Pandemic Failure Or Convenient Scapegoat: How Did WHO Get Here?

Pandemic failure or convenient scapegoat: How did WHO get here?

By Thomas Gaulkin • July 9, 2020 • thebulletin.org/2020/07/pandemic-failure-or-convenient-scapegoat-how-did-who-get-here

n April 7, the number of reported A week later, Trump declared a freeze on US deaths in the United States due to funding for WHO, pending a White House in- COVID-19 reached 12,757—sur- vestigation into its handling of the outbreak. O On May 18—as COVID-19 deaths in the passing the CDC’s median estimate of 12,469 deaths from the 2009 Swine Flu pandemic, United States neared 100,000—the president during Barack Obama’s administration. addressed a letter to WHO’s director general, Tedros Adhanom Ghebreyesus. It included That same day, the US president began attack- a four-page-long bullet list of complaints and closed with an ultimatum: “Commit to major ing the World Health Organization for failing substantive improvements within the next 30 to contain the coronavirus pandemic. days” or the funding freeze will become permanent. Trump didn’t wait that long. On May 29, he announced the United States was “ter- minating” its relationship with WHO and “re- directing those funds to other worldwide and deserving urgent global public health needs. The world needs answers from China on the virus.” On July 7, the Trump administration formally notified the UN that the United vestigation gets underway (if that ever hap- States would withdraw from the WHO. pens), the questions of how the pandemic began and why it wasn’t quashed in infancy But Trump is not alone in raising questions may take years to answer. Still, it’s already about WHO’s response to the novel corona- clear that the developed world—with all of its virus. The organization’s governing body, the advanced medical and communications tech- World Health Assembly, passed a resolution on nologies and national and international gover- COVID-19 in May requiring an “evaluation” nance structures—undeniably and miserably of WHO’s performance “at the earliest ap- failed to stop a lethal disease from infecting propriate moment.” A preliminary report re- the globe and exacting enormous human and leased in mid-May by the WHO Health Emer- financial costs. gencies Programme Independent Oversight and Advisory Committee noted that while the WHO had the job of being the world’s alarm programme had demonstrated its effectiveness system for the coronavirus outbreak. But by responding to 174 “acute events” world- WHO was established as and remains an or- wide in May alone, the COVID-19 pandemic ganization whose members are sovereign na- “has tested WHO as never before,” particularly in the implementation of the International Health Regulations that define how the organization and its member states should respond to outbreaks.

Other WHO members and leading biosecuri- ty experts have called for a more thorough and immediate forensic investigation of the pandemic’s origins. WHO officials have said such an investigation (which would require access to Chinese sites and records) would be dangerous at this time. “It’s like basically taking the fire engines away from the fire, and asking it to go for routine maintenance when desperately needed to put out a flame,” the WHO Direc- tor-General’s special envoy on COVID-19, David Nabarro, told CBS news.

WHO announced on July 7 that it will send a team of experts to China to begin prepara- tions for a mission to identify how the novel coronavirus made the jump to humans—but did not specify a time frame for that mission. The 1897 International Sanitary Conference in Venice was featured on the cover of L’Illustrazione Italiana. The conference No matter when an independent forensic in- introduced new regulations related to plague.

2 Bulletin of the Atomic Scientists tions; its ability to act directly when diseases concerns about the impact of disease (par- threaten is limited by its members’ willingness ticularly cholera) on travel and trade led to or unwillingness to cooperate—and, more fun- multilateral negotiation of the International damentally, by the mandate and resources for Sanitary Conventions. First proposed in 1851 intervention that its member states authorize. and supplemented periodically until 1938, the What does it actually mean, then, when the conventions initially embodied the efforts of most powerful of WHO members, the United a small group of (mainly European) states to States of America, sternly turns around and simplify onerous and country-specific quaran- points the finger of blame at WHO—and, in tine rules (see sidebar below) that kept their no small regard, at itself ? trading ships literally at bay. The rules target- ed a specific set of diseases—mainly cholera, The origins of international yellow fever, and plague—to prevent them health regulation from reaching European borders from the east The earliest modern attempts to coordinate and disrupting trade. international responses to disease also reflected the specific interests of the most influen- “It was not cooperation in the spirit of finding tial countries. Beginning in the 19th-century, global solutions to global problems,” Universi-

