Sorry, I couldn’t resist the cheesy headline, but on a more serious note, while the current debate over the effectiveness of the World Health Organization is much-needed and has merit, it’s also riddled with myths and misconceptions about what the WHO can and cannot do.
In April, President Trump announced he was suspending U.S. funding for the WHO, accusing the agency of botching its response to the coronavirus pandemic, specifically by siding with the Chinese early on.
The backlash was fast and fierce. Critics of the move accused the president of using the WHO (and by extension China) as a scapegoat for his own botched response to the pandemic, and they argue that cutting off funding in the midst of global health crisis is the worst possible time to kneecap the international body specifically tasked with trying to contain that crisis.
Supporters of Trump’s decision point out that the WHO’s delayed response helped the pandemic spread and that its praise of China — despite the country’s lack of transparency — has undermined its authority.
Both are valid arguments, but what often gets lost in any discussion of the WHO are the intricacies of how it actually functions — and the inherent limitations it faces.
The WHO is the U.N. agency responsible for all global health matters. Established in 1948 and based in Geneva, the WHO works with 194 member states in over 150 offices across six regions.
It sounds like this giant international entity doesn’t it? In reality, it’s not all that big.
Many experts say the WHO’s staff — 7,000 — and a biennial budget of just $6.3 billion are not nearly commensurate with its broad mandate. That mandate includes everything from improving access to health services in some of the world’s poorest countries, to supporting initiatives ranging from polio eradication to maternal health, to coordinating global responses to emergencies such as the coronavirus pandemic.
As Bryan Walsh of Axios pointed out, with just over $6 billion to work with in 2018 and 2019, “the WHO has about as much cash to spend as a large urban hospital system in the U.S., and significantly less than the U.S. Centers for Disease Control and Prevention.”
The U.S. is the WHO’s largest funder (in both assessed and voluntary contributions), providing nearly $900 million during its current two-year funding period, roughly 15% of the WHO’s total budget. In comparison, China provided $86 billion over the same two-year timeframe.
Trump’s budget freeze may not have an immediate impact because other countries and donors like the Bill & Melinda Gates Foundation will likely step in to make up for the shortfall. But long term, any loss of funds from the U.S. government would seriously hurt the world body’s ability to combat infectious diseases (including any future pandemics).
The WHO’s reliance on donors is often cited as its biggest impediment, because it naturally constrains its ability to outright criticize those donors.
So there’s a lot of truth to accusations that WHO Director-General Tedros Adhanom Ghebreyesus (who was elected to his five-year term in part because of Chinese support) essentially parroted many Chinese talking points during the early stages of the pandemic, when in fact well-documented reports indicate that Beijing initially hid the true extent of the crisis in Wuhan (and continues to downplay the number of cases).
“The W.H.O. really blew it. For some reason, funded largely by the United States, yet very China centric. We will be giving that a good look,” Trump tweeted.
Even Andrew Cuomo, New York’s Democratic governor, agrees with Trump’s criticisms. “The president says it’s the World Health Organization, and that’s why he’s taken action against them. Not my field. But he’s right to ask the question because this was too little, too late,” he tweeted.
At the same time, the WHO has also refrained from criticizing the Trump administration for its own laggard response (the president did not declare a national emergency until mid-March).
Whether it’s China or the U.S., the WHO can’t exactly bite the hands that feed it.
Here’s another often-overlooked tidbit: Only 20% of the WHO’s budget comes from assessed — i.e. mandatory — contributions from countries. The rest comes from voluntary contributions (from both governments and other donors). Those contributions are earmarked for specific initiatives, such as polio eradication, further hamstringing the agency’s ability to divert resources to more immediate crises.
The WHO also relies on countries to voluntarily disclose information on health crises, so it’s essentially at the mercy of governments to be invited to investigate a crisis. In other words, alienate Beijing and odds are it’s not going to let you in.
But prominent Republicans like Michael McCaul, the ranking member of the House Foreign Affairs Committee, has accused China of “the worst coverup in history.” He told Kimberly Dozier of TIME magazine that whether “through incompetence or complicity,” the WHO is responsible for the outbreak becoming a global pandemic.
