Can the World Health Organization (WHO) be better than the member states of the United Nations that ultimately have a considerable say on its operations?
The WHO’s Director-General Tedros Adhanom Ghebreyesus has shown an evident bias to accept Chinese declarations and denials at face value – this has created a delay in international responses.. This in spite of a very limited Chinese contribution to WHO, but it matches the weakness of other UN organizations in the face of China’s powerful campaigning. As China itself has reversed course on the epidemic, the WHO becomes once more an irreplaceable tool in health emergencies.
TIMELINE OF WHO ACTIONS
- January 14, 2020 – Endorses the preliminary investigation conclusion by the Chinese authorities that there is no clear evidence of human-to-human transmission
- January 23, 2020 – Recognises human-to-human transmission of COVID-19 and recommends airport exit screening. WHO’s Emergency Committee meets for the first time
- February 4, 2020 – Pledges to share information with governments
- February 7, 2020 – Highlights the global shortage of Personal Protective Equipment (PPE)
- February 12, 2020 – Publishes Operational planning guidelines for countries
- February 20, 2020 – Warns that the window of opportunity “may close”
- February 24, 2020 – Recognises potential of a pandemic
- February 27, 2020 – Lists “vital questions” for health ministers
- February 28, 2020 – Releases “Report of the WHO-China Joint Mission on Coronavirus Disease 2019”
- March 5, 2020 – Recommends wide testing
- March 11, 2020 – Announces a pandemic
Can the World Health Organization (WHO) be better than the member states of the United Nations that ultimately have a considerable say on its operations? This is a question that has peaked with the coincidence of rising Chinese influence inside the UN system, and the appearance of a pandemic that by all reasonable accounts has started in China. These questions have been made more acute by the lavish praise of China’s behavior from WHO Director-General Tedros Adhanom Ghebreyesus.
WHO is a key UN organization – with a projected base budget (excluding polio and some other special programs) of 3,8 billion $ in 2020 and a major role in recommending, coordinating and assisting both the prevention and the treatment of major health issues. It is also a frequent subject of potential controversy at times of epidemics, because its role, success and failures will then be scrutinized and occasionally scapegoated. It was accused of being very late in declaring an epidemic over the Ebola outbreak in Africa, and earlier of being slow to recognize SARS as well.
DG Tedros’ permanent and forceful endorsement of Chinese actions throughout the crisis has, of course, created a counter-reaction: the organization itself is now accused of having missed the opportunity to forestall a global pandemic. This is the result of two decisions. First, WHO’s failure to recognize proven human-to-human contamination until January 23 (and going along on January 14 with China’s refusal to admit human to human contamination), despite strong and persistent indications to the contrary, and alerts by Taiwanese health officials directly conveyed to the WHO. Second, the organization’s refusal to declare a pandemic until March 11, when 114 countries had already reported 118,000 cases. These decisions have had global consequences, as WHO guidelines are for better or for worse followed by countries and even by private actors who can base – and later justify – their actions from these guidelines. Such was the case for example in France, where public authorities were still saying there was no proof of human to human contamination on January 20. Beyond the issue of what WHO can do at times of epidemics, there is a ripple effect from its statements.
In the present case of the coronavirus, any quick search for information from unofficial sources in China, including but of course not limited to the courageous doctors in Wuhan who raised the alarm from the last week of December 2019, would have established China’s failure to recognize human-to-human transmission and declare an epidemic. Ironically, Taiwan’s status as a “Chinese province” means its own information was officially ignored. We therefore have to search for explanations on the reasons why a 3,8 billion $ UN agency with large regional offices and some of the world’s most extensive experience of epidemics and emergency responses fell into this trap.
The answers are not easy, and they depend on the interaction between human personalities and structural constraints, real or perceived. Let’s start with the last. WHO is certainly not financially reliant on China’s contributions, because they are very small at this point: 86 millions $ in 2019, of which a paltry 10,4 million $ voluntary contribution in 2017. This is less than 10% of what the United States contributed overall in the same year, and 2,5% of the American voluntary contributions (the Gates Foundation alone made up 8% of all voluntary funding of WHO). In fact, such a large discrepancy can only be explained by WHO’s low level of mandatory funding from UN member states: 80% of its budget comes from voluntary sources, and the template for its 2020-2021 budget plan looks more like a fundraising pitch than a budget presentation. China’s initiatives in international crisis response of recent years generally do not go through WHO: its responses to the Ebola crisis in Africa, for example, was delivered bilaterally. When Tedros thanked donors in the present crisis on February 8, he listed “the US, the UK, the Bill & Melinda Gates Foundation, the Netherlands, the Czech Republic, Japan and the Wellcome Trust” and China did not rate a mention.
Because Ms. Margaret Chan, former director of health of the Hong Kong SAR and the first PRC national to run a UN agency (from 2006 to 2017), and because of the insistence by China’s public diplomacy on human welfare, it has often been said that WHO was directly under Chinese influence: this only shows in the success of China’s campaign to curtail participation of Taiwan. Ms. Chan’s two mandates were lackluster, marked by some polemics at the time of Ebola, by a strange episode of praise for North Korea’s health system, and by several stands against Taiwan for not “respecting” fully the “One China” principle. Ms. Chan’s election in 2006 was the last one to be run with WHO’s Executive Board’s pre-selection of a single candidate, the members of the organization were then asked to ratify this choice. By contrast, in 2017 the members of WHO chose along a panel of 3 pre-selected candidates, and Tedros came ahead with 133 votes out of 186 – a margin that even China’s influence cannot explain, but that has to do with his status as representing “the global South”.
