The world is currently reeling under its biggest crisis since World War II. The COVID-19 pandemic has escalated to catastrophic proportions and threatens to do irreversible damage to global economy, trade, health and development. As countries scramble to implement policies to balance both health and economic imperatives, the actions of the World Health Organisation (WHO) — viewed as the first responder to a global disease outbreak — has come under increasing scrutiny.
A
brief timeline of the events leading to the pandemic outlines the purported sluggish response of the WHO to the crisis. The offending counts include,
inter alia, delay in naming COVID-19 as a “public health emergency of international concern” (PHEIC) and subsequently, a “pandemic”; vacillation in visiting China to survey the situation; delay in acknowledging human-to-human transmission of the virus;
not endorsing the use of trade and travel restrictions; an erroneous appreciation of China’s swift response; and the alleged lack of independence of current WHO Director General (DG), Dr. Tedros Adhanom Ghebreyesus.
These developments have fueled observers to suspect Beijing’s influence on the organisation, and raises questions regarding the politicisation of the WHO. Against this backdrop, this article examines WHO’s institutional underpinnings, its funding, organisational structure — and how these factors together may have contributed to weakening the position of the WHO vis-à-vis its member states.
WHO: Genesis, structure and funding
The WHO was established in 1948 as a United Nations (UN) specialised agency. The potential for spread of diseases due to globalisation, mobility and urbanisation called for the need to create a global institution to expand international health cooperation. The WHO originated in the complex geopolitical environment of the Cold War era, when tensions between the US and the Soviet Union obstructed the realisation of an ideal vision of the WHO. As such, the WHO remained largely subordinate to the United Nations (UN), and was a low-level technical organisation, with limited powers and limited funding.
The WHO originated in the complex geopolitical environment of the Cold War era, when tensions between the US and the Soviet Union obstructed the realisation of an ideal vision of the WHO.
The organisation’s goal, enshrined in Article 1 of the
WHO constitution, is to attain “the highest possible level health by all peoples.” Article 2 prescribes 22 functions for the WHO, which also includes “stimulating or advancing work to eradicate epidemic, endemic and other diseases.” The organisation has a three-tiered structure, comprising:
• The World Health Assembly (WHA), the supreme decision making comprising all member states to determine policy direction;
• The 34-member Executive Board, comprising technical experts to oversee the implementation of WHA’s decisions; and
• The Secretariat — headed by the Director General — functioning as WHO’s administrative and technical organ with the overall responsibility for implementing its activities.
The WHO is funded through a system of assessed and voluntary contributions. Assessed contributions are paid by all member states, and are calculated on the basis of a country’s gross national product and population. Voluntary contributions, on the other hand, are amounts voluntarily paid by other UN organisations, private companies, individuals, NGOs as well as member states. While assessed contributions (
17% of WHO funds)
cover general expenses and program activities, voluntary contributions (80% of WHO funds) are earmarked by donors for specific activities.
The US is the WHO’s largest contributor; it paid a total of $893 million in both assessed and voluntary contributions in 2019. At
22% ($234 million), it has the highest share among assessed contributions of all member states. On the other hand, China’s total contribution stands at
$85 million (only 0.21% of WHO’s entire revenue), and its assessed contribution stands at
12% ($75 million). Though China’s funding to the WHO has grown by
52% since 2014, this is primarily due to a sharp increase in the calculation of its assessed contributions, which
stood at 5.1% ($48 million) in 2014-15 and increased to 12% as of today.
Dr. Tedros, a former Ethiopian minister of health and minister of foreign affairs, is said to have won the 2017 WHO DG elections with backing from Beijing.
Given China’s still limited funding to the WHO, it is Dr Tedros’ close ties with China that has been the focus of global outrage. Dr. Tedros, a former Ethiopian minister of health and minister of foreign affairs, is said to have won the 2017 WHO DG elections with backing from Beijing. Following his election, he committed to endorsing the “One China” principle, leading to Taiwan’s
exclusion from the WHO. As concerns about the COVID-19 pandemic were mounting, Tedros met President Xi Jinping in Beijing on 28 January, and
praised the Chinese leadership for “setting a new standard for outbreak control” and its “openness to sharing information.” This was viewed as being highly deferential to China, when there was mounting evidence of concealment of the outbreak.
Politics and pandemics: Contextualising WHO’s response
Broadly, the WHO’s powers are recommendatory in nature and include proposing conventions, agreements, public health practices and international nomenclatures. Provisions of WHO’s constitution, such its role to “assist” governments when
requested , furnish “technical assistance” on request or acceptance of governments , or giving full power to the WHA to control the organisation’s budget, impose politico-legal constraints on its authority and autonomy, and establish a relatively compliant and subservient international organisation.
