We need to take a cold hard look at the World Health Organization

We need to take a cold hard look at the World Health Organization
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The United States recently announced that it is suspending financial support for the UN’s World Health Organization (WHO) pending a review of the agency’s early conduct in connection with the COVID-19 pandemic.

The U.S. Chamber of Commerce swiftly responded that cutting the WHO’s funding during the COVID-19 pandemic “is not in U.S. interests given the organization’s critical role.” It was joined by the American Medical Association, which noted that “During the worst public health crisis in a century, halting funding … is a dangerous step in the wrong direction.” The European Union asserted that it “Deeply regrets U.S. decision to suspend funding to WHO. There is no reason justifying this move at a moment when their efforts are needed.” The world’s second wealthiest man, Microsoft founder Bill Gates, added that “Halting funding for the WHO during a world health crisis is as dangerous as it sounds. Their work is slowing the spread of COVID-19 and if that work is stopped no other organization can replace them.”

Soon thereafter, Saudi Arabia announced that it was increasing its contribution to the WHO by $500 million, and Ireland described the U.S. decisions as “indefensible” and announced that it was quadrupling it’s support for the WHO. None of these critics of the U.S. suspension of financial support is known for their gullibility or softness towards China. So, what’s going on?

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To begin, full disclosure: I spent several years explaining UN agencies to elected and appointed U.S. government officials a very long time ago as director of the Washington office of the UN Association. I learned quite a bit about the UN system and, surprisingly, most of the questions raised by the U.S. about the WHO today are exactly the same type of questions that I answered about it decades ago.

It's also important to not conflate the issues of China’s early conduct with regard to COVID-19 and the WHO’s actions. Although they are related in the sense that the U.S. alleges too close a cooperation between the WHO and China during this early period, they are entirely separate topics, and the WHO and China are governed entirely separate from each other. My comments address the topic of the WHO.

The World Health Organization was founded between 1946 and 1948 partly in recognition of the global nature of the 1917 Spanish Flu and the fact that nations simply must cooperate with each other to combat communicable diseases. Its work today consists mainly of specific projects, such as those to eradicate polio, HIV AIDS, tuberculosis and malaria; as well as coordinating global health standards and databases. With 194 member countries (and 2 associate members), it is the only global organization that brings together the health authorities of essentially every country. 

As a UN specialized agency, its members are independent sovereign nations, but WHO has no responsibility for these countries’ political issues. The agency raises around $2.2 billion each year, the vast majority of which is for specific projects (like combatting HIV AIDS in Africa) which are supported by a combination of nations, foundations, companies and individuals. About 13 percent of its budget comes from assessed dues and the rest comes from donations.

Donations are normally made to specific WHO projects from organizations like the U.S. Centers for Disease Control and Prevention (CDC), because each donor — after looking at a wide range of alternative public and private organizations — concludes that that WHO project is best equipped for their specific disease-fighting donation. Often, donors choose the WHO because it is trusted and accepted in every country — or because the WHO project staff has the greatest expertise and skills. In the marketplace for health-related donations, the WHO’s projects have been very successful among donors who could easily take their donations elsewhere.

The current review of U.S. support for the WHO is reportedly taking a close look at whether the WHO staff made mistakes in evaluating COVID-19 earlier this year and whether the WHO staff was following instructions from China during this period. All of this in the context of the assertion that the United States is contributing far more money to the WHO than does, say for example, China.

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First, there is the claim that during January and February, the WHO should have publicly rebuked China and forced China to do something regarding the then-emerging COVID-19 outbreak in Wuhan.

There’s no dispute over the fact that on Jan. 30, the WHO declared COVID-19 to be a “Public Health Emergency,” so most of the U.S. questions must be about what the WHO did prior to Jan. 30. There’s also no dispute over the fact that the first publicly-recorded incident of COVID-19 outside of China occurred on Jan. 13 in Thailand. Until that date, COVID-19 was a disease internal to China.

Exactly how the government of China managed the outbreak of COVID-19 within China before Jan. 13 is quite important, but it is not possible to hold the WHO accountable for what the Chinese government did or did not do before Jan. 13.   

There’s little dispute that during this 16-day period, the WHO investigated the outbreak in China’s Hubei Provence and relied heavily on Chinese authorities, who obviously had jurisdiction over their territory, where essentially 100 percent of the known infections took place.

Although it’s sometimes popular in Hollywood movies to portray UN agencies as supranational organizations that directly intervene in any country they wish whenever they wish, nothing could be further from the truth. UN agencies are associations of sovereign independent governments. Particularly when it comes to something happening entirely inside a single country, the UN agency is bound to fully cooperate with that country and basically accept what that member country reports. And if some other country does not accept the reporting country’s statements, then that second country is free to object or complain.    

