David Pratt: Caught in the crossfire - The World Health Organisation

As director-general of the WHO, this Ethiopian microbiologist and internationally recognised malaria researcher rarely makes the global headlines unless the news is bad.

Suffice then to say that Tedros would probably like nothing better right now than to return to the comparative obscurity of which he was part before the coronavirus pandemic landed on his lap. For the foreseeable future, however, the chances of that are slim.

It was only last year that Tedros, while trying to raise cash for the WHO response to the Ebola outbreak in the Democratic Republic of Congo (DRC), observed that donors never seem to pay up until there is “fear and panic”.

As Covid-19 has taken its grip around the world once again there has been no shortage of fear and panic, but the funds the WHO needs to do its job still remain elusive.

Cue President Donald Trump, a man who vehemently advocates an “America First” approach towards foreign policy and has no love for international bodies at the best of times.

Last week, Trump accused the WHO of mismanaging the pandemic and threatened to halt American funding to the body.

It was a move that philanthropist Bill Gates, a major funder of the WHO, said was “as dangerous as it sounds” – and many around the world agreed.

Given that the US taxpayer stumps up some 15% of the WHO’s annual budget, Trump’s threat is not to be taken lightly and has yet again thrust the global health body into the crosshairs of international geopolitics.

Few doubt that Trump’s motive is an effort to deflect blame from his own administration's failure and mishandling of the coronavirus crisis. No doubt, too, he is doing so with one eye on the looming US presidential election in November. But the net effect remains the same, casting the WHO into a political cauldron at the worst possible moment.

Born out of the years following the Second World War and based in Switzerland, the WHO is an agency of the United Nations set up in 1948 whose aim is to “look after the health and wellbeing of people around the world”.

Its origins lie in a cluster of organisations that emerged in this post-war period to co-ordinate global policy on a variety of issues. Others include the International Monetary Fund and the World Bank Group.

In its more than 70-year history, it has tackled some of the most pressing health issues facing the world in modern times, including major emergencies. It helped eliminate smallpox and all but eliminate polio, and battled against tuberculosis and malaria.

It supports the administration of measles vaccines worldwide. More recently it played a role in the 2003 Sars outbreak, the 2009 H1N1 influenza outbreak, and the 2014 Ebola outbreak in West Africa.

With more than 7,000 people working in 150 country offices, six regional offices and its own Geneva headquarters, this is no small operation.

Like every director-general before him, Tedros was elected for a five-year term, his own commencing in 2017. Like his predecessors, too, Tedros – the first African in the role – has had to walk a fine political line alongside which lie WHO detractors and controversies waiting in ambush.

Depending on whom you ask at any given moment in time, the WHO is almost invariably seen as either the hero or villain in any global health crisis.

To a great extent the organisation exists perpetually in a kind of damned if you do, damned if you don’t, dilemma.

It’s one where the pressing issues the WHO faces are a constant juggling of its broad mission of serving the world’s public-health needs, while simultaneously dealing with the realpolitik attached to how the organisation is funded. Or, to put it another way, he who pays the piper almost invariably seeks to call the political tune, Trump being the current example.

Currently, the WHO’s member states provide funding via two routes: assessed contributions and voluntary contributions.

Assessed contributions are calculated on the basis of a country’s wealth and population, while voluntary contributions are often targeted by the donor at specific regions or diseases – such as polio, malaria, or infant mortality in poor areas.

Philanthropic foundations and multinational groups such as the European Commission are also major donors to the WHO, all of which draws it into a geopolitical maze.

“On one hand it’s expected to be a world-class public health agency, but at the same time it’s expected to manage the complicated global politics that emerge on health issues,” was how Steven Hoffman, a professor of global health, law, and political science at York University in Canada, recently summed up WHO’s role in Rolling Stone magazine. “The organisation struggles with that duality,” added Hoffman.

For its part the WHO insists that its three very specific strands of work are clearly identifiable. These it sees as aiming for universal health coverage in every country, preventing and responding to acute emergencies, and promoting health and wellbeing for all.

But like a lot of international institutions, the WHO suffers from false perceptions about its scope and resources. To begin with the idea that it is somehow “the world’s doctor” is completely misleading, say experts. They point to the fact that it does not provide treatment or conduct disease surveillance, although it does advise national and international authorities on those matters.

They stress, too, that it has no power to impose health policies on national governments, and the information it collates and publishes is only as good as the data and expertise it gets from its 194 member states.

According to Michael Meyer-Resende, executive director of the rights group Democracy Reporting International, as a consequence of these limitations the numbers that the WHO publishes, the numbers that journalists and governments around the world refer to, “are contaminated with politics”.

While the health data tells us part of the story, says Meyer-Resende, it often paints a skewed picture.

“The WHO receives its case numbers from governments around the world. It cannot verify these numbers and it cannot oblige governments to provide accurate numbers,” explained Meyer-Resende, in a recent edition of the online newspaper EUobserver.

