By Roger Bate, AEI
President Trump has halted funds to the World Health Organization (WHO). Undoubtedly he is looking to avoid blame for a slow U.S. government response to the COVID-19 pandemic and the tens of thousands of US deaths. But he also has a point. We need a global agency to combat pandemics, but WHO is not it. WHO hasn’t been the agency we’ve needed for decades. Only a new agency focused on pandemics can do what is required.
WHO was founded in 1948 to play a coordination and informational role in global public health. It also oversaw or contributed to three decades of direct health interventions which combatted long-established endemic diseases like yaws, leprosy and malaria, culminating in its top achievement, the eradication of smallpox in 1978. Like all its successes it didn’t do this alone: smallpox was eradicated because donors (including the United States & Soviet Union) made vaccines and ensured those who required them were inoculated. At the time, WHO was an essential health organization, in part simply by providing a forum where Cold War rivals could cooperate. For those 30 years WHO encouraged donors to fund direct efforts, often simply parachuting doctors into desperate situations with vaccines and expertise. This approach was paternalistic, separate from emerging nation health systems, but was highly effective for these targeted interventions.
Ever since the smallpox triumph, sadly, it’s all been downhill. WHO followed other UN agencies by working with member states and simply encouraging them to do the same interventions they had done before. To a certain extent this was inevitable: simply ignoring nation states was never a long run solution for an organization composed of member states. But the inevitable happened: waste and inefficiency. Many nations receiving health aid were more interested in spending scarce resources on other issues (some perhaps warranted, such as education, but the vast majority to prop up regimes, engage in conflicts and oppress citizens). The agency lost its way and donors lost interest in the core mission. WHO staff increasingly survived due to specific donations from large nations or blocks like the EU, undertaking projects of dubious reason for a global health agency, such as combatting obesity and studying deep vein thrombosis.
By being so closely aligned with western health elites, WHO also followed their worst tendencies. It encouraged nation states to have state-controlled public health systems (even if they couldn’t afford them), and it opposed most private sector involvement in health.
Most egregiously, it lapped up radical environmental policy, especially anti-insecticide use, which between 1980 and 2006 hobbled its efforts to combat malaria (and to a lesser extent yellow fever, dengue and other mosquito-borne diseases). WHO barely supported the requirement for insecticide control and were it not for Southern African nations, insecticides that westerners no longer need (like DDT) would have been outlawed from malaria control under a UN Environment Program convention.
Today, parts of Africa face a locust infestation that will massively increase malnourishment and death, but WHO has not been active in promoting the most effective control efforts – insecticides. When the WHO malaria head finally stood up for DDT in 2005-2006, he was unceremoniously dumped within a year. Rocking the boat is not WHO style.
And that is a problem when it comes to dealing with China and other authoritarian regimes. WHO is not equipped to police its member state donors. It failed to lead in the H1N1 and Ebola crises of 2009 and 2016, and it has been a barrier to sensible action during COVID-19. Maybe WHO tried to coax China into more transparency, and delayed announcing a pandemic until March with this aim in mind, but it ultimately failed in its mission. And for that reason President Trump is right to demand whether America is getting value from its considerable financial support.
I will leave it to others to forensically analyze WHO’s actions and how they could have been improved. But its broader failures are manifest. During my 25 years of working on public health policy, I’ve learned that health organizations are well-motivated initially, and much can be achieved if their mission is well-focused. However over time they become driven by growing budgets, the desire to avoid blame, turf wars and internecine squabbles, and many become subject to mission creep and institutional fatigue. WHO is the poster child for this decline.
UN administrators have tacitly recognized the need to work around WHO. As the AIDS epidemic ramped up, WHO would have been the natural place to house efforts against that virus, but in 1994 UNAIDS was formed to focus on the disease. The AIDS pandemic was terrible, but COVID-19 will probably take more lives, and definitely have a far greater economic impact. A new UN agency focusing on pandemics is warranted. WHO cannot do the job and it cannot easily be reinvented. This is not saying it should be abolished, because we need a global health agency within the UN framework — but it needs a total overhaul, which I doubt it will get.
Partly for the wrong reasons, President Trump has shone a light on WHO. Let’s take advantage of this to really investigate how to improve the agency. For starters the many opponents of the President should not reward WHO for its COVID-19 failures with more funding. The U.S. should take the lead and use funds earmarked for WHO to establish a new agency with the energy and focus to combat this and future pandemics. Transparency is vital, and the U.S. and likeminded countries must demand the new organization gets it. If that means publicly confronting China, so be it. To show this intent a new agency should immediately give a seat to Taiwan — something WHO has never done — and seek advice from experts from Germany, South Korea, and other countries who have done the best at combatting COVID-19.
With future epidemics a certainty, it’s clear that WHO just isn’t organized or equipped to deal with this kind of problem. COVID-19 was a wake-up call, highlighting the urgent need for a new, effective UN-backed agency to coordinate global emergency response to threats like coronavirus. The costs of delay could be catastrophic.
Roger Bate is a visiting scholar at the American Enterprise Institute (AEI) where he researches international health policy.