WHO faces stiff test as world tests its authority

David Pierson, Tribune News Service

In a few awkward seconds, Bruce Aylward, a senior official at the World Health Organisation, laid bare the flaws and pressures faced by the global health agency charged with leading the response to the worst pandemic in over a century.

A video that’s since gone viral shows the distinguished Canadian epidemiologist dodging a reporter’s question about why Taiwan is not a member of the WHO. Aylward twitches and blinks. He says he cannot hear the journalist. When she offers to repeat the question, he asks her to change the subject. When she persists, he hangs up on the video chat with a Skype chime thud.

Aylward is a veteran of the United Nations’ health agency, responsible for preventing millions of children from contracting polio and stanching the Ebola epidemic in West Africa. But the agency’s limitations were starkly sketched at the mention of Taiwan. An island nation of 24 million crucial to the fight against the coronavirus, Taiwan has been blocked from joining the WHO because China considers it a renegade province.

The video exchange, health experts say, reinforced how powerful national interests are overshadowing shared interests at a time when the agency is needed to marshal a global response to an outbreak that emanated from China and is threatening to kill millions.

Even before the Aylward interview, the WHO was under fire for taking weeks to raise its highest warning about the novel coronavirus despite its spread globally — a decision widely viewed as deference to China.

Leading a medical response on a wide scale is a volatile mix of politics, disease, money, science, second guesses and lost opportunities. The WHO was blasted for taking too long to sound the alarm over the 2014 Ebola outbreak in West Africa. Five years earlier, though, it was criticized for overreacting to the H1N1 swine flu.

But the WHO’s position today is arguably more fraught than at any time since the end of the Cold War. As COVID-19 ravages more countries, the agency has to navigate political tensions between the world’s two most powerful nations, the US and China. It is also encountering growing nationalism and, in some cases, a rejection of science fueled by populism and social media.

The WHO risks becoming a bystander in the unfolding crisis as countries make unilateral decisions about emergency measures, treatment and distribution of medical resources. The organisation is reminiscent of blue-helmeted U.N. peacekeepers dispatched to stop wars and conflicts but eclipsed by national self interests that undermine their missions.

The fractious climate could result in renewed disease outbreaks and inequities, experts say, especially if an eventual vaccine leads to a free-for-all in which nations hoard supplies. It also raises questions about how the WHO, in an increasingly divided world, could handle an even swifter and more deadly virus, such as what scientists term as a Disease X.

“The WHO has been sidelined from the biggest pandemic of the century,” said Lawrence Gostin, a Georgetown law professor and director of the World Health Organisation WHO’s Collaborating Center on National and Global Health Law. “The powerful forces of sovereignty, nationalism and populism have literally overwhelmed the WHO as an institution for no fault of its own. At a time when the world should be coming together under the WHO banner, solidarity is unraveling.”

That wasn’t the intent when the United Nations body was formed in 1948 after the Second World War to guide international health policy impartially and scientifically. The agency counts among its successes the eradication of smallpox, the suppression of polio and the development of standards for essential medicines.

The WHO’s annual budget, which stood at $4.4 billion last year, often doesn’t leave enough to prepare poor countries for disease outbreaks like Ebola. That’s about one-quarter the budget allocated to fighting opioid addiction in the US.

Only 18% of the agency’s funding consists of assessed contributions from its 194 member states. The rest is provided voluntarily, often from private donors such as the Bill and Melinda Gates Foundation, who have a say in how their money is spent.

The US has long been the body’s biggest benefactor, providing hundreds of millions of dollars in assessed and voluntary contributions each year. China, by comparison, contributes in the tens of millions.

That could change. The Trump administration in February proposed cutting US funding to the WHO by 53% — a move consistent with the president’s distaste for multilateral organizations. The proposed cuts make China’s growing commitment to the agency all the more important at a time when Beijing has been cultivating greater influence in the United Nations and its agencies.

It was against this backdrop that WHO Director-General Tedros Adhanom Ghebreyesus stunned some observers with his effusive praise of China’s handling of the coronavirus in late January.

This, despite revelations that China suppressed information about human-to-human transmission of the disease by muzzling whistleblower health workers, including Dr. Li Wenliang, who died in February after contracting the disease.

“The agency has to play a diplomatic role and keep all countries at the table,” said Devi Sridha, a global health expert at the University of Edinburgh. “Throughout this outbreak it is better to keep China cooperating and at the table.”

The WHO didn’t declare a pandemic-level coronavirus emergency until March 11. By then, nearly 120,000 cases had been reported in 114 countries. The agency had spent the preceding weeks warning countries to prepare for the inevitability of transmissions within their borders.

“We must focus on containment, while doing everything we can to prepare for a potential pandemic,” Tedros said Feb. 24.

That same day, the WHO was reminded it has little sway with Washington. President Trump tweeted that the virus was “very much under control” in the US. It appeared the WHO could not persuade the White House to mobilise a more serious response to the virus, which was viewed as overblown by many of the president’s supporters despite scientific evidence to the contrary.

Complicating matters was Washington’s and Beijing’s tepid cooperation. Rather than lead the world toward a solution to the crisis in conjunction with the WHO, the two governments embarked on a war of words to deflect blame.

Trump and other American officials promoted terms such as the “Chinese virus” and “Wuhan virus,” a reference to the disease’s epicenter in China, that contributed to a wave of racism. Chinese officials pushed a conspiracy theory about the disease being released by the US military in Wuhan. The WHO tried to quash the spat by naming the virus COVID-19.

David Fidler, an adjunct senior fellow for cybersecurity and global health at the Council on Foreign Relations, said the WHO has demonstrated throughout this outbreak that it has little interest in assuming political authority.

That clears the way for the organization’s most powerful members to treat global health “through the distorting lens of the balance of power, reducing the potential for common ground,” he said.

“The post-Cold War golden age of global health is over,” Fidler added. “The COVID-19 disaster marks the turning point into a different, more difficult future.”