- Nov 16, 2018
Donald Trump has declared that he would like the United States to stop funding the World Health Organization. It’s unclear if he has the authority to change policy in this way, but he’s trying. He wants to further break the WHO in ways it’s already broken.
Trump’s ploy to defund the WHO is a transparent effort to distract from his administration’s failure to prepare for the COVID-19 pandemic. It would be disastrous too. Many nations, especially poor ones, currently depend on the WHO for medical help and supplies. But it is also true that in the run-up to this pandemic, the WHO failed the world in many ways. However, President Trump’s move is precisely the kind of political bullying that contributed to the WHO’s missteps.
The WHO failed because it is not designed to be independent. Instead, it’s subject to the whims of the nations that fund it and choose its leader. In July 2017, China moved aggressively to elect its current leadership. Instead of fixing any of the problems with the way the WHO operates, Trump seems to merely want the United States to be the bigger bully.
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Fixing the WHO is crucial, because we desperately need well-functioning global health institutions. But that requires a correct diagnosis of the problem. There is an alternate timeline in which the leadership of the WHO did its job fully and properly, warning the world in time so that effective policies could be deployed across the planet. Instead, the WHO decided to stick disturbingly close to China’s official positions, including its transparent cover-ups. In place of a pandemic that is bringing global destruction, just maybe we could have had a few tragic local outbreaks that were contained.
This mission-driven WHO would not have brazenly tweeted, as late as January 14, that “preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus (2019-nCoV) identified in #Wuhan, #China.” That claim was false, and known by the authorities in Wuhan to be false.. Taiwan had already told the WHO of the truth too. On top of that, the day before that tweet was sent, there had been a case in Thailand: a woman from Wuhan who had traveled to Thailand, but who had never been to the seafood market associated with the outbreak—which strongly suggested that the virus was already spreading within Wuhan.
We can get a glimpse at that alternate timeline by looking at the two places where COVID-19 was successfully contained: Taiwan and Hong Kong. With dense populations and close links to and travel from China, Taiwan and Hong Kong are unlikely candidates for success. Yet Taiwan reported zero new confirmed cases on Tuesday, fewer than 400 confirmed cases since the beginning of the outbreak, and only six deaths. Taiwan’s schools have been open since the end of February and there is no drastic lockdown in the island of almost 30 million people.
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Hong Kong has had a slightly tougher time. It is ruled by an unpopular leader handpicked by Beijing, so not all the recommendations of its health experts could be implemented. But still, the city has had just more than 1,000 cases and only four deaths, despite never completely closing its border with mainland China and despite a lot of the city functioning as usual. Taiwan and Hong Kong succeeded because they ignored, contradicted, and defied the official position and the advice of the WHO on many significant issues. This is not a coincidence, but a damning indictment of the WHO’s leadership.
Taiwan’s and Hong Kong’s health authorities assessed the pandemic accurately, and not just with respect to the science. They understood the political complexities, including the roles of the WHO and China in shaping official statements about the virus. They did not take the WHO’s word when it was still parroting in late January China’s cover-up that there was no human-to-human transmission. They did not listen to the WHO on not wearing masks, which the WHO continues to insist are unnecessary to this late day, despite accumulating evidence that masks are essential to dampening this epidemic’s spread. Taiwan ignored the WHO’s position that travel bans were ineffective; instead, it closed its borders early and, like Hong Kong, screened travelers aggressively.
Hong Kong and Taiwan remembered that China has a history of covering up epidemics. In 2003, the world didn’t learn about SARS until after it had escaped China and become impossible to deny. (Back then, the WHO openly criticized China for its lack of transparency and cover-up, and we contained the epidemic just in the nick of time.) This time, the WHO was told the truth early on: Taiwanese health authorities sent their own medical teams to Wuhan in December. Those scientists confirmed human-to-human transmission—the most crucial piece of information for determining the difference between a local tragedy (if viruses are only jumping from infected bats or pangolins to humans in wildlife markets where people interact directly with them) and a brewing global pandemic. Taiwan isn’t allowed to be a member of the WHO, because of China’s objections, but it still informed the organization. Hong Kong health authorities, too, announced as early as January 4 that they suspected human-to-human transmission was already occurring, as they also looked at the evidence and their own contacts in Wuhan.
Imagine the WHO took notice of the information it received from Taiwan and Hong Kong. Imagine the WHO also recognized that whistleblower doctors in Wuhan were being threatened with jail time. It would have realized that something important was happening, something worth investigating. It could have immediately, but politely, demanded access to the region around Wuhan and its hospitals.
