Whose WHO?

Written by Peter J. Hoffman, Assistant Professor, Graduate Programs in International Affairs, The New School

The World Health Organization (WHO) is the preeminent international instrument for addressing global pandemics, but with COVID-19 infections and associated fatalities soaring many have raised the issue of responsibility for what the organization does and who it serves. On April 7, US President Donald Trump branded the WHO as “China-centric” and claimed it has failed to adequately react in providing information and strategies for mitigating and solving the crisis—and most recently stated he will suspend US funding the organization. Others have similarly referred to the WHO derisively as the “Wuhan Health Organization” or the “Chinese Health Organization.” But, while the WHO has been woefully circumspect in denouncing China’s muzzling, intimidation, and imprisonment of whistleblowers like Dr. Li Wenliang, the polemics of critics fundamentally misunderstand the political contexts in which the WHO operates.

First, like other international organizations, the WHO, is limited by what its members allow it to be and to do. The WHO is staffed by qualified medical professionals, but its technical proficiencies are not the issue. It’s the organization’s political moorings that matter. In this case, the WHO has been hamstrung by the delicate balance it must strike in engaging with China. Pressing China too hard or publicly denouncing the government may have resulted in the WHO being denied access to the country and this would have prevented investigation, surveillance, and documentation that has been invaluable in containing the further spread of COVID-19.

Second, funding for the WHO is structured in ways that limit how money is spent. While there are assessed contributions for core programming that allow for some discretion in spending, over three-quarters is financed through voluntary contributions that are earmarked for specific programming. Additionally, the overall amount of resources channeled through the WHO are paltry and a glaring symbol that the wealthiest countries have a parochial view of public health as intrinsically a national issue rather than understand that infectious diseases are most efficiently and effectively addressed at the global level. The WHO has a biennial budget of a little over $4.8 billion for a world population of 7.8 billion, that works out to be approximately 30 cents per person per year. By comparison, the US federal government’s Department of Health and Human Services (which includes the Centers for Disease Control and Prevention, and the National Institutes of Health) is budgeted to spend over $88 billion for the public health of a population numbering near 330 million, or over $266 per person annually. Even the department of public health for New York City alone has an annual budget that is about two-thirds that of the WHO’s; NYC’s $1.6 billion provides for 8.4 million people, resulting in over $190 per person each year. Moreover, the WHO often is forced to wait on the funding it is designated to receive; for instance, after falling behind in paying its assessed dues in 2019 and not contributing what it owes for 2020, the US is presently over $200 million in arrears.

Yet, the political truth about the material facts that structure the WHO is not what critics of the organization are interested in. Rather, their critiques are an exercise in blame game theater designed to distract from their own culpability. Although it wasn’t until February 8 that the Chinese government let WHO monitors into the country already on January 30 the WHO played its part in ringing alarm bells by designating the disease as a “public health emergency of international concern.” Countries that would have listened and acted at that time would surely have avoided a significant amount of spreading of infections and deaths.

So, who’s responsible for what the WHO has done and has not done on COVID-19? Social distancing by individuals is a short-term medical tactic for addressing infectious diseases, but it is not a successful long-term political strategy for states and societies facing the scale, scope, and reach of global problems. The staff of the WHO have made invaluable contributions in producing timely and vital knowledge, but they alone cannot address the political shackles and resource constraints that impedes responding to COVID-19. That is on those who have not given the WHO adequate power and authority to stand-up to states when necessary, who underfund the WHO’s work, and who dismiss the WHO’s warnings. The “who” behind the WHO is member states. If we want a better WHO for when the next pandemic strikes, it starts with changing who’s in charge of national governments that comprise WHO member states.