Even as the coronavirus pandemic rages on, last week, on 29th May, President Trump announced: “We will be today terminating our relationship with the World Health Organization (WHO) and redirecting those funds to other worldwide and deserving urgent global public health needs.”
In response, on 1st June, Tedros Adhanom Ghebreyesus, the WHO Director General responded with this statement: “The US government and people’s contribution and generosity towards global health over many decades has been immense, and it has made a great difference in public health all around the world. It is WHO’s wish for this collaboration to continue.”
Over the past 15 years, I have had several opportunities to engage with WHO and see how it operates. I will admit – I have had my highs and lows. At times, I have been frustrated with WHO’s bureaucracy, internal politics, and slow pace. I know it is not a perfect agency. And yet, I have volunteered hundreds of hours of my time and expertise to the agency, by serving on expert groups, helping produce guidelines, and by co-authoring scientific papers with WHO staff. I currently direct a tuberculosis center that is a WHO Collaborating Center.
WHO: an easy target
‘Trump needs to find an easy target to deflect blame from the abysmal US response to the pandemic and the George Floyd outrage,” said Devi Sridhar, a global health professor at the University of Edinburgh. “WHO is an easy target. But WHO did indeed raise the highest level of alarm for the world (Public Health Emergency of International Concern) on January 30th. Countries then had to do the hard work of preparing, or not,” she added. Clearly, many countries failed to act on WHO advice in a timely manner.
Sophie Harman, a professor of international politics at the University of London, concurs. “We must defend the WHO but not play to Trump’s tactic to distract from the high cases and deaths from coronavirus pandemic in the US or the murder of George Floyd. The two issues – responding to coronavirus pandemic and racial injustice – are not and cannot be seen in isolation of one another; you just need to look at who is dying from the virus to see this,” she argued.
“The backlash from conservatives in the US against WHO, and those in the USA who use global health funding in imperial ways, is nothing new for feminists,” said Asha George, a professor at the University of Western Cape in South Africa. “The problematic conditionalities and curtailments date back to the Mexico City conference on population when the global gag rule started.” Trump’s global gag rule has had a devastating impact on women’s sexual and reproductive health.
Can the US withdraw from WHO?
“The President does not have the legal authority to withdraw the United States from WHO, with US law requiring one-year notice and the full payment of assessed contributions prior to withdrawal,” said Benjamin Mason Meier, an expert in international law and global health at UNC Chappel Hill. “This announcement appears to be little more than an election promise masquerading as a health policy, and it is likely that WHO will diplomatically ignore it – considering the US an “inactive member” and leaving open the door for US re-engagement under the next administration,” he speculated.
“It’s preposterous,” said Harman. “When Trump talks about withdrawal, I assume he’s talking about money. This could potentially have long reaching consequences for not just WHO budgets, but how global health research and innovation works and is shared around the world. However the US contribution is more than just the government, much of global health financing comes from US private philanthropy and the private sector. What’s Trump going to do, try and sanction the Bill & Melinda Gates Foundation from supporting WHO? Stop research created in the US being read and used around the world?”
Withdraw during a crisis?
WHO has been at the forefront of the global pandemic response. While its performance must be reviewed by member states, nobody expected the US to freeze funding in the middle of a global crisis. “It’s a disaster for public health and to do it at this time is simply unimaginable,” said David Gold, a global health advocate and CEO of Global Health Strategies. “It is unconscionable for Trump to take this step amid the pandemic when the WHO is coordinating the international response,” said Thomas Bollyky, author of the book Plagues and the Paradox of Progress.
“Pulling out financial support in the midst of the response to pandemic of the century is suicidal,” said Joanne Liu, a former president of Médecins Sans Frontières, who now works as an ER doctor. “It is as if, in a middle of a patient crashing in my ER, someone from the hospital board of directors would come and cut off the oxygen flow. You may not agree about the way I manage the case but the time for accountability is not when I am trying to saves lives.” she added.
“In times of crisis, real leadership is characterized by constructive engagement not destructive disengagement,” said Tim Evans, Director of the School of Population and Global Health at McGill University, and former Director of Health, Nutrition and Population at the World Bank. “During the Ebola crisis in 2014-2015, the US and other countries were rightly concerned about WHO’s performance. But rather than withdraw membership and funds, the US, under the excellent leadership of Ambassador Jimmy Kolker, helped WHO reform on the fly and land in a much better place,” he added.
Putting America in danger
Many experts are clear that Trump’s move will put America in grave danger.
“President Trump’s threatened move is the height of folly, shortsightedness, and stupidity and will cause irreparable damage to the WHO and worldwide efforts to cope with coronavirus pandemic,” said Theodore Brown, a historian who co-authored the book The World Health Organization: A History. “If his actions match his rhetoric (they don’t always), his reckless decision will also cause immense damage to the United States. Not only will the US leave WHO and its global health partners less able to cope with the coronavirus pandemic which if left unchecked will threaten the US for years to come, but the US withdrawal will disconnect the country from vital sources of information and collective action which will add an enormous additional threat to the country’s survival,” he added.
