The World Health Organisation, Its Problems and Its Response to Covid-19
- williamdare2
- Jun 22, 2020
- 11 min read
As we continue through this pandemic, I thought it would be interesting to examine the World Health Organisation (WHO) and the reactions they have received from their response. Specifically considering how they dealt with China, and perhaps most controversially their refusal to acknowledge Taiwan. Through this article I want take a look at its problems, consider its failings and give some thoughts on how to make it better
There will be a few sections. First looking at its overall problems, then looking at the specifics of bias, China, Taiwan, Tedros (the current director general) and lastly travel bans.
The UN describes WHO as “the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends”. It works with its 194 member states to better the health of the people of our planet. Its delegations are attended by the member states and is headed by an executive board that puts decisions and policies into action. All members of the executive board are qualified in the area of health, most having experience as medical professionals (I will leave a link to the current members in the sources below).
Consider this quote from Margaret Huang, Executive Director of Amnesty, made in regard to the U.N:
“The U.N. is like your conscience. It can’t make you do the right thing, but it can help you make the right decision.” (whilst not directly about the WHO I think it relevant)
This is the WHO (and U.N) we have, and if want it to be better we need to reform it, not abandon it.
Section 1 – The Limits of its Power and Influence
We need to understand the basic flaws in the institution before going into the specific examples relating to the Covid-19 response
For one, the balance of power, whilst in theory is equal amongst the member nations, is in reality slated towards the more powerful ones, who have the most bargaining chips so to speak, and more influence on the world stage. When it comes to electing board members there is a lot going on the behind the scenes to make deals, and the more influential a nation is on the geopolitical stage, the more control it has. Thus nations like the USA and China can flex their muscle to get the results they want.
This relates to the next issue. The budget. Only 20% of the budget comes from mandatory dues, the rest comes form voluntary donations from either governments (the USA typically pays the majority , about 15% of the budget in 2018-2019, but has been pulling away under Trump, even removing all funding during the epidemic) and private partners (the Bill and Melinda Gates foundation is a substantial donor). The Council on Foreign Relations notes that, especially over the last decade the WHO is becoming growingly reliant on voluntary contributions, which comes with pressure to align with the donor’s goals. Sources vary, but the budget ranges between $2 billion and $4 billion give or take. This may sound like a lot but in reality, this means it is essentially chronically underfunded, as it often doesn’t meet these goals, and it is hugely expensive running a global health initiative, leading in part to its perceived ineffectiveness.
Thirdly we have its decentralisation. It has 6 regional offices, each of which enjoy a lot of autonomy, which also have their own political ideas leading to friction. Journalist Natalie Huet put it this way in 2017 “Imagine running a company with six regional offices who pick their own bosses and who don’t report to you but to their respective offices. That’s the structure of the WHO”
Lastly, and perhaps most importantly is its reliance on member states and thus its lack of real power beyond being an advisory body. The WHO is unable to work in a country without their permission and has no powers such as the ability to sanction uncooperative or rule breaking nations. Neither can it bind countries to resolutions. Therefore it is reliant on its member states to be forthcoming with information and declarations of new diseases and viruses, but given the geopolitical ramifications such as losing trade and travel, they are often reluctant to report these, in part leading to situations such as our current pandemic. Like Huang states, it can only tell you what the right thing to do is but cannot make you do it.
Bias?
All this being said, is the WHO biased? This is the biggest criticism I see it face at the moment. It is often considered a China centric organisation, bending over backwards to appease them, at the cost of human rights and effectiveness. This will be elaborated on further, but it is worth reiterating that the deference it shows comes from the restraints put on it by member governments, including the US, EU nations and countries like China. It comes across not so much as bias, but as part and parcel of its limitations. In many ways it must support the member nations, both to ensure it can have access and authority and also to foster international cooperation. It seems to be an unfortunate reality that the WHO must be so deferential. One can debate as to whether this is necessary or not, but it seems somewhat unfair to levy this criticism at the WHO when it cannot do anything about it.
China
We must now discuss the elephant in the room. It seems that the WHO dropped the ball when it comes to the current pandemic. There is a lot to be said about the way that China handled this outbreak, and not a lot of it is good. Here are some links for those interested at a more in depth look, and their will more in the sources at the bottom.
In short it seems China was protecting its international standing, had elections at the time of the outbreak leading to officials not wanting to admit to a burgeoning crisis, and an authoritarian suppression of information were at the crux of the slow reaction.
Now onto the WHO and its role. The WHO was very supportive of china at the beginning of the outbreak. Here is an excerpt from a speech by Tedros.
“As I have said repeatedly since my return from Beijing, the Chinese government is to be congratulated for the extraordinary measures it has taken to contain the outbreak, despite the severe social and economic impact those measures are having on the Chinese people.”