Sidebar: Vinegar, oilskins, and iron tongs

From The scientific background of the read it without touching it. Letters Another article (616) provided International Sanitary Conferences, from the unfortunate sick or sus- that a surgeon clad in oilskin gar- 1851-1938 by Norman Howard-Jones, Former Director, Division of Editorial pect passengers confined to a laz- ments could operate with special and Reference Services, WHO. aret (quarantine station) had to be long-handled instruments provid- thrown for a distance of ten paces, ed that he carried with him a bra- It is of interest to cite some of the retrieved with long tongs, plunged zier for burning aromatic herbs. It procedures that were in force, as into vinegar, and then passed was firmly believed that low spirits described by Papon in 1800. On through the flame and smoke of predisposed to epidemic diseas- disembarking, the Master of an ignited gunpowder.” es, and Papon cites with apparent infected or suspected ship was approbation the case of a doctor required to stand before an iron Very similar precautions were who was “very careful” to drink a grille, swear on oath to tell the prescribed in regulations promul- few glasses of wine from time to truth, and then throw the ship’s gated in 1835 by the French Min- time when attending a potential- bill of health into a basin of vine- ister of Commerce. Article 614 ly dangerous patient. “He did not gar. An official would then plunge stated that where there was need get drunk,” says Papon, “but he the bill beneath the surface with for surgical intervention, a surgical became merry.” For the involun- the aid of iron tongs and, when student should be “invited” to be tary inmate of a lazaret, the visit it was judged to have been well incarcerated with the patient— of a half-tipsy doctor clad from soaked, remove it by the same students presumably being more head to foot in oilskins and bear- means, lay it on the end of a plank, expendable than doctors. ing long-handled instruments and and thus present it to the ‘con- a portable brazier was probably servateur de la santé,’ who would […] less than reassuring.

thebulletin.org 3 ty of Freiburg historian Thomas Zimmer told Both the Paris Office and League of Nations the Bulletin. “The spirit was ‘we need to pro- health operations were folded into WHO at tect our own borders.’” its founding in 1948, and the WHA voted to consolidate the 13 separate conventions as a But diplomatic coordination around the Inter- single set of International Sanitary Regula- national Sanitary Conventions paved the way tions in 1951. Revised and renamed in 1969 for the World Health Organization, as the first as the International Health Regulations, they international health organizations emerged continued to pertain only to a short list of ep- in part to provide a permanent venue for im- idemic diseases—like cholera, yellow fever, plementing the conventions. The Pan Amer- plague, and smallpox (eradicated by the late ican Sanitary Bureau—which, as the Pan 1970s in one of WHO’s least-disputed tri- American Health Organization (PAHO) now umphs)—through the turn of the millennium. doubles as the WHO’s regional office for the Americas—was established in 1903 to ease It took nearly five decades for the internation- trade between the United States and Latin al regulations to be revised to more compre- America; the Paris-based Office International hensively address the planet’s vulnerability to d’Hygiene Publique was driven by European contagious diseases—including influenza and interests at its creation in 1907, but eventually coronavirus, the two viruses that have caused took over as the global steward of the Interna- the deadliest pandemic outbreaks of the past tional Sanitary Conventions. One of the more century. successful activities of the ill-fated League of Nations was its Health Organization, which The Magna Carta of health coordinated sharing of national health infor- The World Health Organization was con- mation, research, and prevention of disease, ceived in the wake of World War II “to pro- and set the stage for the creation of the WHO. mote and protect the health of all peoples” amid a wave of idealism about the role international institutions could play in creating a peaceful planet. The United States played a pivotal role: Then-US surgeon general Thom- as Parran presided over the 1946 Internation- al Health Conference that drafted the WHO constitution. He dubbed it the “magna carta of health.”

One defining feature of the WHO constitution that distinguishes it from other specialized agencies under the United Nations umbrella is the World Health Assembly (WHA). The WHA decides the organization’s priorities and has unusually strong authority within the UN system to pass regulations and conventions

4 Bulletin of the Atomic Scientists “For most of [WHO’s] existence, it’s been shaped to a significant degree by whatever the United States would allow it to be, or would not allow it to be,” Zimmer said. “That should be reflected in our thinking about what we can expect from this institution.”