There is no shortage of scholars who advocate that the WHO (and perhaps other UN agencies) should be transformed into a supranational organization whose staff directly and forcibly interfere within any country whenever staff sees fit. National governments — including the U.S. — would have to accept the notion that a multinational WHO bureaucracy would have the authority to directly investigate and interfere with national and local health authorities whenever the WHO staff saw fit to do. Imagine a WHO team of experts forcing their way into Fort Dix, N.J., to independently investigate the U.S. report of Swine Flu in 1976.

Until or unless UN agencies like the WHO are transformed into such supranational organizations, these agencies will rely on national permission about events within a member country. And in case you were wondering, there has been virtually no support within the United States to transform the WHO into a supranational organization.

Second, there is the claim that the United States spends a great deal of money on the WHO — more than any other country — and when we spend that much money, the WHO should do what we want; and if they don’t, then we should stop giving them money. And then they’ll change their tune. 

There are three separate issues here: Does the United States actually “give” the WHO “a great deal of money”? And, should the United States “expect the WHO to do what we want” when we give them a great deal of money? Finally, if we take our money away, will they bend to our will?

Like most UN agencies, the WHO administers two quite different types of budgets: assessed dues, which each of the 194 member countries is required to pay under the WHO treaty, and voluntary contributions, which each country, international organization or private organization donates, usually to specific projects that the donor likes.

The rules, which were designed by the United States decades ago, are pretty simple: pay your dues if you want to stay in the club, and then if the club is doing something that you like, you’re free to donate to that project. For the WHO, almost 90 percent of its annual $2.2 billion budget is made up of voluntary donations to specific projects.

In the U.S., our roughly $119 million in assessed dues is paid by the State Department, and our roughly $284 million in voluntary donations to WHO projects are mainly from the U.S. Agency for International Development (USAID) and the CDC.

So, mostly (70 percent) what the U.S. gives to the WHO is donations to specific projects in areas like combatting HIV and malaria.

This is not surprising since in many cases, by pooling our resources with those from other countries like Germany, Japan, Sweden and the UK, we can fight these diseases far for efficiently and effectively than we could alone. Also, many countries would prefer to have a UN bureaucrat helping guide their domestic health programs than an American (or a Russian or a Chinese) official.

What the U.S. pays the WHO in required dues covers the maintenance of global databases, setting standards and hosting meetings.  

It’s true that U.S. total contributions of $403 million amounts to a lot of money; however, U.S. assessed dues to the WHO make up around 3 percent of its total spending, and U.S. voluntary donations make up around 15 percent of its total spending.

Looked at in the context of the current COVID-19 pandemic (which is what the U.S. Chamber of Commerce, the AMA, the EU and Bill Gates did in their statements), U.S. support for everything that the WHO does is about as much as the United States will spend in one hour on our combined U.S. COVID-19 spending packages.

Nonetheless, the United States is the largest contributor to the WHO, so the loss of America’s assessed dues or voluntary donations means a lot. Doesn’t that mean that the United States should get its way and that the WHO should change its tune when the U.S. says it must?

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This is not the first time that the United States has threatened to withhold financial support from a UN agency unless it followed U.S. policies. In 2018, the U.S. announced it would withdraw from the Universal Postal Union (UPU), but later cancelled its withdrawal. The U.S. has withdrawn from the UN’s Educational Scientific and Cultural Organization (UNESCO) twice, re-joining after the first withdrawal and then withdrawing again in 2017; and the U.S. withdrew from the UN’s International Labor Organization in 1977 after it failed to adopt U.S. policies.   

Because of shifts in the global economy, as time passes the economic impact of a U.S. withdrawal declines — and the extent to which other nations become prepared for a U.S. pullout grows. In the case of the WHO today, although many countries have expressed shock over the U.S. decision to suspend funding, it’s unlikely that any country would be unprepared to see it happen. 

Not surprisingly, therefore, following the U.S. announcement, Saudi Arabia and Ireland announced their new contributions. Predictably, China announced that it would contribute an extra $50 million. Perhaps more important, the WHO convened a meeting of heads of many countries — including France, Italy, the UK, Germany, Spain, Norway, South Africa and many others — to plan a strengthened WHO effort on COVID-19.

Clearly, many WHO donors are preparing for life to continue without the United States.

Underlying all of this brouhaha is a widespread post-World War II view in the United States that the USA is the exceptional nation, without whom no world body could survive and whose major policies must be accepted lest the U.S. pull out and thereby shut down the international body. Since the U.S. effectively created and funded many of these UN specialized agencies (the U.S. organized the 1946 meeting in New York where the WHO was created), during their early years, this was certainly true. Whether is remains the case is increasingly in doubt.

Roger Cochetti earned his bachelor’s degree from the School of Foreign Service at Georgetown University and master’s from the School of Advanced International Studies at Johns Hopkins University. Although he has been an international business executive for most of his career with companies like COMSAT, IBM and VeriSign, early in his career, Cochetti served as the director of the Washington Office of the United Nations Association of the USA and assistant director for Legislative & Public Affairs of the U.S. International Development Cooperation Agency.