The organisation’s responsibilities during a pandemic include surveillance, monitoring and evaluation, developing guidance for member states. There is no single document which comprehensively describes its responsibilities, obligations and powers with respect to infectious diseases. A collection of documents, such as treaties and regulations <2005 International Health Regulations (IHR)>, WHA resolutions and operational practices explain WHO’s powers in this regard. However, ambiguities persist in relation to its role as between one of coordination and facilitation, as opposed to action or decision making; coupled with a lack of clarity over the division of roles between the WHO and national governments.
Ambiguities persist in relation to its role as between one of coordination and facilitation.
Past responses to epidemics and pandemics are illustrative of internal and external factors that constitute “grey areas” in WHO’s functions during outbreaks. For instance, the 2003 SARS (Severe Acute Respiratory syndrome) outbreak, which caused over 8,000 infections and 700 deaths, was first detected in China in November 2002. Beijing notified the existence of the virus in February 2003, and WHO issued an alert on March 2003. Initially, the organisation openly criticised China’s attempt to engage a cover-up, following which — remarkably — the PRC government changed its policy to become more cooperative. The WHO also issued advisories to avoid travel to SARS affected areas — a notice that effectively functioned as a travel ban. Many lauded the organisation’s proactive leadership during the SARS outbreak.
These developments are frequently invoked to question why the WHO has failed to react in a similar manner, given a repeat of Chinese cover-up in the current outbreak. At the same time, commentators (Adam Kamradt-Scott in Managing Global Health Security) argue that WHO undertaking the role of a “government assessor and critic” in the SARS outbreak, including its self-expanded function to assess countries — on its own — to issue travel bans was uncharacteristic, impinged on state sovereignty, and could jeopardise the goodwill of member states and weaken WHO’s authority.
The perceived tardiness in WHO’s classification of COVID-19 as a pandemic needs to be contrasted with the similar classification of the 2009 H1N1 influenza (“swine flu”). First detected in Mexico in March 2009, H1N1 was declared as a pandemic in June in the same year. The declaration came when the outbreak hit 74 countries with reported 27,737 cases, and 141 confirmed deaths. On the other hand, in the case of COVID-19 the pandemic declaration was issued when the disease reached 114 countries, 118,000 cases, and 4,291 fatalities.
The perceived tardiness in WHO’s classification of COVID-19 as a pandemic needs to be contrasted with the similar classification of the 2009 H1N1 influenza (“swine flu”).
Numbers aside, the 2009 declaration was deemed premature and incorrect, and inviting sharp criticism from all quarters. Apart from the fact that H1N1 would not result in high morbidity, there were allegations that big pharmaceutical companies who were keen on promoting their patented drugs and vaccines had influenced WHO’s decision making (Sudeepa Abeysinghe in Pandemics, Science and Policy). The mischaracterisation resulted in diminished public confidence and an erosion of trust in the WHO as an institution. Paul Flynn, a rapporteur appointed by the Council of Europe to investigate the matter asserted that this lead to “distortion of priorities of public health services all over Europe, waste of huge sums of public money, provocation of unjustified fear amongst Europeans, creation of health risks through vaccines and medications which might not have been sufficiently tested.”
COVID-19: The geopolitical quagmire
The above establishes that WHO’s characterisation as a technical organisation, its vague mandate, limited funding, lack of defined functions, transparency issues and confusion about the extent of its “authority” over states have weakened the functioning of the organisation. All of this points towards the need to thoroughly evaluate why these problems arise, and what member states can do to resolve them. Unfortunately, the backlash and criticism being faced by the WHO has vastly diminished its global reputation and standing.
Trump’s announcement of the suspension of US funding to the WHO in April 2020 also appears to be a final nail in the coffin. There is, of course, domestic politics writ large in the US decision. Apart from using this as a tool to deflect blame from his own tardy response to the crisis, this also forms a larger part of Trump’s “America first” strategy to withdraw from multilateral engagements and international organisations such as the UN Human Right Council and the UNESCO. At the same time, there is a real concern that with US’ withdrawal provides the perfect opportunity for Beijing to consolidate its own role as a leader in international organisations, henceforth.
While the politicisation of the WHO remains a serious concern, it also presents an opportunity to rethink the underpinnings of the broader global governance architecture. Great power politics has always shaped global institutional evolution, but the crumbling edifice of extant institutional framework should alert us to the very real possibility that time is running out for the creation of viable and effective new international organisations. If not rectified and responded to with a sense of urgency, global governance architecture might witness unprecedented fragmentation at precisely the time when it is most needed. And that would be a travesty for the most vulnerable and weak nations of the world.
The views expressed above belong to the author(s). ORF research and analyses now available on Telegram! Click here to access our curated content — blogs, longforms and interviews.
PREV
