JMIR Publications

ABSTRACT

Background:

The World Health Organization (WHO) plays a critical role in global health governance, but its popular legitimacy, a measure of public trust and support, has faced challenges, particularly during crises such as the COVID-19 pandemic. While legitimacy is widely studied through normative and elite-focused approaches, empirical assessments using public discourse remain limited. Social media platforms like X (formerly Twitter) offer real-time data for evaluating public sentiment toward WHO.

Objective:

This study aims to assess the evolution of the WHO’s popular legitimacy from 2008 to 2021 by analyzing public engagement metrics on X, with a particular focus on changes during the COVID-19 pandemic.

Methods:

We analyzed 46,667 tweets from the WHO using computational methods, including the retweet-to-reply ratio, sentiment analysis, and longitudinal trend evaluation. Metrics such as likes, retweets, and replies were examined to quantify public sentiment, with the retweet-to-reply ratio serving as a key indicator of controversy and support levels.

Results:

The WHO’s popular legitimacy was stable from 2008 to 2019 but declined significantly during the COVID-19 pandemic, reflecting heightened public scrutiny and criticism. Engagement metrics revealed increased replies relative to retweets during this period, indicating greater controversy in public discourse.

Conclusions:

This study demonstrates the feasibility of using social media metrics to measure IO legitimacy over time. The findings highlight the impact of global crises on public trust and provide a replicable framework for assessing legitimacy in other IOs. Social media engagement offers valuable insights for IOs to adapt communication strategies and maintain public trust during crises.