The World Health Organization isn’t perfect, but it needs more money and power, not less
President Donald Trump has announced that he is halting US payments to the World Health Organization (WHO). It’s unclear whether he in fact has legal authority to do so. Leaving that aside, though, as Bill Gates and a variety of world leaders have pointed out, it’s a ridiculous decision. The pandemic would have been much worse if not for the actions the WHO has taken in recent months.
The WHO started issuing daily “situation reports” on covid-19 on January 21, when there were only 282 confirmed cases worldwide. By that point, it had already created interim guidelines for laboratory diagnosis, clinical management, infection prevention and control, and risk communication. By mid-February, the organization was sending personal protective equipment to developing countries with the greatest need. On February 14, it started sending out covid-19 laboratory testing kits to 56 countries; by the end of the month, it was up to 93 countries. It compiled a registry of hundreds of clinical trials and worked to create a “master protocol” for such trials, to increase their size by pooling patient groups around the world.
The result was a global megatrial, called Solidarity, which was launched on March 20. Solidarity will use data from hospitals in dozens of countries to assess the efficacy of four drugs that may slow or kill the new coronavirus. Such a global approach is particularly crucial in a pandemic: trials have to go where the disease is. If effective public health measures get an outbreak under control in one area before enough data is gathered, it becomes much harder to figure out whether or not drugs work: it’s important to be able to combine data gathered from different hot spots as they flare up.
This is not to say that the WHO has always done the right thing at the right time.
The WHO did not declare a “public health emergency of international concern” until January 30, after the outbreak had spread to 19 countries and the count of known infections had passed 8,000 people. And it didn’t declare a pandemic until March 11, which critics contend was far too late.
That leaves two choices. We can conclude, as Trump has, that multilateral organizations like the WHO are inadequate to a severe crisis, so we must revert to an international order where nation-states are the only significant powers. Or we can accept that in a globalized world we need strong global institutions.
In fact, there is no choice: we need the global response. The WHO needs more authority, not less.
It needs the capabilities to independently investigate outbreaks and to provide rapid and significant support to control those outbreaks where they occur. The WHO should be able to fund and coordinate the development and global rollout of tests, equipment, treatments, and vaccines, and it should be able to rely on other parts of the United Nations to support a financial response designed to limit the economic costs of an outbreak. The WHO has many of these powers on paper. What it needs is more money to execute them.
More broadly, many of its member countries need more money for disease surveillance to detect outbreaks before they become crises. The world needs more coordinated support to rapidly develop and roll out tests, treatments, and vaccines for pandemic and potentially pandemic infections. The sums involved are not huge: in 2016, the Commission on a Global Health Risk Framework for the Future estimated that an additional annual global expenditure of $4.5 billion would be enough to address the most urgent weaknesses in global health security.
But member countries flatlined the WHO’s core budget beginning in the 1980s. And from 1993 onwards, the policy has been zero nominal growth—with no accounting for inflation. More of the WHO’s budget should come from mandatory contributions from a broad base of countries instead of donations from a small number of countries. Currently 80% of its funding comes from “voluntary contributions” over and above what members are obligated to pay as a condition of membership. The US has been by far the largest donor in recent years. In 2018, the most recent year for which complete statistics are available, the US made a voluntary contribution of $281 million to the WHO’s general fund, as compared with $6.3 million from China.
In giving advice, the WHO’s leadership has had to navigate a thin line between panic and complacency while responding to the inevitable political pressures the organization faces as a UN body funded by national governments. China actively suppressed information on covid-19 and arrested whistleblowers. The WHO was slow to negotiate a mission to China to study the outbreak, and Tedros Adhanom Ghebreyesus, the WHO’s director general, praised China’s response while trying to get approval for the mission. That led to inevitable condemnation from anti-China commentators in the United States.
A number of these complaints echo ones made in the aftermath of the WHO’s lackluster response to the West African Ebola outbreak of 2014, which killed over 11,000 people across Guinea, Liberia, and Sierra Leone. An international panel set up by the WHO after the Ebola crisis called for a transformation so that the organization could act independently and decisively. This plan would have given the WHO both more power and more money.
An internal audit in May 2019 found that most of the recommended reforms had not been made. According to the WHO itself, its Health Emergencies Program, created to lead response to outbreaks after the Ebola crisis, is chronically underfunded and not as capable as it should be. The WHO also says that many countries aren’t living up to their responsibilities under the International Health Regulations, a supposedly binding international treaty the WHO is meant to enforce, which has been agreed to by almost every nation on earth.
Given these shortfalls, some might argue for abandoning international institutions and relying on unilateral alternatives. But there are lots of problems that uncoordinated action by nation-states cannot solve, short of permanently shuttering borders. Travel bans can’t protect connected countries. Ignoring international advice—on testing equipment, for example—has led to delays and deaths. Development, testing, and rollout of vaccines and cures already involves networks of scientists and companies around the world, with the coordination of the WHO. Only an international body has the global credibility and trust to make sure information is released. Though the WHO-China joint mission should have taken place sooner, it was the first source of reliable data on the outbreak and response in Wuhan.
At a time of strained international relations, the WHO plays an irreplaceable role as an honest broker. And though the Ebola response was not its finest moment, and there have been stumbles in its handling of the current crisis, there are important successes to remember as well. The WHO played a central role in eradicating smallpox, with the support of both the United States and the Soviet Union, even in the midst of the Cold War. This was the most successful fight against global infection in human history.
All international organizations face governance challenges. But that does not mean they should be abandoned, any more than the fact that some people don’t pay their taxes is a reason to shut down the IRS. It is a reason to provide more resources to help these organizations encourage national policy response in the common good.
It is not just in the case of pandemics that we need greater global coordination and respect for international organizations. Stronger adherence to the Kyoto protocol and agreement on a binding treaty to reduce greenhouse-gas emissions would have helped slow climate change, for example. Globalization is today a reality, not an ideological preference, and our well-being is increasingly determined by issues that cross borders. We need cross-border institutions with the budget, authority, and influence to respond.
Charles Kenny is a senior fellow and the director of technology and development at the Center for Global Development, and the author, most recently, of “Close the Pentagon: Rethinking National Security for a Positive Sum World”.