Catching the flu early on The United States was an early contributor to WHO’s work to prevent pandemics, particularly with influenza. The Global Influenza Programme was among the first projects developed by WHO, proposed even before WHO’s Country delegates signed global health agreements, including constitution took effect. At first consisting of a the WHO constitution, at the International Health Conference held in New York in June and July 1946. (WHO/UN) single World Influenza Center based in Lon- don, the program soon added a collaborat- that are formally binding on member states. ing center in the United States. These early At its founding, WHO had 55 members. To- collaborations were formalized in 1952 as the day 194 countries and two territories are rep- Global Influenza Surveillance Network. The resented in the WHA. network today has six collaborating centers, 144 National Influenza Centers, and addition- The prospect of relinquishing any form of al labs in 122 countries devoted to surveilling sovereign control to a UN body has always viruses, gathering samples, and sharing data to been controversial in the United States. Al- enable speedy response to outbreaks and vac- though President Truman quickly approved cine development. US membership in WHO in 1946, legislators delayed ratifying the WHO constitution until “There are no laboratories at the WHO head- just 10 days before the first World Health As- quarters in Geneva,” said Nancy Cox, former sembly convened in June 1948. Some in Con- head of the US Center for Disease Control gress argued that WHO would be “an agent and Prevention’s influenza program. “All of of socialized medicine, that the WHO was too the laboratory work and epidemiology work close to the Soviet Union,” Zimmer said. as well is done in-country. Data are collated and sent to the World Health Organization, In fact, just a year after WHO’s founding, the where they try to put together a global picture Soviet Union was the first member state to for influenza.” withdraw its membership. Though it rejoined in 1956 during the so-called Khrushchev (Even though COVID-19 is caused by coro- Thaw after Stalin’s death, Zimmer says the navirus, Cox told the Bulletin, “there’s been a Soviet Union’s absence during the early years long-term recognition of the fact that an in- opened room for US interests to dominate the fluenza pandemic plan can be rapidly repur- organization’s agenda. posed for another respiratory pathogen. An thebulletin.org 5 influenza surveillance system can be rapidly this really aggressive flu pandemic spread- repurposed for a new pandemic threat.”) ing around the world, killing almost 120,000 Americans, there was no one saying, ‘Oh, my The global picture during the first pandem- god, is this the new Spanish flu? Is this the ic events on WHO’s watch was quite differ- new global pandemic?’ It was just like, ‘Yeah, ent from today. Although the United States there’s a bad flu. All right, let’s get vaccinat- suffered 116,000 fatalities from the 1957 ed.’” “Asian flu,” which killed up to four million worldwide, that pandemic and the later 1968 Despite the rapid emergence of new diseases “Hong Kong” influenza, which killed around in the 1970s—like Marburg and Lassa fevers, one million people globally had little impact and the first Ebola outbreak in 1976—glob- on WHO’s agenda. At the time, vaccines had al attention to pandemics remained scant. proven their worth against seasonal flu and In 1976, an epidemic of H1N1 linked to the other diseases. WHO’s priority at the time was Spanish Flu strain sparked fears about a re- global eradication of malaria—encouraged by peat of 1918 in the United States and led to the invention of DDT and heavily sponsored a nationwide vaccination program. But the by the United States, which sought to open up flu’s impact turned out to be relatively mild, economies of developing nations during the and the program was halted after some 45 Cold War. The public perception was that it million citizens were vaccinated, including was just a matter of time before science would several hundred who developed neurological eliminate malaria and other epidemic threats. disorders as a result. The “fiasco,” as the New “This was a period when the belief in biomed- York Times referred to it, also damaged public ical technical solutions to treat infectious dis- views of vaccines and infectious disease more ease was still very strong,” Zimmer said. broadly.

