Since the outbreak of the Covid-19 pandemic, the World Health Organization (WHO) has been coordinating one of the largest global responses to a disease outbreak in its history. Despite these efforts, in May 2020 U.S. President Donald Trump said that he would suspend funding of the United Nations (UN) health agency and began formal withdrawal from the WHO in July 2020. In response, Joe Biden vowed to reverse the decision on his first day in office.
Following Biden’s victory in the 2020 United States presidential elections and his remarks about the WHO, it is worth asking why Trump wanted to leave the WHO in the first place, whether his critique was justified and what Biden’s election means for the future of the organisation and global health.
Trump’s critique of the WHO
Trump has criticised the WHO’s response to the Covid-19 pandemic for various reasons. In April 2020, he said that the organisation ‘failed to adequately obtain, vet and share information in a timely and transparent fashion’. He also directly addressed the WHO in May stating that the organisation had ‘consistently ignored credible reports of the virus spreading in Wuhan in early December 2019 or even earlier, including reports from the Lancet medical journal’. In this letter, Trump further mentioned that the WHO spread the idea that human-to-human transmission was not taking place as of January 14, and emphasized that the WHO has ‘an alarming lack of independence’ from China.
Investigating the value of these claims, BBC found that most do not hold ground. While it is true that the WHO tweeted on January 14 that ‘preliminary investigations’ by Chinese authorities had not found evidence of human-to-human transmission of the virus, another WHO expert suggested the same day that limited human-to-human transmission had been observed in Wuhan. Shortly after, the WHO reported that there was evidence of human-to-human transmission, but further investigation was needed. Additionally, the Lancet only published its first reports about Covid-19 on January 24. During this period, many experts and political leaders, including Trump himself, praised China’s initial response to the outbreak..
Trump is not the only one who has now criticised the WHO’s stance towards China. Even as evidence mounted that the Chinese government silenced whistleblowers and undercounted cases, the WHO’s director general, Tedros Ghebreyesus, praised the ‘transparency’ of the country’s response and thanked the Chinese government for sharing the genetic map of the virus ‘immediately’. The appraisal seems surprising given the fact that, behind the scenes, WHO officials were actually complaining that China was not sharing enough data to assess how the virus spread between people. In fact, China waited to release the genetic map of the virus for more than a week, and waited two more weeks before providing the WHO with detailed data on patients and cases. Various news outlets suggest that Ghebreyesus lauded China to coax more information out of the Chinese government and to ensure that he would not lose Beijing’s cooperation as Covid-19 spread globally. In this line of thought, careful diplomacy and public praise keep countries in crisis from shutting out the world.
Was Trump right?
In the end, Covid-19 mostly showed the WHO’s shortcomings by demonstrating that the organisation is too dependent on cooperation from its member states. It is not an independent organisation that can tell countries what to do but it functions as a consensus-building secretariat. This function also shows in its decision-making procedures as member states meet in the annual World Health Assembly (WHA) and the secretariat carries out what is decided upon in the WHA. As a result, the WHO can only act within the limits set by its member states and provide advice to member states. This means that the WHO cannot be compared to organisations like the United Nations Children’s Fund, which can go into a country to provide tools or resources on the ground. In contrast, the WHO’s role relates to intelligence-gathering and alerting countries.
Another problem for the WHO is the nature of its funding 17% comes from assessed contributions, which member states pay based on their wealth and population. Unfortunately, these mandatory payments have not kept pace with the organisation's needs, and the WHO has become increasingly reliant on donations from states, international organisations and private foundations. Voluntary contributions can be divided into two types: 'core' and 'specified'. The WHO can spend assessed and core voluntary contributions (3% of the total contributions) flexibly, meaning it has full control over one-fifth of its revenue. The remaining four-fifths comes from specified voluntary contributions, which as their name suggests, are earmarked by donors for specific purposes. As a result, the WHO is highly susceptible to the influence of individual countries as those that provide more funds to the WHO have a larger say in the agenda-making of the agency.
What can the Biden administration do for the WHO?
There are various things that the Biden administration can do to improve the WHO’s performance. Above all, as the largest donor of the WHO, the U.S. should ensure that the agency is provided with an adequate budget. Nevertheless, to achieve proper sustainable funding, and to provide the WHO with full control over its actions, all member states should significantly increase their contributions and especially the proportion of assessed contributions compared to voluntary contributions. Another important aspect is that the U.S. should refrain from opposing WHO initiatives that might run counter to the interests of transnational corporations. In previous years, the U.S. has opposed, for example, the International Code on the Marketing of Breastmilk Substitutes and even removed statements from documents that supported soda taxes in countries with soaring rates of obesity. Likewise, the U.S. has not ratified the Framework Convention on Tobacco Control. Advancing the interests of corporations by the member states adversely affects the WHO’s unbiased decision making and the means to refrain from ‘conflicts of interest’.
In response to the Covid-19 pandemic, the U.S. should also become a part of COVAX, an international initiative to develop a COVID-19 vaccine and distribute it equally around the world, including to countries that lack the resources to purchase it. By doing so, the Biden administration might be able to restore the huge trust deficit that has been created in the last four years. According to Suerie Moon, co-director of the Global Health Centre at the Graduate Institute Geneva, another impressive move to restore U.S. relationships with allies and international institutions would be to share American health technology — such as vaccine discoveries — with the world to help end this pandemic. Although most technologies are held by private companies, they have been developed with federal tax dollars, with help from government scientists and public procurement guarantees. Sharing these technologies would be a powerful signal that a Biden presidency will not be back to business as usual — when medicines were seen primarily as a U.S. export — but that he wants to show real leadership in global health.
Written by Marie Smit and Morane Verhoeven
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