cluster, insistently attempted to be in the spotlight, unaware of the unspoken dynamics well-studied by everybody else. I am inclined to interpret the general caution to invite League members, along with what Sze identifies as the continental or French school, as an effort to eliminate any opportunity for the involved parties to preserve the interwar plurality or, even more significantly, the interwar duality and competition of legitimacies in international public health, which were crucial to the continued existence of the Parisian Office.

The drafts submitted for consideration of the TPC might also vary in one or the other technicality, but the final version was, at a closer look, the product of collective work with traceable inputs from all four mentioned drafts (though arguably with a US-American touch). What seems interesting about the whole debate is, however, less the issue of formulations in drafts, as these would be dynamically abandoned or adopted while in discussion, but rather that all four drafts and all involved parties, despite the unspoken tensions and motifs, maintained a very feasible, largely overlapping core imagery of what the future WHO should look like. Technical differences between drafts might touch upon a proposed composition of the governing body or positioning certain programmatic moments (e.g. aims and scope of the organization) either en passe in the preamble or more extensively in the text body. One crucial moment of discussion, which we will consider in the next Section of this article, was the impactful decision of embeddedness within the mother organization, the UN, or autonomy from it. However, all the drafts, including the French one, proposed one unified organization. To achieve this, it was necessary to administratively “kill off”, that is to merge, l’Office, which the LNHO never managed and for which the chance presented itself now.

The TPC may not have run satisfactorily for many actors. Sze was dismayed about postponing the WHO there and then, as well as about Štampar’s presumed overfriendliness with the Soviets. Biraud disliked what to him apparently felt like preferential treatment of state officials over international health experts. Mackenzie (rightly) suspected Štampar of having too close a connection with the League’s remaining officers. The League’s experts did not hesitate to mention that the British, including Mackenzie, were overcrowding the delegation with members that were unrelated to health, hinting at some of these being experts’ spouses.

However, in the view of the TPC, its major institutional contribution – apart from establishing the foundation upon which the WHO could now be built – was the fact that the most central yearning of many fractions, and, unacknowledged to each other, both Americans around Parran and Europeans around Biraud and Štampar, was now finally being brought to life. It became possible to merge all formerly existent regional, interregional and international health organizations into a single one, most notably of the French l’Office International.

This merger agreed on a landslide change in international public health. An important consequence was that new comprehensive rules for staffing had to be created, or also merged. Let us now look at the transformation and transfer of the League’s practices of hiring, managing and deploying personnel into the WHO.

When approaching the history of international organizations from the contemporary viewpoint, “backward” in time, an elusive yet quite persistent impression emerges of the years around 1945 as being a clear-cut zero hour separating effective and functional internationalism of the second half of the twentieth century from its implicitly faulty interwar predecessor. The winner narrative of the new start, largely propagated by the early UN itself, must have struck a nerve on many levels, be it the strife for political and socioeconomic reconstruction or the subsequent fragmentation of worldwide politics across the lines of the Cold War or decolonization, where UN bodies frequently served as the only available common ground for warring sides to cooperate productively aside from otherwise outweighing animosities. Within the decades to come, the WHO had a series of such cooperations in the balance, which, though sometimes assessed as sub-optimally executed due to superpowers’ rivalries, still brought relief and improved the living conditions of millions of people across the globe.⁹⁴

This article discusses the transfer and transformation of administrative culture and within it the personnel between the WHO and its interwar predecessor, the LNHO. I argue against programmatic statements and their logic that the years 1945-46 were a truly novel zero hour of internationalism. Arguably, this zero hour mentality might fit better into other technical organizations – the momentum would be considerably different for those UN agencies that did not have direct predecessors in the interwar League of Nations design. We might expect the zero hour argument to hold better with UNICEF, for example. At the same time, a number of postwar UN agencies underwent a rather comparable change to the WHO: let us think of UNESCO growing out of the interwar International Committee on Intellectual Cooperation (ICIC) or FAO also having its firm ties in the League’s design. Comparing the transfer and transformation patterns across these not-so-new agencies demands a study in its own right. It would be my pleasure to imagine my modest contribution from the sphere of international public health igniting a scholarly curiosity to pursue such a topic. Concerning public health, however, the fine mixture of continuity and adjustment is well traceable and clearly refutes the zero hour statements of the founding years.

