It was one thing when it just involved trade. Although countries’ industries and people’s jobs were on the line, the bluster and brinksmanship seemed to be just tactics for the world’s largest toddler to get the toys he wanted.
But the health of all people on the planet is not a game. US President Donald Trump’s withdrawal of funding for the World Health Organization (WHO) puts us all in jeopardy. Here’s why.
Until 2007, there was no global public health system. I hope you find that surprising — I did! If a disease outbreak hit more than one country, there was no agreement to share information, no system to track the disease, no funding to help a country bring in public health measures. Countries were on their own to decide what to do.
But that changed in the wake of SARS in 2003, as countries agreed to adopt international health regulations. And pandemics like the current COVID-19 crisis were precisely why countries agreed to put a global public health regime in place. That’s what’s at stake here.
As a reporter for the Canadian Medical Association Journal, I covered the international health regulations in 2013, during an outbreak of the Mediterranean respiratory syndrome (MERS). At that point, 195 member states had agreed to abide by the regulations, which involved developing national disease surveillance and response systems by 2012. But 110 of those countries asked for a 2-year extension and only got on board in 2014. Today, these countries — including several with authoritarian governments and repressive regimes — have signed on to counting cases and reporting outbreaks.
Without this agreement, the WHO could not be telling us, as it is, how many cases of COVID-19 there are day by day. It also has the right to investigate reports of outbreaks from media and social media that have not been reported by governments. And to walk into a country to ensure it’s managing an outbreak effectively or to help it contain spread.
Part of the regulations is declaring an emergency — the technical name is a “public health emergency of international concern” — for an outbreak that has gone beyond one country. The WHO has declared an emergency five times before COVID-19 and has taken some flak for getting two of these wrong.
The first emergency was influenza H1N1 in 2009, which arguably should not have been declared. It was a bad pandemic influenza, but nowhere near, say, the scale of the current emergency.
The third emergency was the Ebola outbreak in west Africa in 2014, to which the WHO reacted too slowly. As the International President of Médecins sans frontières, Dr. Joanne Liu, a Canadian physician, told me in 2015, “It’s a failure of political will that prevented the world from responding in the first six months,” rather than any problem with funding, expertise or technology. “The location [West Africa] is not a priority in terms of trade or political leverage.”
In light of its failure on Ebola, the WHO did a full review of the International Health Regulations, completed in 2016, and revamped its emergency program.
Which brings us to COVID-19. The parallels with SARS are obvious: a new coronavirus that jumped to humans from a live wild animal in a Chinese “wet” meat market. Early denials and lack of information from Chinese officials, which were replaced by official admissions of the outbreak and public health measures as the contagion spread. Confirmed reports that doctors who shared information about the virus were harassed and intimidated. US intelligence reports that the true number of cases was underreported. The rest of us thought, “Did China learn anything from SARS?”
To its credit, the WHO worked with China. Under the regulations, the WHO needs to play ball with member states to get them to report and to take action to control outbreaks. It clearly has to walk a fine line with states that are less open and transparent, in order to get them on side. The Chinese government did turn around quickly, containing the virus’ spread more successfully than many other countries. The WHO send its experts to work with the Chinese government — to what extent they were involved in China’s turnaround we cannot know.
Crucially, the WHO needs to remain apolitical and work with any member state. Sometimes it does this successfully and even creatively. WHO Director-General Dr. Tedros Adhanom Ghebreyesus stated outright at one of his daily media briefings that some countries were underreporting cases. When asked which countries, he explained that the WHO could not single out members. He faced the camera and said, “You know who you are.” Some countries are lying, some are in wilful denial of the pandemic. And they do know who they are. As do we.
When Dr. Ghebreyesus talks calmly to the world each day and cleverly calls out member states, the WHO is doing its job. Its continuously updated dashboard on the pandemic is unlike any source of data the world has previously seen in a disease, and it has been emulated by several countries. These steps have arguably caused member states to take preventive action and saved millions of lives.
At some points, though, I have been disappointed to see the WHO toeing China’s political line. In an interview with a reporter from a Hong Kong media outlet, Dr. Bruce Aylward, a Canadian and a senior advisor at the WHO, first pretended not to hear the reporter’s question about Taiwan, then said he had answered about China, then ended the Skype call. He was clearly refusing to acknowledge Taiwan as separate from China. Perhaps he was concerned about alienating Chinese officials after efforts to get them on board, but it came across as taking a political position, which the WHO should not do.
Of course, such incidents do not justify Trump’s accusation that the WHO is biased toward China, or that it “mishandled” the early days of the pandemic. The WHO has a responsibility to work with all member states, but it is always going to be difficult to get authoritarian (or just plain ill-equipped) governments to report cases, as they have committed to under the regulations.
Now, Trump is pulling the US funding, estimated at 10% of the WHO’s budget. In fact, the US is in arrears on its funding to the WHO already. And it provides a handy place for Trump to lay the blame for his own mishandling of COVID-19. He is shooting himself in the foot, as usual, because the WHO has helped all of its member countries, including the US, understand and respond to COVID-19. The International Health Regulations work because all member countries commit to them and follow them. Without the compliance of member countries, the regulations could fall apart. And that would be a disaster.
Because, without the WHO and the regulations, COVID-19 would have been worse. Much, much worse.