WHO's non-political nature prevents it from questioning U.S. for poor healthcare services amid COVID-19 outbreak

April 28, 2020 - 15:32

The World Health Organization has always rendered its services to the world countries away from political considerations otherwise it would hold accountable the U.S. for the Washington's poor healthcare services to the Americans when the country faces the heaviest waves of the novel coronavirus disease.

Dalton Price, an incoming Ph.D. candidate at the University of Oxford whose research focuses on the politics of global health and effective coordination of actors during times of crisis, says, "If the WHO did get political, maybe the U.S. wouldn’t have chosen corporate profit over basic human rights, because the WHO would question why the world’s richest country is unable to provide healthcare.'

"I agree, Mr. President. The WHO is ill-prepared to handle the COVID-19 pandemic but not for the reasons you claim. You suggest they are China-centric, misled and lied to the U.S., and got “every aspect” of the response wrong. These falsities led you to the dangerous decision to halt funding for a lead health agency during an unprecedented health crisis and when we need them the most," he wrote in his research published by Common Dreams.  

But you miss the mark on where the WHO goes wrong. There is an elephant in the room, a piece of history, that we overlook yet explains this ill-preparedness: that one of the WHO’s earliest and most important rules was to avoid politics at all costs. It isn’t set up to deal with, well, you. This forgotten history seems to be more relevant now than ever before.

Imagine it is the 1920s and you are given a seat at the table of what would soon become a 30-year-long discussion about a new international, intergovernmental health organization that is tasked with safeguarding humanity. It is among the earliest conversations, and it would be the first of its kind. The need for global cooperation in bringing this bold idea to life is abundantly clear. Yet outside the walls of the building in which you sit are growing tensions between communist and capitalist countries, authoritarian and democratic regimes alike.

National politics are just as unstable as the international conflicts that recently manifested as a global war, World War I. You watch the rise of communism and a civil war in China in 1927, a newfound authoritarian dictatorship after the Spanish Civil War in 1939, and the rise of Nazism in Germany and fascism in Italy. Domestic tensions quickly become international actions with many engaging in expansionist and interventionist policies, despite the League of Nations’ continued call for world peace.

You hear about Germany’s remilitarization of the Rhineland, Italy’s colonization of Ethiopia, and countless other offensive moves in China and Poland. The French president, Prince of Yugoslavia, and Chancellor of Austria are all assassinated. You are fully embedded in these tumultuous conditions and fearfully watch as World War II begins. There is the intensifying Arab-Israeli conflict and Indo-Pakistani war; United States’ use of nuclear weapons to bomb Nagasaki and Hiroshima; and Japanese invasion of Hong Kong, the Philippines, French Indochina, Portuguese Timor, Indonesia, and Malaya. You hear about millions of Jews dying in Germany, but you were not quite sure how many. Europe is weary of more war, divided and jaded, but so are you. And when you think it is finally over, your home continent is suddenly up for grabs in the eyes of the Western world and Soviet Union.

A geopolitically-tense Cold War and battle between capitalism and communism ensues, and you’re right in the middle of it—both geographically and ideologically. You watch as the parliaments of Rome, Berlin, and Tokyo fall and the Second World War comes to a slow conclusion.

But OK. Snap out of it. You have to get back to the mission: global cooperation at the largest scale in history. You need to build this thing—the International Health Organization, the World Health Organization, you are still unsure of what it will be called. You are confident it will save lives. And frankly, that is all you want to do during these dark, bloody, tense, and painful times.

You try to make this all work, you try to bring the right people to the table and make something productive happen, but wartime politics drowns out your efforts. You are forced to speak with foreign-affairs ministers, diplomatic commissions, and other governmental figureheads. They are suspicious of hidden political agendas – and really just all things Western. The tension and hostility among them are palpable. You wish there are more medical representatives or health ministries involved, as you feel that they are always the delightful ones. You see regional blocs quickly form with some countries already pooling and sharing public health data, but these pools are not made available to everyone.

You expect the divide between capitalist and communist countries but are then taken aback by secretive collaborations between the United States and Great Britain, both of whom you catch trying to suppress conversations about an independent health organization. You are exhausted, sick of politics, and regretfully wonder if a new worldwide agreement would even be possible. You quiver at the thought of this game-changing health organization, the one in which you wholly believe, being left to agreements negotiated between certain countries or regions. You realize there is only one way out. You need to do whatever you can to depoliticize the topics, to make international, cross-bloc cooperation possible. You need to avoid politics at all costs.

And so you do. You weave an antipolitics into the fabric of what will soon become the world’s largest and most influential international health organization, the WHO.

You are right, Mr. President. The WHO is flawed; it is ill-prepared. An effective response to COVID-19 would require politics. Yet they have avoided politics since their founding in a politically-fraught time and continue to do so today. It is the perfect anachronism.

