The World Health Organization Does Too Much to Be Defunded, Especially Now

Health Letter, June 2020

By Michael T. Abrams, M.P.H., Ph.D.

The World Health Organization (WHO) is now under clear and present threat by Donald Trump, right in the middle of a global infectious disease pandemic. President Trump claims the WHO mishandled the early COVID-19 response. Accordingly, beginning in mid-April he suspended funding to the organization, marshalled resources to investigate it and now — pursuant to that investigation — threatens to quit membership and discontinue all future funding to the WHO unless it commits “to major substantive improvements within the next 30 days.”[1]

Trump’s ultimatum came on May 19 in the form of a four-page letter to the WHO, which has health experts vexed. “I found the letter full of unsubstantiated interpretations of certain events,” said Kelley Lee, a professor at Simon Fraser University.[2]This letter is not about dealing with the coronavirus pandemic, rather it is an undisguised political attack on China. Most of it is straightforwardly wrong, and the rest is twisted out of recognition,” said Professor Davey Smith of University of Bristol.[3]This letter is written for [President Trump’s] base to deflect blame. China and the US are fighting it out like divorced parents while WHO is the child caught in the middle trying not to pick sides,” said Professor Devi Sridhar of University of Edinburgh.[4] And yet, Trump’s salvos against the WHO persist, simultaneously thwarting the global response to COVID-19 and many other threats to human health.

Any disruption in U.S. contributions is consequential, though not lethal, to the WHO. Still, Trump’s assault on the agency must be taken seriously, and it has been by several expert commentators. Robert Weissman, president of Public Citizen, said that Trump’s funding halt is “sadistic, spiteful, stupid and self-defeating.” Richard Horton, editor-in-chief of the medical journal The Lancet, directly refuted Trump’s allegations and further wrote that the president “should restore WHO’s funding immediately and offer the agency his full and unconditional backing.” Bill Gates, Jr., Microsoft founder and a leading public health philanthropist, tweeted that disruption in funding to the agency “during a world health crisis is as dangerous as it sounds.”[5] Even Republican leaders such as Sen. Roy Blunt (Missouri) have questioned Trump’s strategy regarding the WHO.[6]

According to reporting in the Wall Street Journal, the U.S. is presently withholding $300 million from the WHO, including roughly $60 million intended to support the agency’s COVID-19 response.[7] Moreover, presumably encouraged by Trump’s accusations, some lawsuits have been filed against the WHO in federal court in an apparent effort to discredit the agency and further squeeze additional financial resources from it.[8]

Although the WHO is not a perfect actor, it does have a long-standing and distinguished role in the maintenance of human health.

About the WHO

Immediately following Trump’s temporary funding freeze, the Kaiser Family Foundation released a primer about the WHO,[9] summarized below. The organization was founded in 1948 as a “specialized agency” of the United Nations. Its mission is to provide technical assistance, set standards, coordinate emergency responses and promote the overall health of persons across the planet.

The organization currently has 194 member nation states, and it manages an annual budget of approximately $2.4 billion — a small amount compared with the budgets of the U.S. Departments of Health and Human Services ($1.2 trillion)[10] and Defense ($670 billion).[11] The WHO convenes expert gatherings to deliberate on health care strategies around the globe. Its “supreme decision-making” body, the World Health Assembly, comprises representatives from its member nations. Accordingly, the WHO is driven simultaneously by bioscience and geopolitics. The tension between these two factors is the organization’s main challenge as it must constantly work to encourage the best medicine and public health around the globe despite natural human tendencies towards tribalism and avarice.