Yet a closer look at the timing of the WHO’s actions reveal a more nuanced story.
As a group of Democratic senators pointed out in a letter to Secretary of State Mike Pompeo: “On January 23, the World Health Organization (WHO) warned of the virus’ human-to-human transmission, its four percent death rate, and that the virus had the potential to reach any country, a warning that proved prudent given that the U.S. had announced its first confirmed case two days prior, on January 21. U.S. diplomats were returning from Wuhan around the same time and the State Department’s epidemiologist warned that the virus could develop into a pandemic. On January 30, one day after President Trump announced the formation of the White House Coronavirus Task Force, the WHO declared COVID-19 a public health emergency of international concern.”
That said, the WHO is no stranger to criticism that it’s dragged its feet.
The Washington Diplomat has an excellent article — in my humble, unbiased opinion 🙂 — on how the WHO used the lessons it learned from its flawed response to the Ebola outbreak in West Africa in 2014 to inform its current response to coronavirus.
Dr. Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention, said the WHO’s response to the pandemic “has been much better than the Ebola response.”
“This is an unprecedented situation,” Frieden told our reporter Deryl Davis, “and the WHO is generally doing a good job,” although he added that the agency’s formal designation of the outbreak as a pandemic on March 11 “was slightly overdue.”
But for Republicans like McCaul — who has called for the resignation Dr. Tedros — “slightly” is a gross understatement. They argue that the WHO wasted precious time as the pandemic spread and are launching investigations of what went wrong. Democrats point out that those investigations conveniently ignore Trump’s own handling of the pandemic, which he downplayed as the flu for weeks.
There’s little doubt the WHO, like many sprawling bureaucracies dependent on donors, is in need of reform.
Even Dr. Tedros has admitted as much, pledging a review of the agency’s coronavirus response.
But he says that should come after, not during, a pandemic. For now, the priority should be on saving lives.
“If you don’t want many more body bags, then you refrain from politicizing [the debate],” he warned.
Others agree that the timing couldn’t be worse. “Now is a time for unity in the global battle to push the COVID-19 pandemic into reverse, not a time to cut the resources of the … WHO, which is spearheading and coordinating the global body’s efforts,” U.N. Secretary-General António Guterres said in a statement.
Those efforts include providing vital testing kits, medical equipment and advice to poorer countries at risk of a major explosion in cases.
A tweet by Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, neatly sums up the decision to cut off funding now is counterproductive — akin to defunding a fire department in the middle of a fire “on the grounds they ought to have got to the fire sooner.”
Moreover, experts say the U.S. can exert far more influence in reforming the WHO by continuing to be a major financial player in the organization. And fixing an imperfect WHO from the inside is a whole lot easier that trying to establish a brand new global health body from scratch, an idea some Trump aides have reportedly floated.
Finally, critics argue that abandoning the WHO to protest Chinese interference is self-defeating because China will be all too eager to fill the void that the U.S. leaves behind.
In fact, China has been quietly trying to do just — and not only in the WHO but in other multilateral bodies — as Kristine Lee reported in an April 15 article for Politico Magazine.
“It might be easy to dismiss this move [to cut off funding] as trademark Trumpian blame deflection or saber-rattling or shortsighted isolationism. But for people who’ve been watching China’s growing activism in the United Nations closely, the WHO’s deference to China is no surprise. In fact, it’s just the exposed tip of a dangerous iceberg — and Trump is careening straight toward it,” Lee wrote.
“Beijing’s leverage over the WHO cannot be understood independently of a much longer and broader campaign, one that aims to bend the arc of global governance toward a more illiberal orientation that privileges the interests of authoritarian actors,” she argued, adding that, “Over the past several years, Beijing has systematically positioned Chinese nationals at the head of a wide range of U.N. agencies.”
On that note, after Trump’s announcement, China announced it was pledging an additional $30 million to the WHO, on top of a $20 million cash donation it made in March.
Photo: By United States Mission Geneva – Flickr: World Health Organization Headquarters and Flag, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=18609992
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