Spotlighting this continuity between the interwar LNHO and the postwar WHO, I occasionally signal that the volatile moment around re-establishing the new international order in the late 1940s also allowed for changes and adaptations. One crucial adaptation was the long overdue gradual carry-over of the interwar’s coexistent and partially contestant regional and superregional public health organizations. The most prominent example here was l’Office International d’Hygiène Publique’s attempt to maintain an overly strong position. This led, as I discuss in the first part of the article, to a somewhat counterintuitive situation of mutual anxiety and almost estrangement between US-American and European players, the former apparently expecting the League’s officers to advocate for l’Office and thus holding them in check.

There is a consistent continuity of actors in decision-making positions: largely all the same group of experts who spent many years in contact with or at the service of the LNHO were now entitled to draft the future of international public health. In doing so, these experts actively utilized their knowledge, true and false, of each other, at times enhancing each other’s agencies and blocking each other out for fear of the larger vision suffering should they not act. Reading their correspondence and diaries from the omniscient vantage point of today, it appears that such standing in each other’s way was largely unnecessary, given that seemingly all these experts shared a broad, though unexpressed, consensus of what their future WHO should look like.

The developing WHO was in many regards an expanded and also somewhat modified version of the LNHO. On the one hand, the health organization was finally upscaled in personnel and budget. However, even more prominently, it could finally be unified by merging various public health bodies that resisted productive unity in the previous generation. A closer look into the staff pooling, hiring and managing policies of the early WHO, reveals an unbroken transfer of administrative cultures from the LNHO to the new agency. In these terms, and unlike in the proclamationlike statement by Lord Cecil from the beginning of this text, the League was far from being dead. Indeed, the UN and its many quite productive agencies carried on with its ideas, practices and cultures – the WHO being one of these carriers.

There were of course other public health organizations that I come to mention only in passing: the PASB and the wartime UNRRA being two such examples. It is an endeavor in its own right to trace and compare the process of how the annihilation of the PASB into the solidifying system of the WHO differed from that of the l’Office – an ambitious idea I reserve for another contribution. In a similar manner, it will take broader research and a text of its own to pursue an intriguing cross-organization comparison, which would help to embed the continuity and change of public health in other international endeavors carried out between the inter-and postwar periods. Simply claiming that the UN agencies pragmatically carried over what they could and upscaled everything thanks to US money, does not do the intricate transformation process around the time justice, nor the rapidly changing geopolitical landscape.

Where for public health, Thomas Zimmer largely attributes the institutional stability, longevity and effectiveness of the WHO to the radically different – and directly involved – participation pattern of the US⁹⁵ (which the League’s Health Section lacked, though partially balanced out through engagement with the Rockefeller Foundation), I am inclined to see the success story of the WHO more as a felicitous congruity of “endemic” transformation and exogenous change of the international context. One of many contributing factors was, surely, the approaching Cold War and its competition of two political and world systems for minds and sympathies across the globe (Zimmer touches upon this issue rather marginally. Cueto, Brown, and Fee suggest a more detailed insight into how the Cold War translated into public health and occasionally pushed it up). Emerging decolonization also dramatically changed weights and introduced new players into the field of internationalism, players for whose allegiance superpowers no longer competed on the battlefield, but in spheres focusing on heightening the standard of life, precisely like public health, or, an equally interesting comparison by Peter Ridder, in the area of human rights.⁹⁶ Still, it would take an article, or rather an edited volume of its own to do this matter justice. This contribution was set to work with a limited sample of administrative staff considering transfer and transformation in public health.

Summing up, a highly dynamic picture emerges – one of transformation embedded in a large and systematic continuity. Unlike the early declarations of UN authorities, documents on the founding years of the WHO reveal the continuity of many administrative practices, functional bodies and work focus areas of the LNHO. These largely lived under new labels and added to the legitimacy that the WHO needed in its formative years. In revealing and analyzing these continuities from the interwar decades of public health internationalism, my article contributes to a more complex and comprehensive picture of how global international bodies survive and live on even after their presumed and declared death.