In its endeavors, the WHO has had numerous successes and some failures. Counted among its historic successes are an international commitment to primary health care (1978), the eradication of smallpox (1980), a framework convention on tobacco control (2003) and an updated international agreement that charts global responses to health emergencies (2005).[12] The WHO’s response to an Ebola outbreak in West Africa (2014-2015) was widely criticized, but the organization responded to those criticisms by leading a successful response to a similar outbreak (2018) in the Congo, a region with one million refugees and over 100 armed factions.[13]

Some of the WHO’s most recent achievements are highlighted in its 2018-2019 midterm report.[14] In 2018 the agency investigated 481 potential emergencies in 141 countries, including the aforementioned Ebola outbreak and a cholera outbreak in Yemen. In October 2018, member countries agreed to a formal declaration of a “reinvigorated commitment to strengthen primary health care, laying a foundation for universal health coverage.” This commitment to universal health care as a human right is an explicit goal of the WHO, and perhaps one reason that Trump and other Republicans are tepid in their support of the organization. Still, the WHO proudly notes that in 2018 its support greatly advanced universal health care coverage efforts in Greece, India and Kenya. The WHO also has a drug “prequalification” program that certifies the safety and efficacy of medications to address illnesses such as river blindness, HIV, polio and typhoid fever. Over the years, the WHO has provided the world with a reliable endorsement of more than 455 medical products.[15] Additionally, since 1946 the agency has developed and maintained a precise cataloguing of diagnoses and treatments known as the International Classification of Diseases (ICD). Updated to its version 11 in 2018, the ICD is a practical mainstay for health care operations and research around the world.[16],[17]

Responding to health crises: threatening, acute or persistent

In responding to health emergencies that include disease outbreaks, natural disasters and armed conflicts, the WHO collaborates with its network of internal and external expert organizations (for example, U.S. Agency for International Development, Red Cross and Doctors Without Borders). In response to the 2018 Ebola outbreak in the Congo, the WHO coordinated the creation of a regional management system, including setting up a basecamp for 160 frontline responders and another 400 administrative staff, and overseeing the vaccination of more than 60,000 persons. They further established Ebola screening stations to diminish the spread of the disease to neighboring states.[18]

In 2018 the WHO delivered 1,900 tons of health supplies to Syria and trained 30,000 health workers there.[19] In that same year, the WHO assessed nearly 180 health events each week across the globe, supported the completion of national action plans for health in 28 nations, trained 850 laboratory personnel in 62 nations and separately trained 2,800 health professionals in 141 nations regarding health security.[20]

And there is more.

In the infectious disease domain beyond COVID-19, smallpox, Ebola, polio and other diseases previously noted, the WHO has many ongoing efforts to control such scourges. Their global work against tuberculosis contributed to saving 54 million lives from 2000 to 2017 and presently addresses antibiotic-resistant strains that have emerged.[21] Malaria, a mosquito-borne illness that kills over 400,000 people per year,[22] has long been a target of the WHO. In 2018, the agency identified 21 nations as ready to eliminate that disease by 2020.[23] Other recent achievements by the agency further include establishing hepatitis C laboratory procedures in Mongolia, responding to a measles outbreak in Europe that infected 83,000 and killed 72 in 2018, and maintaining a database on antimicrobial resistance that directly involves 67 countries.[24]

Other health initiatives

The WHO also is engaged in noncommunicable disease control and health promotion efforts. The agency has a range of programs focused on maternal and child health issues and on housing, transportation, health and long-term care concerns of the elderly. This work includes direct engagement in workforce training and clinical trials regarding intensive parenting approaches known as “kangaroo mother care” for newborns.[25]

In terms of behavioral health, the agency has recently assisted at least 12 nations in their efforts to reduce gender-based violence and sexual assault,[26] and more broadly the WHO maintains a “Mental Health Atlas” which coalesces global data on the availability of such specialized services by nation.[27] Suicide prevention also is an ongoing endeavor of the WHO.[28]

Other notable WHO projects include those pertaining to the health effects of environmental degradation and general health promotion activities relevant to humans everywhere. Regarding the former, the agency has recently assisted Ethiopia in its water supply planning efforts and hosted a pollution conference which spawned a 25% increase in air-quality reporting from Middle Eastern nations.[29] Finally, the agency’s lifestyle initiatives include a 2018 to 2030 plan to promote healthy exercise around the world through constructive policies, including developing more parks and bicycle routes.[30]

Sustaining support for the WHO

Although it is certainly the case that many of the aforementioned actions by the WHO can be and are conducted by other organizations, the agency has a strong, long-standing record of coordinating such efforts with essentially all nation-states as engaged stakeholders. The U.S. is clearly a dominant supporter, and that support is both monetary and collaborative.[31],[32] The WHO, however, is greater than the sum of its parts, as it develops and coordinates health policies and responses that transcend geopolitical barriers in favor of humanity at-large.

