Global health emergencies will be a fact of life in the 21st century. So, too, will be the World Health Organization’s chronic inability to rise to the occasion.
President Donald Trump is hoping that the body’s failures in dealing with the Covid-19 pandemic can be corrected with punishment. The U.S. will halt payments to the WHO to hold it “accountable” for its failure to warn earlier of a public health emergency and recommend travel restrictions from China, he said Tuesday in the U.S.
There’s a certain pot-kettle quality about a president who spent weeks declaring the pandemic was under control and likely to disappear naturally blaming others for a failure of leadership. On top of that, there’s strong empirical backing for the view that travel bans are rarely enough to halt a pandemic — especially not ones that exempt most citizens from quarantine,as in the U.S. Analysis of virus genomes indicates that most of the key early cases in the New York area originated in Europe, not Asia.
Still, as my colleagues Therese Raphael and Adam Minter have written, criticisms of the WHO’s handling of the outbreak are justified. The trouble is, holding back funds in the middle of a global pandemic will only harm public health, without forcing any change to the organization’s behavior.
If it was money that talked in the WHO’s Geneva headquarters, no one would be complaining about Chinese influence. The country is notoriously stingy in its contributions to an organization that gets three-quarters of its funding from voluntary donations. The $10.2 million that China provides through this route is less than comes from Kuwait, Pakistan or the Democratic Republic of Congo. Even private donors such as Rotary International, the Wellcome Trust and the Bill & Melinda Gates Foundation give more. Almost all the money China contributes comes through its membership fees, which are assessed for each state based on its population and income, and make up just 17% of WHO revenue.
How, then, does Beijing manage to exert such influence in Geneva?
Part of it comes down to the way the WHO operates through regional and country offices. As defenders of the organization have pointed out, it’s only able to work as a guest in countries where disease breaks out, and has few mechanisms to force compliance. Governments far short of China’s international stature have nonetheless managed to cow the WHO: During the 2014 Ebola outbreak in West Africa, Guinea, Liberia and Sierra Leone caused the organization to delay warnings about the epidemic until it was too late.
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More important, though, are the subtle arts of diplomacy — stacking influential United Nations committees and organizations with allied countries and representatives, so that they’re simpatico with your views of the world even if they’re not dependent on you for cash. Beijing’s tight-fistedness at the WHO in some ways helps in this regard: Most of its spending to support public health overseas is provided directly to foreign countries instead, giving more opportunities for demanding quid pro quos than if the funds were being consolidated through a multilateral body.
Western countries retained an outsize influence at the top of UN agencies decades after the fall of colonialism. It’s welcome that trend has passed, but democracies’ slow-footedness in cultivating friends in the emerging world had until recently left the field wide open for China to establish its hegemony. There are signs this is finally changing. Last month, the U.S. threw its weight behind Singaporean Daren Tang to head the World Intellectual Property Organization and won, beating off China’s favored candidate. The same approach now needs to be taken across the board.
Withholding funds isn’t the way to achieve that end. We tend to look to the WHO for leadership precisely when it’s least equipped to deliver: during emergencies. At those moments, an organization with the budget of an average city hospital (much of it locked down for long-term programs like polio eradication) is expected to suddenly mobilize more effectively than entire governments.
A better approach for the U.S. would be to work with other countries to raise the level of member contributions going to the WHO’s core budget, giving it the funds and operational flexibility it needs to respond in a crisis. Much of the voluntary donations that currently go through Geneva for specified programs could then be brought back into the bilateral arena, making the U.S. not just a distant funder but a partner to nations in the emerging world. That would be particularly beneficial in sub-Saharan Africa, where the triple plague of tuberculosis, HIV and malaria still accounts for a paltry 5% or so of WHO spending and where improved health would generate ample goodwill.
Trump isn’t wrong in diagnosing the WHO as sick. His mistake is in spurning a more holistic treatment. Doctors have long since given up bloodletting as a cure for disease. Diplomats need to take the same approach to funding. – Bloomberg
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