But if they did get political, maybe our outbreak in the U.S. wouldn’t be so bad. Maybe we wouldn’t be the only O.E.C.D. country without universal health coverage, because the WHO would have pushed us to meet this standard. Maybe we wouldn’t have chosen corporate profit over basic human rights, because the WHO would question why the world’s richest country is unable to provide healthcare. Maybe black Americans wouldn’t disproportionately suffer the burden of COVID-19, because the WHO would have long ago called out the institutionalized racism and deep-rooted health disparities it has created. Maybe, just maybe, thousands of Americans wouldn’t have lost their lives to COVID-19, because the WHO would have pushed us over the past 70 years since its founding to simply do better.

And boy, do I wish the WHO would get political. It seems more necessary now than ever before.

In mid-April, President Trump announced that he would U.S. funding for the World Health Organization for 60 to 90 days as his administration reviews the group's handling of the coronavirus pandemic. He made the announcement at his press conference at the time, saying he wanted to suspend U.S. contributions "while a review is conducted to assess the World Health Organization's role in severely mismanaging and covering up the spread of the coronavirus."

Trump said that the WHO was slow to respond to the crisis and that the organization has been "China-centric."

"We regret the decision of the president of the United States," WHO Director-General Tedros Adhanom Ghebreyesus said in a press conference a day after Trump's decision. "WHO is reviewing the impact of our work of any withdrawal of U.S. funding, and will work with our partners to fill any financial gaps we face and to ensure our work continues uninterrupted."

The agency, founded in 1948, describes itself as "the directing and coordinating authority on international health within the United Nations system." It coordinates activities and provides guidance for their 194 member states and two associate members (Puerto Rico and Tokelau).

Activities range from promoting the polio vaccine to supporting childhood nutrition to playing a leadership role in the case of health emergencies.

"There will be guidelines on what kind of essential medicines there should be, what kind of essential diagnostics there should be, what might be the regimens to use in relation to HIV in different countries, taking into account the resources available," says Rifat Atun, professor of global health systems at Harvard University, was quoted as saying by NPR news website, adding, "Countries are not under any obligation legally to follow these guidelines, but many do in relation to epidemics."

The World Health Organization runs on a two-year budget cycle. For 2020 and 2021, its budget for carrying out its programs is $4.8 billion, or $2.4 billion per year.

"The WHO has a budget around the size of a large U.S. hospital. It's about one quarter of the budget of the U.S. Centers for Disease Control and Prevention," says Lawrence Gostin, a law professor at Georgetown University and director of the World Health Organization Collaborating Center on National and Global Health Law, which is an independent agency that works with that WHO.

Annual donations from its member states made up 51% of the WHO's funding, according to a report from its 2018-2019 budget cycle.

These contributions fall into two categories: assessments (i.e. membership dues) and voluntary contributions.

"The assessed money is like operational support," says Jennifer Kates, director of global health and HIV policy at the Kaiser Family Foundation. "Here's the money. You can figure out what to do with it."

Each member state pays assessment fees based on the country's wealth and population.

Countries also make additional voluntary contributions, as does the United Nations, philanthropic foundations and nongovernmental organizations. Donors typically earmark these monies for specific causes. The largest allocation from voluntary contributions goes to polio, which has an $863 million budget in 2020-2021. "It means that the organization is primarily driven by a lot of the outside influences of donors in terms of how it can budget," says Kates.

Over time, Kates says, voluntary contributions have grown to dominate the WHO's budget.

For the 2020-2021 budget, $957 million comes from assessments and $4.9 billion comes from voluntary contributions.

"The U.S. is the largest single government donor in the world," says Gostin, "so WHO's budget does rely very much on U.S. contributions."

For the two-year cycle of 2018 and 2019, U.S. contributions accounted for about 20% of the WHO's total budget.

The money comes in two streams. The U.S. contribution to the pool of assessed fees is $237 million. That's 22% of the total assessed fees, the largest share of any nation. By comparison, China contributes 12% of this pool of monies, and some low-income countries pay 0.1%.

In addition, the U.S. pledged more than $656 million for specific programs, according to the WHO's program budget portal. These voluntary contributions were earmarked for programs including polio eradication, health and nutrition services, vaccine-preventable diseases, tuberculosis, HIV — and preventing and controlling outbreaks.

What does a U.S. funding freeze mean? There is no definitive answer to this question. At the press conference, Trump said that the review would take 60 to 90 days and that a "very thorough investigation" is underway. But no details have been released on how the funding suspension will be executed.

And it is unclear whether the president has the authority to unilaterally halt funding for an international institution such as the WHO.

"If the money is already committed and already given, he probably can't take it away," says Gostin, but the president could withhold outstanding payments or instruct agencies such as the United States Agency for International Development ito scale back on cooperation with the WHO.

"A lot of the voluntary money is provided at the agency level," says Kates, so it's possible that the president could demand that the CDC for State Department stop providing money to the WHO for project work.

MJ

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