Still, Trump’s scapegoating of the WHO seems persistent, and sadly, U.S. Secretary of State Mike Pompeo is promoting Trump’s cynical misdirection.[33] It is an ironic position for the nation’s senior diplomat to take, though Pompeo did recently state that where the WHO has unique function, the U.S. will continue to support it “because we are good humanitarian partners.” Hopefully such sentiments will overshadow the Trump administration’s tendency towards blaming others. Pompeo and Trump have a choice to make: They can denigrate and damage a significant international institution, or they can move forward by supporting its long-standing and shared programs aimed at the mitigation of human diseases from malaria to depression.

In response to Trump’s attacks on the WHO, China has raised its financial support of the agency markedly (by $2 billion) in a move that some observers say aims to upstage U.S. standing regarding international humanitarian aid and cooperation.[34] Mainland China, along with over 100 other member-nations including the U.S., has further agreed to have the WHO formally investigate the origins of the COVID-19 outbreak, albeit after the crisis recedes so as not to disrupt the response in the middle of the pandemic, and absent a focus on China’s early missteps.[35]

Finally, and more to the point, punishing the WHO with rhetoric and financial sanctions will certainly disrupt its current effort to address COVID-19 just as the novel coronavirus remains uncontrolled in the U.S. and is about to slam low- and middle-income nations. One expert recently noted that 110 developing countries are now bracing for the pandemic to hit them with projected deaths estimated at 1.4 million over the next year. How will the response be coordinated such that this tsunami of illness is managed and contained from re-emergence everywhere? Can the White House be trusted to go it alone or even redeploy collaborative resources in this present crisis?

It is safe to say that most Americans are not confident in Trump or Pompeo’s geopolitical insights and machinations, especially regarding COVID-19. Thus, now is a good time to let your current and prospective federal representatives know that the WHO has, since just after World War II, been a critical health science partner to the U.S. and most governments around the world. Accordingly, strong support for the WHO must continue, now more than ever.

Update: As this article went to press, on May 29, 2020, only 10 days after issuing his 30-day warning to the WHO, Donald Trump announced that he is withdrawing the U.S. from that international organization.[36] Simultaneously, he revoked Hong Kong’s special diplomatic status with the U.S. in a move designed to punish the Chinese Communist government in Beijing. Trump announced these actions with Secretary of State Mike Pompeo and Treasury Secretary Steve Mnuchin at his side, without taking questions from the press. It remains to be seen if these pronouncements will stick politically or legally. WHO’s history and contributions remain as distinctive endeavors for most of the planet’s population, even as Trump’s capricious actions aim to denigrate that institution.


References

[1] Letter from U.S. President Donald Trump to Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. May 18, 2020. https://www.whitehouse.gov/wp-content/uploads/2020/05/Tedros-Letter.pdf. Accessed May 20, 2020.

[2] Huang P. Fact-checking and assessing Trump’s letter of rebuke to WHO. May 20, 2020. https://www.npr.org/sections/goatsandsoda/2020/05/20/858911395/fact-checking-and-assessing-trumps-letter-of-rebuke-to-who. Accessed May 26, 2020.

[3] Science Media Center. Expert reaction to letter sent from Donald Trump to Dr Tedros Adhanom, Director-General of the WHO. May 19, 2020. https://www.sciencemediacentre.org/expert-reaction-to-letter-sent-from-donald-trump-to-dr-tedros-adhanom-director-general-of-the-who/. Accessed May 22, 2020.

[4] Ibid.

[5] Hinshaw D, Alpert LI. U.S. allies leave WHO funding gap unfilled as China and others step up. Wall Street Journal. April 24, 2020.

[6] The Editorial Board. Trump and Pompeo need to stop making the WHO a scapegoat for their failures. The Washington Post. April 27, 2020.