“We would have seen many more cases outside China by now – and probably deaths – if it were not for the government’s efforts, and the progress they have made to protect their own people and the people of the world.”
“This is the time for facts, not fear.
This is the time for science, not rumours.
This is the time for solidarity, not stigma.”
These last few lines may suggest that this was a diplomatic play by the WHO, nothing could be done to change the past and perhaps the hope was to foster international unity rather than dissention.
Criticism flows from the idea that the WHO acted on the whim of the Chinese government to protect them and their interests, rather than doing their job as the leaders on world health and this on the surface seems true, however we must be careful of not misunderstanding or overstating the WHOs power and authority to really do anything to the contrary. As previously stated, they rely on their members for information, and without access they had to trust China was being truthful and forthcoming. There were warnings of course, with whistle-blowers, who were subsequently silenced, coming out to say that the situation was more serious than was being shown. For example there were claims that transmission was happening human to human, but the official narrative denied this. Davidson Hamer (a global health researcher with the Boston University) said they had no official confirmation or reasonable evidence until mid January. He would later go on to say the WHO had been too trusting of the Chinese government. Hindsight is 20-20, and we can question to what extent the WHO were culpable when considering their abilities. Here is a brief timeline of relevant information.
December 1st earliest known cases of symptoms
December 30th the first leak within China came out from Dr Li Wenliang where he warned
his medical school classmates. 3 days later he was forced to write statement labelling his behaviour as “illegal”.
December 31st a statement came from the Wuhan Health Commission saying the disease was “preventable and controllable” and contacted the Beijing WHO office, although they underplayed the seriousness.
January 7th Covid-19 got its identity
January 11th its genetic makeup was made available on a database for scientists everywhere.
January 15th Guan Yi (Professor of Infectious Diseases, University of Hong Kong) “If there are no new cases in the next few days the outbreak is over”.
January 18th Chinese Government sends epidemiologist Zhong Nanshan to assess the situation in Wuhan
January 20th Zhong Nanshan confirms on Covid-19 can spread via human contact. Xi Jinping makes his first public statement regarding the outbreak. Chinese CDC declares Covid-19 a Class B infectious disease, but claims Class A measures are being implemented
January 22nd WHO meets to discuss whether this is an international emergency
January 23rd Wuhan placed on lockdown. WHO decides not to declare it a Public Health Emergency of International Concern of PHEIC
January 28th only now does China announce it will admit a WHO team to aid in research and response.
January 30th WHO declares the outbreak a PHEIC
(I would like acknowledge that on February 7th Dr Li Wenliang died due to Covid-19)
The WHO was unaware of the seriousness as whistle-blowers were silenced and they were only allowed access on January 28th. Given the previously discussed limitations to its abilities, there is not a lot could have done previously, as up to this point it was reliant on the official Chinese narrative which was underplaying the situation
The Director of the Harvard Global Health Institute Ashish K. Jha stated "We now have good evidence that Chinese authorities knew about the spread and were hiding it at this time," but “it’s unclear how much the WHO could have possibly known about that at the time”, especially with the silencing of whistle-blowers.
Taiwan
We of course need to address Taiwan. There was an, now infamous, interview where the WHO assistant director – general Bruce Aylward was asked by journalist Yvonne Tong (For RTHK) about the way Taiwan dealt with the Covid-19 pandemic, only to comment “we’ve already spoken about China” and pretending to not hear her and even dropping the call to avoid the question. This has highlighted the issue of Taiwan and the erosion of its sovereignty
The BBC stated “It also means the WHO lists Taiwan's coronavirus statistics together with China's, a move Mr Kao says denies the world of accurate and timely information on the pandemic. The exclusion, coupled with the WHO's repeated praise of China's response to the outbreak - which public health experts have criticised - has led some to accuse the organisation of political bias towards China, a major contributor to the organisation.”
There are very real implications to this behaviour by the WHO, although not a lot it can do without the UN officially recognising Taiwan. As stated above it prevents the accurate spread of medical information, the key job of the WHO, and leaves Taiwan reliant on China and its health department for information, which can often be delayed. It is a precarious position for the Island to be in, especially with China laying claim to it.
Unfortunately it seems the WHO is hamstrung by its role. It seems unlikely that it could make an overt political move by acknowledging Taiwan, especially as this would probably come with serious ramifications from China. The bias towards China and political hoops it must jump to is something I believe needs to be fixed with reform.
Tedros
Tedros has been at the brunt of a lot of criticism. He is the current director-general of the WHO, with a Ph.D. in Community Health and a Master of Science in Immunology of Infectious Diseases, however a lack of experience directly in the medical field. This being said he has been essential in substantial health boons in his home country of Eritrea, for example dropping child mortality by 2/3rds and HIV infections by 90% during 2005 -2012 when he was health minister of Ethiopia.