This alternate timeline does not ignore realpolitik. China is not a nation known for cooperating with international agencies when it doesn’t want to. (This tendency is not specific to China. A U.S. law nicknamed the “Hague Invasion Act” threatens to invade the International Criminal Court in The Hague should any U.S. service member be indicted.) If China refused access, as it likely would have, the expectation isn’t that the WHO officials would just get up and yell “Freedom!” at China’s leadership. But there was a path that would recognize the constraints of international diplomacy, but still put the health of billions above all else.
When independent access to Wuhan was denied, instead of simply relaying what China claimed as if it were factual, the WHO could have notified the world that an alarming situation was unfolding. It could have said that China was not allowing independent investigations, and that there were suggestions of human-to-human transmission that needed urgent investigation. That would have gotten the world’s attention. And it could have happened the first week of January, mere days after China reported 41 cases of a mysterious pneumonia, but before China’s first announced COVID death. This is when Taiwan banned travel from Wuhan and started aggressive screening of travelers who had been there in recent weeks. It’s also when Taiwan ramped up its domestic mask production, in order to distribute masks to its whole population, despite WHO (still!) claiming they aren’t necessary. This is when Hong Kong health authorities started implementing similar measures, in that case in spite of their own government dragging its feet. Hong Kong’s population started a massive grassroots campaign to don masks. Activists from Hong Kong’s protest movement used their organizational networks to acquire and distribute masks to the elderly and the poor. This is also when U.S. health authorities were looking at the signs and desperately trying to get the administration to start preparing. As we know now, they were ignored.
The WHO should not have waited until January 22 to confirm human-to-human transmission, after China finally did. By that point, a deadly horse had mostly left the barn. The WHO should not have waited until the end of January to declare a Public Health Emergency of International Concern—a move that recognizes the severity of the crisis and calls for “a coordinated international response.” The WHO should not have let February and nearly half of March pass before finally declaring a pandemic. By that point, a staggering 114 countries had already reported cases, and more than 4,000 known deaths had occurred. By then, the declaration did not matter in the same way an earlier one would have.
Pandemics are exponential events. In January and even in early February, the world had a fighting chance. The first case known to occur in Seattle was as late as February 21. We know this with relatively high confidence because Seattle has an excellent flu-tracking program, which gave it a time machine: the ability to go back and test earlier flu samples for COVID-19. Many countries may not have had their first imported case until late January or early February. Researchers estimate that acting even a week or two early might have reduced cases by 50 to 80 percent. With proper global leadership, we may have had a very different trajectory.
A mission-driven WHO would not have repeatedly praised China for its “transparency,” (when it was anything but) nor would it have explicitly criticized travel bans when they were being imposed on China but remained silent when China imposed them on other nations. Strikingly, the only country the WHO’s leader, Tedros Adhanom Ghebreyesus, has directly criticized is Taiwan, whose diplomats he accused (without proof) of being involved in racist attacks on him. Unfortunately, the WHO seems to remember its principles only when they align with China’s interests. For example, the WHO correctly opposes calling SARS-CoV-2 the “Chinese virus,” as the U.S. administration has tried to do, in another of its attempts to shift the conversation away from its own failings and onto the familiar turf of culture wars. But when China goes on a brazen global misinformation spree, making outrageously false claims about SARS-CoV-2 being a CIA operation or calling it a “U.S.A. virus,” the WHO is silent.
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Speaking up against China might have ended the international political career of Tedros Adhanom Ghebreyesus, who was elected to his post with the support of China and its bloc. But that is the cost of putting mission first.
Be that as it may, President Trump’s own attempt to bully the WHO is worse than being merely a distraction from his own lack of preparation and the spectacular public-health failure that is now unfolding across the United States. The president wants to break the WHO even more dramatically, in precisely the way it is already broken. He wants it to bow to the outsize influence of big powerful nations at the expense of its mission.
Defunding the WHO is not just foolish. It is dangerous: A pandemic needs to be contained globally, including in the poor countries that depend on the WHO. The WHO is the only global organization whose mission, reach, and infrastructure are suitable for this. The U.S. funds about 15 percent of the WHO’s current budget, and the already stretched-thin organization may not be able to quickly make that up.
We must save the WHO, but not by reflexively pretending that nothing’s wrong with it, just because President Trump is going after the organization. We should be realistic and honest about the corruption and shortcomings that have engulfed the leadership of an organization that is deeply flawed, but that is still the jewel of the international health community. The WHO employs thousands of dedicated and selfless health-care workers in 194 countries, and even now it is leading the fight globally against polio and Ebola. It needs to be restructured, and the first order of business is to make sure that it’s led by health professionals who are given the latitude to be independent and the means to resist bullying and pressure, and who demonstrate spine and an unfailing commitment to the Hippocratic oath when they count most.