“It’s honestly striking how small the cultural “It was seen as a complete overreaction,” Zim- footprint was,” Zimmer said. “When you have mer said, “as a drastic failure of both political

President Ford receives a swine flu inoculation from his White House physi- cian, Dr. William Lukash, on October 14, 1976. (Gerald R. Ford Library)

6 Bulletin of the Atomic Scientists leadership and expert leadership… As a con- al aid for family-planning campaigns that in- firmation that there was nothing much to be cluded abortion. Though the United States worried about influenza pandemics.” eventually resumed its funding for the organization, it has frequently remained in arrears, Mixed agendas and budget cuts as it often does across the United Nations system. Three months before Trump announced WHO’s structure and funding went through a freeze, the US already owed more than $200 some big changes in the 1970s and 1980s. Un- million of its 2020 and prior year assessed til then, the US was the heavy-weight driving contributions (those that WHO has discretion WHO’s agenda, especially around disease eradication efforts like the malaria program. to budget as needed for its core operations and Through the decolonization process and the planning). introduction of newly recognized independent states, WHO grew in the 1960s by near- Critically, the Reagan administration and oth- ly three dozen members from Africa alone. er major member state contributors pushed This new voting bloc of less wealthy states had a “zero-growth” policy for WHO’s regular equal votes in the World Health Assembly and budget, which eventually froze states’ man- sought to redirect WHO’s energies toward ar- datory dues to the organization at nominal eas of less immediate concern to the wealthy 1990s levels. (The US assessed contribution states, like improving local health infrastruc- 25 years ago was $104 million. In 2020 it was ture and securing equitable access to medicine. $120 million.) The budgetary vacuum created by this policy left the door open for increased “[WHO] started getting involved in the regu- “extra-budgetary” funding, supported entirely lation of the medical and pharmaceutical in- by voluntary contributions from member state dustry in the late 1970s,” Zimmer said. “That donors and private organizations. did not go well with the United States, and it really led to a very strange relationship be- This marked the beginning of a long-term tween Washington and Geneva. It escalated to budgetary crisis that WHO still labors under. the point of open hostility in the mid-1980s.” Voluntary contributions, which WHO typical- ly can only use for the purposes designated by Inter-agency conflict in the UN system and the their donors, have accounted for an increas- competing agendas of wealthy and developing ingly large portion of WHO’s budget pie. countries helped further erode WHO’s stature. Up from 20 percent in the 1980s, voluntary “It’s really a terribly difficult situation to man- contributions now comprise more than 75 age,” Cox said. “The interests of [wealthy] percent of WHO’s finances. In WHO’s last countries and those of low- and middle-in- bi-annual budget cycle from 2018-2019, the come countries, in terms of what health prior- United States provided $650 million, or about ities should be focused on, are quite different.” 11 percent of WHO’s entire funding, through this type of specified contribution. The Bill US President Ronald Reagan froze WHO’s and Melinda Gates Foundation was the sec- funding in the early 1980s over these disputes, ond largest donor with contributions totaling as well as emerging objections to internation- $520 million, more than every other country. thebulletin.org 7 Those two voluntary contributions alone top By the early 1990s, the influenza program that the entirety of regularly assessed contributions had been one of WHO’s founding initiatives ($889 million) from every single one of its 196 had dwindled dramatically. While the global members. influenza surveillance network stayed active sharing information about new viruses and “It never fails to amaze me that every time identifying seasonal flu strains for vaccine de- an outbreak happens, everyone says, ‘why is velopment, by the time Cox began working at WHO not doing this or that?’” Clare Wen- the CDC in 1988, the Global Influenza Pro- ham, a professor of global health policy at the gramme employed “one senior person,” she London School of Economics, told the Bul- said. “He had one other individual working letin. “Well, look how much money they’ve with him who was responsible for putting to- got to do it. The whole of the WHO has less gether reports and that type of thing. They re- money than a mid-tier hospital in the US. And ally had a very, very limited budget.” then think about how much of that is allocat- ed to emergency response, compared to HIV, The return of infectious disease or malaria or whatever. It hasn’t got the mon- Despite, or perhaps because of, the lack of re- ey and the staff.” sources invested in pandemic preparedness,

