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COVID-19 is a stress test for the WHO

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As COVID-19 presents challenges for health systems and economies throughout the globe, the World Health Organization (WHO) is emerging as a critical battleground for a global blame game.

U.S. Secretary of State Mike Pompeo recently blamed the WHO for not enforcing rules requiring countries to report outbreaks — despite the WHO lacking enforcement capabilities. Meanwhile, following President Trump‘s announcement of halting U.S. funding to WHO, and amid the U.S. and Australia’s calls for a WHO probe into the virus’ origins, the Chinese government increased its WHO contribution by $20 million.

We might think of COVID-19 as akin to a stress test for a heart — a test doctors use to examine how well the heart is handling its workload, revealing weaknesses and irregularities in the process. What can we learn by applying this notion of COVID-19 as a “stress test” about weaknesses in the WHO?

To understand weaknesses in WHO’s handling of COVID19, first, we need to understand the role the organization is supposed to play. Founded in 1948, the WHO emerged after World War Two, when the spirit of international collaboration was high. 

The WHO has the lofty goal of “the attainment by all peoples of the highest possible level of health,” with a mandate to “act as a directing and coordinating authority on international health work.” It has played crucial roles in essential health initiatives, like promoting universal health care, and issue-specific initiatives such as tobacco control, vaccine accessibility, the successful eradication of smallpox.

The WHO is, therefore, akin to the heart of global health work. It is supposed to circulate comprehensive health policies, initiatives, and resources, get country representatives and other stakeholders behind those initiatives, and provide an umbrella for coordination. Its myriad operations are dependent on the approval and active cooperation of member countries. In practice, WHO is both a technical body with health expertise and a political body, where country representatives debate approaches to health issues.

Today, some feel the key challenge for the WHO is inadequate funding, which at US$5.8bn biennially for 2020-2021 is lower than operating budgets of some U.S. hospitals. The WHO budget likely needs to be increased to enable effective, ongoing surveillance of emerging infectious diseases, in addition to other important initiatives like health systems strengthening, prevention, and addressing communicable and non-communicable diseases. Yet WHO’s inadequate funding is echoed by the low funding of other world bodies. It’s an issue, but the budget is not the WHO’s key stressor. 

As voluntary contributions from member countries account for 80 percent of its budget, WHO has to depend on the largesse of member nations to fund its operations. In matters of health, it cannot function like the World Trade Organization, using sanctions and suspensions as a means of exerting pressure.

However, there are controversial calls to give WHO power to send in investigators during outbreaks. WHO is supposed to do all of its regulatory, technical and coordination functions while at the same time cajoling, pleading, and pressuring member nations to participate meaningfully. How can we expect the WHO to continue to stroke donor country ego while also exercising much needed regulatory oversight? It’s no wonder the WHO is demonstrating stress.

COVID-19, as a stress test, demonstrates that the WHO’s structure as both a technical and political body is the WHO’s real stressor. And unlike post-WWII, when international cooperation was highly valued, recently nationalist and isolationist attitudes have been spreading in both popular and political spheres, and these attitudes often vilify international cooperative bodies. Yet critiques that WHO “blew it” neglects the failure of member states — including the U.S.A. — to hold up their part of the bargain. An entity as important as the WHO shouldn’t have to play politics to save lives.

COVID-19, as a stress test, shows us why countries need to keep up their social contract with international bodies like WHO as a common good. In a globalized economy, nationalism and isolationism can’t work. COVID19 demonstrates how reckless this kind of thinking is. Viruses know no borders. We can’t keep international trade going and suppose that we’re going to be immune to the next pandemic. The question is never whether the next pandemic will hit your shores; in our interconnected world, the question is merely when, particularly if we’re unprepared.

An adequately funded WHO, peopled by member countries invested in meaningful collaboration, is central to coordinating a truly global response — one that can not only save lives but also improve upon the systems and global connections that ensure livelihoods at home and abroad.

Shailey Prasad is the executive director of the Center for Global Health and Social Responsibility, and a family medicine physician at the University of Minnesota. Noelle Sullivan is a medical anthropologist and associate professor of instruction in the Program in Global Health Studies at Northwestern University.

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