[7] Hinshaw D, Alpert LI. U.S. allies leave WHO funding gap unfilled as China and others step up. Wall Street Journal. April 24, 2020.

[8] Retschman AS, Gatter R. Smoke screens: An initial analysis of the coronavirus lawsuits in the United States against China and the World Health Organization. Saint Louis University School of Law. Legal Studies Research Paper Series, No. 2020-04, April 21, 2020.

[9] Kaiser Family Foundation. The U.S. government and the World Health Organization. April 16, 2020. https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-the-world-health-organization/. Accessed May 21, 2020.

[10] HHS.gov. Putting America’s Health First. HY 2010 President’s Budget for HHS. February 2018. https://www.hhs.gov/sites/default/files/fy-2019-budget-in-brief.pdf. Accessed May 21, 2020.

[11] Office of the Secretary of Defense (Comptroller). Defense Budget Overview: Fiscal year 2019 request. February 2018. https://dod.defense.gov/Portals/1/Documents/pubs/FY2019-Budget-Request-Overview-Book.pdf. Accessed May 21, 2020.

[12] Kaiser Family Foundation. The U.S. government and the World Health Organization. April 16, 2020. https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-the-world-health-organization/. Accessed May 21, 2020.

[13] Michaud J, Kates J. The latest Ebola outbreaks: What has changed in the international and U.S. response since 2014?” Kaiser Family Foundation Issue Brief. August 13, 2018.

[14] World Health Organization. WHO Results Report, Programme Budget 2018-2019, Mid-Term Review. https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_35-en.pdf. Accessed May 21, 2020.

[15] World Health Organization. New Essential Medicines and Diagnostics lists published today. July 9, 2019. https://www.who.int/medicines/news/2019/updates-global-guidance-on-medicines-and-diagnostic-tests/en/. Accessed May 21, 2020.

[16] World Health Organization. History of the development of the ICD. https://www.who.int/classifications/icd/en/HistoryOfICD.pdf. Accessed May 21, 2020.

[17] World Health Organization, International Classification of Diseases (ICD) Information Sheet. https://www.who.int/classifications/icd/factsheet/en/. Accessed May 22, 2020.

[18] World Health Organization. WHO Results Report, Programme Budget 2018-2019, Mid-Term Review. https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_35-en.pdf. Accessed May 21, 2020.

[19] Ibid.

[20] Ibid.

[21] Ibid.

[22] Centers for Disease Control and Prevention. Malaria. https://www.cdc.gov/parasites/malaria/index.html. Accessed May 21, 2020.

[23] World Health Organization. WHO Results Report, Programme Budget 2018-2019, Mid-Term Review. https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_35-en.pdf. Accessed May 21, 2020.

[24] Ibid.

[25] Ibid.

[26] Ibid.

[27] World Health Organization. Mental Health Atlas. 2017. https://apps.who.int/iris/bitstream/handle/10665/272735/9789241514019-eng.pdf?ua=1. Accessed May 21, 2020.

[28] World Health Organization. WHO Results Report, Programme Budget 2018-2019, Mid-Term Review. https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_35-en.pdf. Accessed May 21, 2020.

[29] Ibid.

[30] Ibid.

[31] Kaiser Family Foundation. The U.S. government and the World Health Organization. April 16, 2020. https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-the-world-health-organization/. Accessed May 21, 2020.

[32] World Health Organization. WHO Results Report, Programme Budget 2018-2019, Mid-Term Review. https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_35-en.pdf. Accessed May 21, 2020.

[33] Welna D. U.S. was behind on payments to WHO before Trump’s cutoff. Morning Edition, National Public Radio. May 7, 2020. https://www.npr.org/2020/05/07/850326053/u-s-was-behind-on-payments-to-who-before-trumps-cutoff. Accessed May 21, 2020.

[34] Restuccia A, Lubold G, Hinshaw D. Trump threatens to permanently cut funding to World Health Organization. Wall Street Journal. May 19, 2020.

[35] Ibid.

[36] Crowley M, Wong E, Swanson A. Trump Moves to Strip Hong Kong of Special U.S. Relationship. The New York Times. May 29, 2020Ibid.