Dr Neil Shastri-Hurst is a former British Army Officer, surgeon, barrister, and senior member of the Voluntary Conservative Party in the West Midlands.
“The WHO really blew it…We will be giving that a good look”. President Trump fired a shot across the bows of the World Health Organization (WHO).
In his Tweet on April 7 this year, the President barely concealed his disdain. It had been clear for some time. Going further, he vowed to defund the organisation.
At the time, many questioned whether the president had the authority to shift policy in such a dramatic way. Then, at the beginning of July, Trump’s administration notified both Congress and the UN that a formal notice of withdrawal from the WHO was being submitted.
This week, Mike Pompeo, US Secretary of State, even accused it accused of being a “political not a science-based organisation”, whose director general is too close to Beijing.
These criticisms of the WHO are as scathing as they are clear. Trump claims that the organisation is submissive to China, complicit in assisting a cover up as to the risk Covid-19 posed, and, as a result, has failed to sound the klaxon sufficiently swiftly to the wider world amid the spread of the virus.
Is there credence to his analysis? In short, yes. There is no doubt that the WHO’s response could have been better. There are genuine concerns as to the credibility and weight given by the WHO to China’s assurances regarding Covid-19; in particular, China’s unsubstantiated declaration that there was “no clear evidence of human-to-human transmission”.
Given China’s history of misinformation, scepticism is justified. Those defending the WHO will point to the challenge it was faced with. Professor Devi Sridhar, Professor of Global Public Health at the University of Edinburgh, is a self-confessed critic of the WHO.
However, she has acknowledged that “[i]t’s hard to fault a lot of what the WHO has been trying to do, given the difficult balancing act of trying to get countries to address this epidemic and take it seriously, while also trying to keep all countries at the table”.
And that is one of the real sticking points; the WHO has a diplomatic as well as scientific role. There is some strength to the line of argument that publicly confronting China may have proven detrimental in the longer term. After all, the importance of data sharing, with respect to this and future pandemics, will be vital. The retrospectoscope is a dangerous tool. Therefore, it would be unfair to laden the WHO with too many criticisms when faced with a novel and evolving situation.
However, in certain respects the WHO’s response has appeared somewhat leaden footed at times. Optics matter, and presentationally a firmer stance with China was needed.
Not dismissing its shortcomings, the United States’ decision to withdraw from the WHO is of concern for all players. I fear that it will serve to weaken our collective ability to tackle future global health crises.
The challenges and, dare I say, deficiencies of the WHO have been apparent for some time. During the Ebola epidemic that spread across West Africa, questions were being asked about institutional failings and their impact on global health. Arguably, the time for reform was some years ago. As the world takes stock in the shadow of Covid, it is high time that such reform takes place now.
When the WHO first came into existence, in 1948, it was at the vanguard of global health. Made up of the world’s leading minds pioneering the health agenda, it was the epicentre of concentrated knowledge. But times have changed. The field is much more crowded, with multilateral and bilateral agencies competing alongside large non-governmental organisations (NGOs) for space.
With the emergence of new stakeholders, the WHO has, at times, appeared to have lost its sense of mission. Its scope has outgrown its budgetary resources. It is weighed down by bureaucracy. It is, in many ways, a conflicted organisation; independent scientists operating in an overtly political arena.
That said, the WHO still carries cachet; its formal authority can and must be harnessed to mobilise other global health organisations in the pursuit of better health outcomes.
A prime example of that cachet can be seen when one looks at information gathering. Its members are provided with access that would otherwise not exist if nations operated in isolation. It is unimaginable that US scientists would have, albeit belatedly, been permitted to enter Hubei Province, and the city of Wuhan, had they not done so under the auspices of the WHO.
In the midst of a global fight against a deadly pandemic, I would implore the United States, and other nations minded to follow suit, not to retreat from the WHO but to reform it. The WHO is more than a sum of its parts: it is incumbent upon its members to work together and shape it for the better.
Covid-19 cannot be managed by nations acting alone. It needs a global response. This will be just as true of future pandemics. Less economically-developed countries will continue to rely heavily on the WHO in tackling these health crises. It is the only global health organisation that has the reach and infrastructure to do so.
By walking away from the WHO, America will take with them 15 per cent of the WHO’s $4.85 billion two-year budget. This will only mean that the organisation, already cash-strapped, will find fulfilling its mission all the more difficult.
There is another point that must not be overlooked. The sizeable hole left by the US will provide an opportunity for less altruistic countries, such as China, to fill the void. With a greater financial stake, they will have greater power and influence to wield.
The task facing the international community is to preserve the integrity of the WHO, while at the same time acknowledging its faults, and setting about reform. This will not be a simple process but its importance must not be underestimated.
There are a number of different models that will need to be considered. One example would involve leveraging expertise from NGOs and multilateral agencies by outsourcing key activities. In order to achieve such a co-ordinated approach, it would be imperative that the WHO provides strong, global leadership and policy direction from the centre.
Furthermore, there is a strong argument for the WHO beefing up its powers. The first step would be bolstering the International Health Regulations 2005, so that the WHO can impose sanctions on those countries who repeatedly and fragrantly contravene the rules.
History is punctuated with examples of when the world has found itself at a crossroads. The world currently finds itself in such a situation. Rather than turn inwardly, we must hope that nation states look outwards. We must hope that global co-operation continues to grow. We must hope for the reform that is desperately needed.
The WHO must embrace this challenge. In facing emergent health threats, a reformed WHO will unite the global community.