Does the World Health Organization have the freedom to do what it needs to do about covid-19?

The Chinese government has effectively “intimidated” the World Health Organization, Sen. Marco Rubio (R-Fla.) claimed this week. As a brand-new infectious disease rapidly spread across the globe, Rubio argued, China didn’t share information, best practices and data on infections among health-care workers.

However, WHO Director General Tedros Adhanom Ghebreyesus praised China’s early efforts to combat the disease. But the result, Rubio points out, is that the United States — and every other country — is effectively on its own as the world tries to deal with this new coronavirus.

This isn’t the first time critics have accused China of covering up or downplaying the severity of an infectious disease outbreak. Media coverage recalls China’s poor handling of H5N1 influenza, also known as bird flu, in 1997 — along with denials about SARS in 2002 and 2003.

Has the international community been too willing to accommodate the Chinese government because of its political and economic influence? In reality, the story isn’t that simple, and it’s not just about China. Disease diplomacy is tricky, and covid-19 is proving just how hard it is for the global community to respond to infectious diseases.

Who is in charge?

International organizations like WHO face unique pressures when trying to operate effectively, and international relations scholars have long sought to understand what allows international organizations to have greater influence.

One common issue is the principal-agent problem. In 1948, the countries of the world came together to create WHO to coordinate international responses to health issues. In other words, WHO is the agent trying to carry out the wishes and interests of its member-states (or principals). If you have one agent answerable to one principal, the process can be relatively simple.

What happens when you have an agent answerable to 194 principals? That heightens the likelihood of confusion, inefficiency and operational paralysis.

In the case of the coronavirus outbreak, China’s interests are not necessarily the same as those of the United States or Australia or any other WHO member-state — and WHO is trying to balance all of these competing pressures. Satisfying one set of interests may risk angering other member-states.

You catch more flies with honey than vinegar

Here’s another issue: WHO doesn’t have many direct levers of power at its disposal. If a country does not cooperate with its recommendations, WHO cannot impose economic sanctions. There’s no “country jail” for nations that don’t follow global health guidelines. WHO can’t threaten to invade to get accurate epidemiological data.

What WHO can do, though, is call countries out by “naming and shaming” uncooperative governments. The idea is that governments don’t want to be embarrassed by an international organization calling out their failures to the rest of the world. As a result, governments will be more willing to share information to keep their reputation intact and be seen as an upstanding member of the international community.

This approach can backfire, though. Countries may dig in and resist or offer counter-narratives to explain their actions.

With a new infectious disease outbreak originating in China, WHO may have decided the best way to get the Chinese government to cooperate is by playing “good cop” — praising China’s efforts and thanking Beijing for its cooperation as a way of keeping it on board and engaged with WHO. Rather than highlighting China’s lack of information sharing, WHO officials may have calculated that “naming and shaming” would be unlikely to produce a better outcome.

Health is always a political (and economic) issue

This logic, however, largely ignores how politics and economics are inextricably linked to global public health actions.

Countries worry that by disclosing infectious disease outbreaks other governments will impose trade and travel restrictions. This is not merely a theoretical matter — it’s a real concern, and any country can suddenly find itself a target. In December 2003, officials in Washington state reported a case of “mad cow disease.” Japan and South Korea responded by blocking the importation of beef from the United States, costing U.S. beef producers nearly $11 billion in lost revenue between 2004 and 2007.

Policymakers inevitably take the potential political and economic effects into consideration when making decisions about global public health responses. In 2014, WHO delayed declaring the Ebola outbreak in West Africa a Public Health Emergency of International Concern (PHEIC) precisely because it feared that the designation would devastate the economies of the affected countries and make it harder to mobilize an effective response.

The current global health governance system is set up to give credence to these political and economic effects. The International Health Regulations, a global treaty focused on reducing the effects of international disease epidemics, explicitly states that its mission is to implement strategies to stop the spread of disease outbreaks while also “[avoiding] unnecessary interference with international traffic and trade.”

The World Health Organization finds itself caught between many competing interests — making it harder for the organization to implement necessary and effective disease control protocols in a timely and consistent manner.

But the 194 WHO members also have the power to change how they engage with the organization and the rules by which WHO operates. This could include using the tools it has to exert more legal authority, adding more stakeholders in its decision-making processes, creating a freedom of information policy and giving WHO more control over its budget. These steps could boost WHO’s capacity and efficiency to address future disease outbreaks.

Jeremy Youde is a global health politics researcher and dean of the College of Liberal Arts at the University of Minnesota Duluth. Follow him on Twitter at @jeremyyoude.

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