On Tuesday, President Trump formally began the process of pulling the United States out of the World Health Organization, having accused the organization of not holding the Chinese government to account for its handling of the coronavirus.
The withdrawal would not go into effect until next July. But the prospect of losing the United States as a member, far and away the W.H.O.’s largest donor, is a big blow to the organization, and comes just a day after 239 scientists in 39 countries wrote an open letter claiming its guidance on airborne transmission was outdated.
Mr. Trump’s criticisms of the W.H.O. may be hypocritical, but many public-health experts and journalists say they are not entirely unfounded. What has the pandemic revealed about the organization’s shortcomings, and how can they be remedied? Here’s what people are saying.
What exactly is the W.H.O.?
The World Health Organization was founded as part of the United Nations in the wake of World War II, at the dawn of what some call Pax Americana, or the American Century. A product of that era’s heady faith in international cooperation, the W.H.O. stated as its founding objective “the attainment by all peoples of the highest possible level of health.” In practice, this broad mandate has translated to alerting the world to potential public-health threats, preventing the spread of diseases, and championing universal health care policy.
During emergencies like the coronavirus, the W.H.O. is meant to act as a coordinating body, employing its 7,000 workers spread over 150 offices worldwide to organize a global response, guide containment, declare emergencies and make recommendations in cooperation with member nations. If a vaccine is ever discovered for the coronavirus, the W.H.O. will play an important role in coordinating its distribution and influencing its pricing.
But the W.H.O. was never vested with any direct authority over its members, as my colleagues Daniel Victor and Christine Hauser explain, so its mission often exceeds its abilities. And like any governing body, the organization is subject to budgetary and political pressures, especially from powerful nations like the United States and China, as well as from private funders like the Gates Foundation.
The W.H.O.’s track record of responding to emergencies is uneven, The Times editorial board writes. While it boasts many momentous achievements — including the eradication of smallpox, the near eradication of polio, the development of an Ebola vaccine and a huge expansion of basic health care services in low-income countries — it also suffers from institutional sclerosis. The W.H.O.’s sluggish response to the West African Ebola outbreak in 2014 was primarily responsible for the severity of that epidemic, which killed 11,000 people in two years. According to ProPublica, the Obama administration was so displeased with the W.H.O. that it largely bypassed the agency to coordinate its Ebola response with other countries.
The W.H.O.’s communication about the evolving science of the virus had been drawing scrutiny well before this week.
- From the beginning, the organization was loath to recognize evidence that symptomless transmission was playing a significant role in the virus’s spread. Instead, Amy Davidson Sorkin writes for The New Yorker, the organization dug its heels into semantic distinctions that were “terribly misleading.”
- The W.H.O. also initially refused to endorse masks for the public despite a growing body of evidence of their potential effectiveness. The W.H.O. reversed its recommendation only in June, by which time virtually all scientists and governments had been recommending masks for months.
The W.H.O. has been mired in political controversy, too, in large part because of its perceived deference to the Chinese government.
- Doctors in China were raising the alarm that the coronavirus was potentially spreading from human to human as early as late December. Through the middle of January, however, the W.H.O. continued to confirm Chinese officials’ claims to the contrary.
- By the time a Chinese official publicly acknowledged the risk of human-to-human transmission on Jan. 20, the virus was already seeding in major Chinese cities and had reached Washington State. The W.H.O. didn’t declare a global health emergency for 10 more days, during which time the virus may have been spreading across the United States.
- The W.H.O.’s exclusion of Taiwan, which China refuses to recognize as a sovereign state, may also have hampered the global response to the pandemic. Taiwanese health officials say that they warned Beijing and the W.H.O. on Dec. 31 about “atypical pneumonia cases” in Wuhan, but did not receive a satisfactory reply. That same day, Taiwan started taking precautionary health measures, which epidemiologists have described as among the most effective in the world: The island has had fewer than 500 cases.
The timeline of the W.H.O.’s response matters because of the exponential nature of the coronavirus’s spread. In New York City, for example, researchers have estimated that acting even a week or two earlier might have reduced cases by 50 percent to 80 percent. To prevent a similar calamity from occurring again, the Wall Street Journal editorial board argues, the W.H.O. must either be reformed to gain more independence from China or be defunded.
‘Still the world’s best hope’
Despite its flaws, the W.H.O. has been proved a force largely for good over its 72-year life, the Times editorial board argues. But with an annual budget of only $4.8 billion, the organization clearly does not have the resources to adequately serve its mission. “It’s not a failed bureaucracy,” William Foege, a former director of the Centers for Disease Control and Prevention who worked on the international campaign to eradicate smallpox, told ProPublica. “If you go there and see all they do every year, and they have a budget for the entire world that’s smaller than many medical centers in this country.”
The answer to this problem, the board says, it to give the W.H.O. more power and funding, not less: “The United States and other member nations — like Brazil, which also recently threatened to leave the organization — should try seeing the W.H.O. for what it is: a reflection of the countries that created it and that wrote its bylaws. If they don’t like what they see, they should work to improve that reflection.”
More funding could also help the W.H.O. become less dependent on China, Yu-Jie Chen and Jerome A. Cohen write in The Japan Times. Beijing’s influence is not primarily financial. Rather, it stems from Beijing’s talent for building coalitions within the organization, which affords it significant sway over the body’s decisions, including the selection of its leader. So in withdrawing funding, they argue, the United States would be forfeiting its primary point of leverage.
Experts also told The Times that while the W.H.O. has made some missteps during the pandemic, it has done well overall given its organizational constraints. Dr. Ashish Jha, director of the Harvard Global Health Institute, said that the withdrawal “will both harm global public health and harm the health of the American people.”
The W.H.O. 2.0
Fixing the W.H.O. begins with funding, but it won’t end there, writes Zeynep Tufekci in The Atlantic. “We must save the W.H.O., but not by reflexively pretending that nothing’s wrong with it, just because President Trump is going after the organization,” she argues. “It needs to be restructured, and the first order of business is to make sure that it’s led by health professionals who are given the latitude to be independent and the means to resist bullying and pressure, and who demonstrate spine and an unfailing commitment to the Hippocratic oath when they count most.”
The W.H.O. may even need to be transformed rather than fixed, according to Kelley Lee, a researcher at Simon Fraser University in British Columbia who published a book about the organization. As she explained in Vox, the W.H.O. and the United Nations were conceived during a period when nation-states — and particularly the United States — were the primary agents of global power. While states won’t be going away anytime soon, the rise of the internet and multinational tech giants like Facebook mean they aren’t the only important actors on the world stage anymore.
As an analogy, she suggested, think of an old computer: You can upgrade it over the years, but at a certain point, you’ll need to buy a new one. Instead of trying to retrofit your Macintosh II to stream Netflix, you might be better off getting an iPad.
But what would “this new, iPad version of the W.H.O.” look like? Dr. Lee thinks it should probably take the form of a supranational authority that requires countries to cede power at the state level in exchange for global security. An example of such an institution is the World Trade Organization, which was created in the 1990s and has the power to enforce sanctions.
But even the World Trade Organization has been hobbled by the Trump administration’s refusal to appoint judges, and right now many countries are seeking to wrest power from international institutions, not cede it. “Some countries may decide that, no, we’re going to retreat into our castles,” Dr. Lee said. “And obviously that didn’t work when the Black Plague came along.”
Spencer Bokat-Lindell is a staff editor in the Opinion section.