“A cursory glance at the numbers provided shows that some of them are implausible,” he added, before explaining why, in certain instances, some countries would not report coronavirus cases to the global health watchdog.

“These countries are ruled autocratically and have no free media or effective opposition. If their governments do not want to admit that they have coronavirus cases, they won’t do so,” said Meyer-Resende, highlighting how some central Asian countries neighbouring China and enjoying close trade links were slow to report a single case in a population of 72 million people.

And so it is that the WHO finds itself hindered by such skewed or withheld data and little power to force countries to divulge information despite the perception that it has substantial global leverage.

Critics of the WHO, however, say such shortcomings are not all outwith the organisation’s control, insisting that many of its major flaws are of its own making.

It was, for example, criticised last year over its reluctance to declare an international public-health emergency during an outbreak of Ebola in the Democratic Republic of Congo though it did eventually give way.

WHO's response during and after an earlier outbreak of Ebola in West Africa in 2013 also led to criticism, though this was before Tedros’s time. When it comes to the current crisis, however, the director-general has found himself very much in the firing line from certain quarters.

Most of the criticism centres on concerns about the agency’s deference to Beijing and that Chinese influence is being brought to bear over the institution and UN as a whole. Some critics have not pulled their punches.

“This corruption of the WHO’s function is symptomatic of a wider trend, which has seen Beijing take over one-third of the UN’s 15 specialised agencies, appointing its officials to important posts where they immediately beginning implementing 'Sinocentric' policies, using a combination of arm-twisting and lobbying,” wrote Dr John Hemmings, associate fellow with the Henry Jackson Society Asia Studies Centre.

Some have even gone as far as to suggest that the Chinese government deceived the WHO over the coronavirus outbreak.

As the New York Times reported, in Japan, Taro Aso, the deputy prime minister and finance minister, recently noted that some people have started referring to the World Health Organisation as the “Chinese Health Organisation” because of what he described as its close ties to Beijing.

Among other criticisms are claims that WHO officials accepted misinformation from the Chinese government as the outbreak unfolded and waited too long to declare an emergency.

Taiwanese officials say the WHO ignored its early warnings about the virus because China refuses to allow Taiwan, a self-governing island it claims as its territory, to become a member.

One commentator, writing in the US magazine The Atlantic, went as far as to suggest that speaking up against China might have ended the international political career of Tedros, given that he was “elected to his post with the support of China and its bloc” in the wider UN.

In Tedros’s defence, many WHO observers say he has been leading an attempt to reform the agency. At times, too, he has displayed a willingness to call out unacceptable comments or behaviour from other global superpowers such as when he bemoaned the “level of stigma we are observing” in a not-so-subtle slight at the racist language Trump has used to describe the virus.

Such political responses, however, remain difficult not least because much of the money the WHO receives is tied to member countries' pet projects.

Faced with an emergency like Covid-19, the organisation has no choice but to raise funds on the hoof, making it vulnerable to political pressures of the type brought to bear by the Trump administration last week.

Responding to a question about US accusations that the WHO had mismanaged the crisis, Dr Mike Ryan, executive director of the organisation’s health emergencies programme, said: “In the first weeks of January, the WHO was very, very clear.

“We alerted the world on January 5. Systems around the world, including the US, began to activate their incident management systems on January 6. And through the next number of weeks, we’ve produced multiple updates to countries, including briefing multiple governments, multiple scientists around the world, on the developing situation – and that is what it was, a developing situation.”

In the main many countries remain supportive of the WHO and its response to the pandemic.

Now is not the time to withhold funding was the prevailing view of most world leaders to Trump’s threat, echoing Antonio Guterres of the United Nations, who defended the WHO in a statement on Tuesday, saying it “must be supported, as it is absolutely critical to the world’s efforts to win the war against Covid-19”.

Not content with simply speaking out, some countries have shown their support for the WHO in hard cash. Last week, the Republic of Ireland announced it is to quadruple its contribution to the health organisation. Despite such supportive gestures, however, the WHO, which was never created to be independent, remains very vulnerable to the whims of the nations that fund it.

“The World Health Organisation has done exactly what we’ve designed it to do — no more, no less,” Kelley Lee, the director of global health studies at Canada’s Simon Fraser University, who has been studying WHO since the 1990s, explained to Rolling Stone magazine recently in an in-depth look at the organisation.

“It has kept us informed. It has mobilised scientists and co-ordinated data and research. It has collected the best evidence and tried to put forward very clear guidance about what should be done,” said Lee.

“The big question is whether we’ve given it enough authority and resources to act the way we want it to act?” she asked.

No doubt that question – and the answer to it – will take on a new resonance within the organisation once the world emerges from the coronavirus pandemic.

For the moment, however, the WHO has other priorities to contend with.

“There is a common enemy on this planet, warned Tedros Adhanom Ghebreyesus last month. “One we need to fight in unison.”