Public/Global Health

WHO’s diplomatic balancing act faces new challenge with Trump attacks


President Trump’s attacks on the World Health Organization (WHO) over the coronavirus pandemic are shining a spotlight on the diplomatic balancing act the agency faces as it struggles to navigate the interests of member states that are often working at cross purposes.

The chronically underfunded agency has been at the forefront of the global response to the pandemic, winning praise from public health experts who derided its poor performance just a few years ago during an Ebola outbreak in West Africa.

But many of those same experts say this pandemic has highlighted the fact that the WHO has few real powers. While it can use a megaphone to encourage member nations to take action, agency officials have almost no authority to enforce their guidance — especially when it comes to large nations like the United States or China.

“The current governance situation requires the World Health Organization to maximize the agreement or assent of the most countries possible to the kinds of actions it takes. So it’s always by necessity going to be the lowest common denominator,” said Amanda Glassman, executive vice president and senior fellow at the Center for Global Development. “They have several strategies. One is buttering up, and the other is calling out and shaming.”

The WHO’s diplomacy faces its latest challenge with Trump’s announcement that he would halt U.S. funding to the agency.

Trump, who dismissed the threat of the coronavirus repeatedly even after the WHO sounded alarm bells, said Tuesday he would place a hold on U.S. funding for the Geneva-based group as his administration reviews actions the WHO took in the days and weeks after the virus was discovered in a small cluster of pneumonia cases in China.

“This is an evaluation period. But in the meantime, we’re putting a hold on all funds going to World Health. We will be able to take that money and channel it to the areas that most need it,” Trump said Tuesday.

Trump’s move to shift blame away from his administration’s lackadaisical and dysfunctional response to the virus comes with help from conservative allies in Congress, who have increasingly questioned the WHO’s actions over the last three months.

Those critics accuse the WHO of turning a blind eye to China’s handling of the outbreak. Beijing has almost certainly underreported the number of coronavirus cases and deaths at the epicenter of the outbreak in Wuhan, an industrial city of about 11 million residents.

Trump’s funding move is likely to have an immediate impact on WHO missions to promote health, either through fighting the coronavirus or through its other initiatives that promote vaccinations and health programs in developing countries.

The United States contributes about $400 million to the WHO’s $4.8 billion annual budget, making it the largest individual source of funding. Trump has pointed to China’s contributions, which are a fraction of what the United States gives.

WHO leaders made a measured response Wednesday, pledging to work with the United States to address Trump’s concerns.

“The United States of America has been a long-standing and generous friend to WHO and we hope it will continue to be so,” WHO Director-General Tedros Adhanom Ghebreyesus told reporters at a press conference. “We regret the decision of the president of the United States to order a halt in funding to the World Health Organization.”

In the past, China has proven to be the more challenging country for WHO when it comes to diplomacy. The Communist government’s tight grip on information has proven a global health risk in the past.

When another coronavirus that attacks the respiratory system, known as SARS, broke out in China in 2002, the government spent months denying its existence before asking for international help. Those critical lost months likely gave the virus a chance to infect thousands more people than had China disclosed its existence earlier; ultimately, at least 8,000 people were infected and 774 died.

In the nearly two decades that have followed, WHO and the American Centers for Disease Control and Prevention (CDC) have both worked carefully with China’s government to encourage more transparency. Experts say surveilling potential diseases in a country like China, where people are much more likely to come into contact with animals that harbor potentially deadly viruses, is critical to protecting global public health.

“In the past, we’ve seen more of a close collaboration between U.S. CDC and China’s [Ministry of Health and the Chinese Centers for Disease Control] to work together on influenza prevention, surveillance and training,” said Jennifer Bouey, the Tang chair in China policy studies at the Rand Corporation’s Center for Asia and Pacific Policy. “China is engaging more with WHO’s office and continuing to work with WHO on its training and surveillance programs.”

But Beijing is still touchy about criticism. In recent weeks, it has kicked journalists from major American news outlets out of the country in retaliation for reporting that angered the government.

The WHO, senior officials say privately, does not want to risk a similar diplomatic dust-up — one that could rob it of any surveillance capabilities in a country that is especially prone to spawning new strains of influenza or coronavirus that could become global pandemics.

WHO’s budget does not allow it to undertake virus surveillance in every country. Frequently, when member nations report suspected outbreaks, WHO teams up with local public health officials to investigate, as they did in China.

“They’re relying on the collaboration with the Chinese government to allow them to get the data,” Bouey said. “China finally, over the first delay and cover up, is starting to use its national network to report cases, and they want to keep that transparency in place. If you are punishing China for reporting these case numbers, that can be counterproductive in a way, from the WHO’s viewpoints.”

The WHO has often come under criticism during and after deadly outbreaks, particularly following an Ebola outbreak in three West African nations in 2014 and 2015. The WHO’s disastrously slow response efforts spurred a major overhaul in the way the agency works worldwide, and the way it has responded to the coronavirus itself.

The agency has since won praise for its actions across the globe, as well as its early warnings about the spread of the coronavirus that began as a cluster of just 41 cases in a Chinese city of 11 million people. China publicly shared the genetic sequence of the coronavirus on Jan. 12, just days after alerting WHO to the new virus, and WHO’s technical leader on the case — an American, Maria Van Kerkhove — said two days later that the virus may be spreading between humans.

Though Tedros was measured in his response to Trump’s funding announcement, Mike Ryan, who heads WHO’s health emergencies program, offered a stiffer defense of the agency’s actions in those early days.

“In the first weeks of January, WHO was very, very clear. We alerted the world on Jan. 5,” he said Wednesday. “We’ll be very happy when the after-action reviews come. In fact I am very anxious for the after-action reviews to come.”

The WHO declared a “public health emergency of international concern” on Jan. 30. That same day, Trump formed a coronavirus task force then headed by Health and Human Services Secretary Alex Azar, who has since been sidelined. He also predicted the virus’s spread would have “a very good ending for us.”

Eleven weeks later, more than 605,000 Americans have tested positive for the coronavirus, far more cases in than any other nation on earth. More than 25,000 people have died from it.

Glassman, of the Center for Global Development, said she hoped the Trump administration’s funding pause would be only temporary. She focused on one phrase Trump used — “putting a hold” — to suggest that the administration would find a way to continue funding the world’s main public health agency in the midst of a pandemic, and she pointed to the benefits the United States reaps from a strong WHO.

“We need the WHO in lots of different ways. We’re able to have access to strains of flu from outbreaks in Indonesia and other places around the world in order to develop a flu vaccine for the United States because of the WHO,” Glassman said. “I’m just hopeful that we’ll see a reversal sooner rather than later. The United States’ participation in the WHO is not optional.”

Tags China Coronavirus COVID-19 Donald Trump Ebola Pandemic SARS Tedros Adhanom Ghebreyesus WHO World Health Organization Wuhan
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