8 Bulletin of the Atomic Scientists a growing chorus of expert voices began to had been slow to inform WHO about SARS, sound alarms during the 1990s. A deadly out- waiting months before it acknowledged the break was not a matter of if, but when, went outbreak and shared data. Criticism of China the refrain. Security concerns at the end of the by WHO’s then director-general, Gro Harlem millennium turned away from Cold War fears Brundtland, was seen as withering, given how toward new threats, and the explosive global- uncharacteristic it was coming from the or- ization of trade and air travel increased the ganization’s top official: “It would have been risk of global crises. At the same time, active much better if the Chinese government had resurgence of epidemic diseases like cholera been more open in the early stages,” she said. in South America, plague in India, and Ebola (which struck the Democratic Republic of the Cox, who led the CDC’s WHO Collaborating Congo during the World Health Assembly’s Center for Surveillance, Epidemiology and meeting in May 1995) signaled that the threats Control of Influenza from 1992 to her retire- were not hypothetical—the assembly called ment in 2014, said the United States’ support for an update of the International Health for pandemic preparedness with WHO accel- Regulations to “ensure the maximum possible erated after the SARS outbreak and recogni- protection against infection with minimum in- tion of the threat posed by the H5N1, or avian terference in international traffic.” flu, another virus still emerging in Asia.

Progress on the revisions was slow. But WHO’s “We at the CDC influenza group began getting response to the 2003 SARS coronavirus out- additional designated funding for internation- break—bolstered by a new sense of urgency al work,” she said. “It grew significantly un- following the 2001 9/11 and anthrax attacks der the Bush administration, and it continued in the United States—helped push the health through the Obama administration.” She said regulations review into high gear amid a the CDC was able to support WHO’s work broader securitization of health policy. China on coordinating global disease surveillance

Nancy Cox (front row, right) and other WHO collaborating center directors met with Chinese officials in November 2009 to establish a fifth collaborating center in Beijing. (Chinese Center for Disease Control and Prevention)

thebulletin.org 9 by providing funding for low- and middle-in- measures and guidance; WHO could now come countries’ own influenza surveillance use non-state information to make emergen- networks. “We provided funding not only for cy declarations; and the regulations obligated some of the national influenza centers,” Cox member states to work toward achieving core said, “but also for keeping staff on at WHO readiness to prevent and control pandemics who would be involved in looking at the data within their own borders. that is collected around the world and estab- lishing platforms for data sharing and dissem- But the expanded provisions of the Interna- ination.” tional Health Regulations faced their first major test in 2009, when the Swine Flu broke That extended to working with China to im- out. A new strain of a new H1N1 virus first prove its ability to respond to viral threats, and was identified in Mexico in March, reaching prevent a repeat of its first experience with the the United States in April. Shortly afterward SARS coronavirus. “China now has a rich- an IHR emergency committee convened by er collaborating center for influenza,” Cox WHO’s then director-general Margaret Chan said. “And that was largely possible because recommended the first declaration of an in- of the collaboration that began back in 1988 ternational public health emergency under the through 2004—when [the CDC] actually got revised International Health Regulations. By some funding that we could put in place—and June the pandemic had reached 74 countries. then that collaboration really expanded from The CDC later estimated that in the United 2004 to 2020.” States, between 8,000 and 18,000 people died out of a total 60 million cases. Upwards of International health regulation 200,000 likely died worldwide. 2.0 When WHO member states finally adopted a But at the time WHO was initially accused of new set of International Health Regulations exaggerating the severity of the pandemic, in in 2005, it was seen as a watershed moment part because a lack of transparency about the for epidemic preparedness and response. The experts on the emergency committee stoked regulations expanded the classification of dis- conspiracy theories that the committees mem- eases that WHO member states were required bers were making decisions favorable to phar- to provide notification about—beyond chol- maceutical companies. A series of reports and era, yellow fever, and plague—for the first the ultimate tally of cases eventually vindicat- time, including influenza, coronavirus and any ed WHO. But the events constituted a first “unusual or unexpected” diseases. challenge to the usefulness of the new Interna- tional Health Regulations and raised the issue There were other key innovations: WHO’s of transparency about WHO’s decision-mak- director-general could now declare a global ing in declaring a public health emergency or health emergency (known as a Public Health pandemic. Emergency of International Concern), to both signal the need for national action and trigger In 2014, an outbreak of Ebola struck West Af- WHO’s authority to recommend temporary rica, first in Guinea, then Liberia and Sierra

10 Bulletin of the Atomic Scientists Nancy Cox (front row, right) and other WHO collaborating center directors met with Chinese officials in November 2009 to establish a fifth collaborating center in Beijing. (Chinese Center for Disease Control and Prevention)

