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Two Cheers for the World Health Organization

It’s getting slammed by Donald Trump and others. Better to credit the WHO for what it does, and make it better.

Crawford Kilian 8 Apr

Tyee contributing editor Crawford Kilian blogs about COVID-19 here.

Well, it had to happen. On April 7, President Donald Trump tweeted: “The WHO really blew it. For some reason, funded largely by the United States, yet very China centric. We will be giving that a good look. Fortunately I rejected their advice on keeping our borders open to China early on. Why did they give us such a faulty recommendation?”

Bashing the World Health Organization is almost a diagnostic feature of a serious disease outbreak. It’s come in for criticism over bird flu, swine flu, Ebola and most other emerging diseases. But the world would be far worse off without the WHO. In fact, given the limitations built into the WHO’s budget and governance, it’s amazing that it still performs so well.

Current WHO criticism also includes some hard hits from my admired Tyee colleague Andrew Nikiforuk, who recently blasted the WHO: “But even now, response is hampered and the catastrophe is compounded, because the World Health Organization led by Tedros Adhanom Ghebreyesus has acted more as a diplomatic arm of China’s dictatorship than as a dispassionate professional agency sworn to protect global public health.”

Similarly, Terry Glavin in Maclean's said that “WHO Director-General Tedros Adhanom Ghebreyesus has lavished praise on Beijing’s handling of the outbreak, going out of his way to support Xi Jinping’s insistence that any precautionary travel restrictions would be an unacceptable encumbrance to China’s economy.”

I tend to agree with Nikiforuk and Glavin, but their criticism is beside the point. The WHO is far from a “dispassionate professional agency.” It is a creature of the United Nations and its member states. It was designed to be a servant, not a master. UN members can ignore its advice (as Nicaragua is doing in the present pandemic). Member states can also vote to reduce the WHO’s budget, and often have.

Public health disasters are hazardous for the WHO as well as for their victims. Disease outbreaks make governments look lazy and incompetent. No government likes to be embarrassed, and attracting the WHO’s attention is usually an embarrassment.

It’s bad enough for poor African and Latin American states to try to cope with, say, dengue or malaria. When a rich state like Saudi Arabia finds its hospitals seething with another coronavirus, MERS, the House of Saud prefers to ignore both it and the consequences for its obese, diabetic population who contract the disease from camels or from Saudi hospitals’ kidney dialysis machines.

Criticize member states at your peril

Still, Saudi Arabia is a UN member and thereby a member of the World Health Assembly, which sets the WHO’s budget and approves its agenda. The WHO criticizes the Saudis at its peril.

That budget is derived partly from assessments, a kind of tax that UN members impose on themselves (though they may then choose not to pay it). In its 2017-2018 budget, assessments amounted to US$501 million; voluntary contributions made up US$2.2 billion. The top 20 voluntary contributors to the budget included the U.S., with the Bill & Melinda Gates Foundation in second place ahead of the U.K. Canada is number 17, just behind China.

For unexpected emergencies like the expulsion of the Rohingya from Myanmar or the emergence of Zika virus disease in Latin America, the WHO must simply beg for spare change. In some cases, such appeals bring in considerable money, as in West Africa’s 2014-2016 Ebola outbreak. In others, like improving health conditions in refugee camps in the Central African Republic, the WHO’s begging bowl goes unfilled.

Even COVID-19 needs yet more public-private funding: the WHO and other agencies have set up the COVID-19 Solidarity Response Fund as “the only way for individuals and organizations to contribute directly to the WHO’s global efforts to tackle the pandemic.”

At present, the WHO must deal with a host of health issues from abortion to zoonoses (animal-borne diseases), through six regional organizations plus national offices in 149 nations. It must stay on good terms with superpowers and failed states alike — but especially with the superpowers.

Peacekeeping with mercenaries

Take the cholera debacle in Haiti a decade ago. When the United States wanted a UN peacekeeping force installed in Haiti, the UN obliged. Since Lester Pearson invented peacekeeping amid the Suez crisis of 1956, it has become a politically convenient tool for the great powers: instead of sending in their own troops, which looks like imperialism, they can outsource military muscle to third-world states, effectively hiring their armies as mercenaries.

That’s how Nepali soldiers ended up in a camp in Haiti near the Artibonite River in 2010. Some of the soldiers had cholera from an outbreak back home the previous month, and their excrement was dumped into the river. The disease exploded across the poorest country in the Americas, eventually killing almost 10,000 people before it was finally stopped. Haiti’s ministry of health knew from the outset what the source was, but couldn’t name and shame the UN; the political and economic consequences would have been even worse than cholera.

The UN in turn refused for years to admit its responsibility, and it certainly hasn’t pointed out that it wouldn’t even have been in Haiti except for American pressure. The WHO, as an arm of the UN, was equally reluctant to take the blame for a catastrophic failure to protect the Haitian people.

Given that Haiti was the WHO’s most spectacular failure in recent years, its present obsequious treatment of China becomes understandable if not forgivable. Trump’s America is no friend of the UN; China is both the origin of COVID-19 and a major medical, industrial and geopolitical power. And given Trump’s abdication of leadership in global health, China is moving into a power vacuum.

A spoonful of flattery

Just as serious public health experts like Dr. Anthony Fauci must weave their way around Trump’s self-serving idiocy, the WHO must kowtow to Xi. If WHO Director-General Dr. Tedros must lavish praise on China, it’s just a spoonful of sugar to make the medicine go down, precisely like the flattery Donald Trump demands.

After all, what’s the alternative for the WHO? If it offers any serious criticism of a UN member state, that state will withhold data, deny entry to health personnel and aggravate the health problem.

In the last pandemic, the powers of 1918-19 didn’t let the Spanish flu get in their way. Woodrow Wilson sent thousands of young men to their deaths in overcrowded training camps and troop transports. Lenin pushed his revolution. The European governments fought the war and bungled the peace while millions died around the world.

This time should be different, but many governments still seem to regard the pandemic, to paraphrase Carl von Clausewitz, as the continuation of politics by other means — to put their opponents off balance and increase their own power, whatever the cost in lives and suffering to their own people.

Better to save the recriminations and punishment for later. Few governments will emerge intact from this experience, and many will be transformed altogether. Why punish a government that may be history when the pandemic ends, and its replacement may deserve all the help it can get?

It’s equally pointless to scapegoat the World Health Organization when it has saved countless millions of people around the world. Better to take note of its design flaws and rebuild it stronger and better resourced. When the next pandemic comes, we’ll need it that way.  [Tyee]

Read more: Health, Politics, Coronavirus

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