It is worth mentioning that, judging from his CV and mission statement, that reducing political friction and increasing international cooperation were important to him, which sheds a light on his approach to the politics of health, prioritising diplomacy over aggressive stances. In a BBC article , Lawrence Gostin, a professor global health at Georgetown University stated "His strategy is to coax China to transparency and international co-operation rather than criticising the government," however we can question whether that is working, and Gostin would also express concern on the damage of the WHOs reputation by the praise given to China.
Many are critical and cynical of his behaviour, largely due to how he was elected. The critics say that he is essentially in China’s pocket due to them being major supporters of him during his campaign, perhaps due to their growing support of Africa. Tedros has been keen to reassure China that the WHO would seek further cooperation.
The question is essentially whether his support of China is a political bias or an attempt to be diplomatic. It is impossible to say but worth considering. We must see how his leadership impacts the ongoing pandemic before coming to significant conclusions about his ability to lead the WHO. Whilst I am sceptical of his approach to diplomacy, his previous record seems good, and I do sympathise with a his unifying approach.
Travel Bans
The last critique I find often brought up is that of travel bans. These seem like a simple response to slow or prevent the spread of pandemics, and many see the opposition to them by the WHO as an issue of political correctness. However it seems that it is not quite that simple
The International Health Regulations treaty in part aims to prevent nations exacting penalties on nations that reveal outbreaks, such as travel and trade bans/restrictions, noting that these hamper response work and the nations economies and encourages nations to be secretive. The WHO notes that these measures give a “false impression of control”, with bans being incorrectly perceived as a sufficient measure to stop the spread of an outbreak, leading to nations being unprepared, such as the USA in the current outbreak.
This being said, there attitude comes from previous outbreaks such as that of Ebola, and may be outdated or ineffectual for other outbreaks as different diseases spread differently. We have seen this in action during our current pandemic with countries getting a handle on the outbreak only to be re-infected by someone travelling in from abroad.
It seems that the WHO is critical travel bans for more complicated reasons than political correctness. It is a complex issue; different diseases require different responses. Their attitude may be ineffectual at the moment. Whilst I understand the concern for political ramifications it must not prevent the best course of action. Furthermore, it doesn’t seem that there attitude prevents countries from being secretive regardless. All this being said I am not a medical professional so am hesitant to call them out as being wrong or naïve.
An update
There is to be a comprehensive review into the origins of Covid-19 by the WHO, decided at the 73rd annual meeting of the WHO. China was initially opposing it but has now decided to support it, most member states (120 of them at the time of writing) also back it. The investigation will look into the origins and the WHOs handling of the pandemic.
Keep an eye on the news to see how this develops.
A conclusion and my thoughts.
In the end, the WHO has some problems. Many will see this as a failure of globalism and instinctively want to pull away. In reality, it is an indication of the need for reform. The WHO is a crucial institution in our world, with the ability to help make the world a safer place, and we need to embrace it, give it more funding, more control and more influence in the world. We should support its aim to depoliticise health issues so we can deal with outbreaks in a scientific way without it fuelling tension.
We need to be wary of misinformation and misunderstanding. A lot of criticism seems to come from those who don’t understand the function and role of the WHO, and comes across as very cynical, often attributing power to the WHO it doesn’t have, then criticising it for not using it. This being said it will be interesting to see the results of the investigation.
I will leave my sources down below and would urge those interested in this topic to give them a read. I had to cut out a lot to keep some semblance of brevity. It’s a complicated geopolitical issue and cannot be effectively covered in 1 article.
Sources
UN.org
WHO.int/about
https://www.thinkglobalhealth.org/article/updated-timeline-coronavirus
https://www.who.int/dg/speeches/detail/who-director-general-s-statement-on-ihr-emergency-committee-on-novel-coronavirus-(2019-ncov)
https://www.theguardian.com/news/2020/apr/10/world-health-organization-who-v-coronavirus-why-it-cant-handle-pandemic
https://www.politifact.com/article/2020/apr/16/fact-checking-donald-trumps-criticism-world-health/
https://apps.who.int/gb/gov/en/composition-of-the-board_en.html
https://www.theatlantic.com/international/archive/2019/07/taiwans-status-geopolitical-absurdity/593371/
https://www.bbc.co.uk/news/world-asia-52088167
https://www.cfr.org/blog/tedros-taiwan-and-trump-what-they-tell-us-about-chinas-growing-clout-global-health
https://www.statnews.com/2019/05/14/could-an-emergency-declaration-over-ebola-make-a-bad-situation-worse/
https://www.washingtonpost.com/outlook/2020/04/14/trump-who-coronavirus-response/
https://www.thinkglobalhealth.org/article/world-health-organization-and-pandemic-politics
http://www.chinafrica.cn/chinese/focus/201703/t20170315_800091452.html
http://usa.chinadaily.com.cn/world/2017-05/25/content_29490575.html
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