Once affiliated with Ethiopia’s Liberation Front, Tedros has been educated in infectiology and malaria prevention. He has been a minister of foreign affairs and minister of health, and cuts a much more flamboyant figure than Ms. Chan. Indeed, he comes from a country and a continent that is easily critical of Western actors, yet he has gone down well with many private health donors. During the current crisis, he has defended his praise of Beijing by the need to obtain cooperation. Yet it took WHO a month and a half – between China’s first report to WHO of an “unknown illness” and February 13 – to send a full expert WHO mission on the ground in China, and with very limited access to Wuhan.
But is this a personal failure, or a reflection of where things have gone more generally at the United Nations and indeed in many international organizations? There are other examples of these courting a China that does not deliver. A case in point is the UN Refugee Agency (UNHCR) which, year after year, heaps official praise on China’s Belt & Road Initiative (BRI). Above any other consideration, BRI simply has no discernible relation to refugee issues. In 2018, China contributed to the UNHCR a paltry 1,3 million $ of specified voluntary contribution, while the US contributed 1,6 billion $ in the same class, and Europeans as a whole 1,2 billion $.
There are other reasons for the proclivity of many international organizations to China: its sheer geopolitical weight and above all its capacity to say no, and in some cases to garner voting coalitions; in the UN system, the importance of its mandatory budget contribution (soon going to 10 % of this class), and the control that China now exercises through its higher profile in budget committees (so-called 5th Committee). And there is the never extinct hope that Beijing will contribute more in the future, and will be more flexible. In short, while the United States talks loudly but carries a small stick, China now speaks softly but carries a big stick throughout the UN system.
The question therefore becomes: how reliable WHO really is when major epidemics originate in China? WHO behaves in this case as a true and tried intergovernmental organization, not questioning its official sources, and therefore fails in this regard with its mission of information. What is worse in the present emergency: a number of governments and organizations either believed naively those claims, and the resulting reluctance to declare an epidemic and later a pandemic, or they chose to rely on this false comfort in order to delay difficult measures. We are not privy to the deliberations of the WHO’s Emergency Committee that met for the first time on January 23 – three days after China’s turnaround on the epidemic. But it seems impossible that its members, coming from the scientific community, would not have reflected on the declaratory gap that remained, even if it was not diplomatically useful to challenge China. In the same vein, WHO advised at that time against general travel and trade restrictions. There never was a word about the delay between December 31st and January 23, including the catastrophic failure to stop all Chinese New Year travel at home and abroad.
Since January 23, WHO – and Tedros – have fulfilled much of their essential function: they have repeatedly called for changes in government policy, describing then “a high risk” for the whole world. He lauded China’s containment measures as a “window of opportunity” given to the world: and it is clear that this time around he was right. WHO recommended airport exit screening on January 23. It then pleaded to share information with governments (February 4). It highlighted the global shortage of Personal Protective Equipment (PPE) on February 7. Operational planning guidelines for countries were published on February 12. WHO warned on February 20 that the window of opportunity “may close”, and recognized “pandemic potential” on February 24. It listed “vital questions” for health ministers on February 27. The publication of its China mission report led to recommendations essentially taken from the all-of-government and all-of-society approach in China: not a wrong perspective, given the clear progress made by the country that had also made the worst blunder in the beginning! Wide testing was recommended from March 5, and encapsulated later by Tedros’ objurgation: “test, test, test!”. WHO has emphasized the policy choices of South Korea – although it assiduously avoids any mention of Taiwan, excluded from the organization. WHO is now cooperating with the Jack Ma Foundation to distribute masks made in China, where production is said to have ramped up to 115 million per day, with a goal to reach quickly 200 million.
Looking at the timeline, and at Tedros’ speeches, a reluctance to criticize China in any form is evident. There is also an accent on preventing the spread of “fake news” and to avoid over-qualification of the crisis: clearly, there was a will to avoid panic, and perhaps also an African born experience of other equally challenging crises in the past, even if they remained regional. But there is no shortage of warnings and guidelines, even in the most general media communications.
Responsibilities will need to be assessed – and the blame game is unavoidable. At this stage, what one can conclude about WHO’s performance is that it has been greatly hampered by China’s limited communication and official denials until January 20, and by a clear political will at the top of the organization to avoid calling out that country. The lesson is clear for international organizations, and in fact not limited to the UN system.
But it is equally clear that once China finally started to implement strong measures against contagion from Wuhan city and Hubei province, the WHO has been able to increasingly play an important role in coordinating information and promoting responses among its 194 members. Those who wanted to have no ears and no eyes for themselves were free to follow the politicization that Tedros clearly brought to the WHO’s communication process, and to use it as an excuse for delayed responses. The excuse might be valid for smaller, less developed and less experienced nations. It does not hold for larger member states with strong participation in the WHO process.
The mutualization of efforts that WHO allows – even if it cannot achieve this by itself – and the dissemination of information, best practices and guidelines, remain irreplaceable. How to lessen the impact of a relentless authoritarian regime remains an issue. Perhaps, avoiding preemptive submission, and questioning official truths instead of pretending to heed them, would be a start.