“The USA will not be safe from coronavirus pandemic until it is eradicated everywhere. A US withdrawal from the WHO will weaken global health and weaken the global response to the pandemic. That will be bad for the health of people everywhere and bad for health and economy in America,” said Roopa Dhatt, Director of Women in Global Health.
Loyce Pace, Director of the Global Health Council, agrees. “Leaving WHO or pulling critical resources in the middle of a pandemic is incredibly dangerous for the US to do. WHO plays a central role in the global response to coronavirus pandemic, from country guidance to vaccine trials, and we are by no means out of the woods with regards to the pandemic. But even beyond the current crisis, withholding essential funds or technical support could jeopardize polio eradication and other immunization campaigns not to mention work preventing or controlling infectious diseases that – left unchecked – put us as risk for yet another wave of economic and humanitarian fallout,” she added.
Clare Wenham, a professor of global health policy at the London School of Economics, echoes these concerns. “If USA withdraws from WHO – they will no longer have access to disease pertinent information, and the US will be left to fight against a disease without intelligence,” she said.
David Gold points out that the Pan American Health Organization (PAHO), headquartered in Washington DC, will be hit hard by the US exit from WHO. “PAHO is especially dependent on US funding. PAHO prevents outbreaks from spreading across Latin America and to the US. To stop its funding is insane and a threat to all Americans” he said.
Time for other countries to step up?
For decades, America has dominated the global health landscape with its financial might, research and technological prowess. Trump’s move might bring about a seismic shift. If the US could indeed withdraw from WHO, can other countries step up and play a bigger role in global health?
Ilona Kickbusch, a global health professor at the Graduate Institute of International and Development Studies in Geneva thinks so. “No matter how this plays out in the end – the US move provides the opportunity for other alliances of countries to reform the WHO, make it stronger and less dependent on one large contributor – multilateralism should be just that. Think India, European Union, South Africa and the alliances of smaller states,” she said.
Wenham is optimistic that funding and leadership gaps can be plugged. “Since the talk of US halting funds to WHO in April, we have seen moves by other governments and donors to fill the gap. Simultaneously, the normative leadership gap can also be plugged. What legitimacy does the US have to contribute to leadership in global health security anyway, given its abysmal response to coronavirus pandemic (Covid-19)? New leaders are emerging; both from other Western Governments, such as Germany, and LMICs, such as Nigeria, Uganda – who have all manged to keep a handle on this outbreak where the US has failed,” she said.
Global solidarity needs a stronger WHO
“If ever there was a need for global solidarity, this is it,” said Pascale Allotey, Director, UN University -International Institute for Global Health. And solidarity requires all countries to cooperate during this crisis, and back the WHO to do its job.
This includes the United States, which simply cannot afford to abdicate its global health responsibilities. “The US needs to decide if they are in or out to ensure that serious debates can be had about global health futures, and actions taken without being disruptive with the constant prevarication and equivocation,” said Allotey.
Mario Raviglione, the former director of the Global TB Programme at WHO laments that the US has “missed the chance of exploiting the coronavirus pandemic crisis to strengthen an organization that is vital to the world. Instead they are pursuing the disastrous consequence of returning to a pre-WWII chaotic, anarchic health situation.” He hopes that the US will rapidly revert the decision and resume support to the WHO. “This is also a tremendous opportunity for other countries to build further leadership by helping finance the orphaned WHO programmes,” he added.
For years, WHO has struggled to get adequate funding from countries. The resultant lack of capacity was exposed during the Ebola outbreak in West Africa. During this coronavirus pandemic, WHO was forced to raise money by creating a COVID-Solidarity Response Fund. WHO has also been forced to accept funds from philanthropic foundations, which often have over-sized influence on WHO’s agenda. It is well known that WHO has limited flexibility with budgets, and that makes the agency less able to deal with sudden crises which demand new resources.
In addition to the chronic lack of discretionary funds, WHO suffers from the problem of reporting to many masters. The agency is accountable to all member countries and is often unable to publicly criticize countries that misbehave (e.g. by delaying release of vital information, or violating International Health Regulations).
Given these structural problems, why do countries expect so much out of WHO, when they are unwilling to fully fund it? In fact, over the past decades, many new agencies and partnerships have been launched in global health, progressively weakening WHO.
The world has a critical choice to make: to either make WHO stronger and more capable, or to undercut the agency and withdraw from it.
“You want a strong WHO? Then pay for it to deliver common goods,” said Kickbusch. I agree and have made the same argument. We simply cannot expect an under-resourced agency to deliver consistent, quality performance.
Also, even if countries chose to shut down WHO, what agency could take it’s place and coordinate the health agenda? If a new international health agency were to be created, what would we call it? Wait, I can think of a good name: the World Health Organization.