Leone. WHO immediately deployed an un- the outbreak, WHO’s member states agreed precedentedly large contingent—more than to a 51 percent cut in its outbreak and crisis 100 experts—via the Global Outbreak Alert response budget, leaving key departments un- and Response Network, which WHO estab- derstaffed just as new epidemics were on the lished in 2000. But it still took nearly five more rise. Chan told the World Health Assembly months for WHO’s then Director-General that demands on WHO during the Ebola cri- Margaret Chan to declare an international sis were “more than 10 times greater than ever health emergency. A mid-June internal memo experienced in the almost 70-year history of made explicit WHO officials’ reluctance to this Organization.” activate the emergency provisions of the In- ternational Health Regulations, because their At the same time, WHO’s reluctance to chal- use “could be seen as a hostile act in the cur- lenge official state health reports “is argu- rent context and may hamper collaboration ably one of the most damning indictments between WHO and affected countries.” As in of the [organization’s] performance,” Kam- the 19th century, the international response to radt-Scott wrote. “The [WHO] secretariat’s public health crises remains intimately con- error is made particularly acute when consid- nected to concerns about trade (the West Afri- ering the historical record of governments’ at- can mining industry, in this case) and politics. tempts to conceal disease-related events as a result of concerns that these may lead to trade Yet global health security experts say the blame and travel sanctions—a practice that, ironi- cannot be shouldered by the WHO officials cally, member states had hoped would be ad- alone. In a 2016 assessment of WHO’s Ebola dressed when they commissioned the IHR to response, global health security scholar Adam be revised.” Kamradt-Scott noted that just one year before thebulletin.org 11 Try, try again states. By the end of 2019, the Health Emer- gencies Programme had only secured some 80 In the aftermath of Ebola, WHO restruc- percent of its 2018-2019 budget. The entire tured. In 2016 Chan oversaw the launch of funding received for the organization tasked the Health Emergencies Programme, which with defending the planet against disasters like centralized the agency’s work on disease and COVID-19 was $454 million—about one fifth other health disasters, and established more of the 2019 New York City Fire Department uniformity among WHO’s three levels of gov- budget. ernance at its headquarters and regional and country offices. Facilitating individual coun- Global health politics expert Kelley Lee told tries’ pandemic preparedness is a primary fo- the Bulletin most of the efforts to improve cus of the four-year-old program. Yet by 2019, have been insufficient to achieve real change. 75 percent of WHO’s member states had still “I often compare WHO reforms of the past not met the requirements of the International decades as rearranging deck chairs on a sink- Health Regulations. ing ship,” said Lee, professor of public health Nevertheless, compared to the way pandem- at Simon Fraser University. “We are in a vi- ics were addressed in the 20th century, the last cious circle—donors do not want to throw 20 years show an undeniable concentration good money after bad. WHO cannot improve of WHO’s attention to emergency response, unless it has proper resourcing.” despite the lack of funding—thanks largely to the 21st century security concerns of Western “That’s the problem, right?,” Wenham said. states. “In the inter-crisis era, people don’t fund for outbreaks because it’s not a political priority. In addition to recent regulation and structur- It’s a ‘never event’—it might not happen in al reforms, new endeavors like WHO’s R&D your time in office. So it never gets funded.” Blueprint (which partners with researchers and the private sector to speed development According to Lee and others, the confused of vaccines and treatments for a specific set global experience of COVID-19 is more re- of epidemic diseases and was among the first flective of WHO’s inherently limited capacity groups activated to begin researching mea- for enforcement than of a mandate the orga- sures against coronavirus) and modern surveil- nization failed to meet. “It is not WHO’s re- lance mechanisms like the Epidemic Intelli- sponsibility to reform itself,” Lee said. “It is gence Open Source system (which first alerted member states which must come together to WHO to the Wuhan outbreak at the end of drive change. This is where we have problems. December) have helped modernize and ac- Member states are in huge disagreement about celerate how WHO and the world reacts to what authority and resources WHO should be emergent threats. given. As a result, we are in this terrible grid- lock.” But these innovations can do little to overcome the delayed or inadequate action of member Some reports suggest that China at various states or the funding gaps enforced by those points delayed notifying WHO of early cas-

12 Bulletin of the Atomic Scientists es of what came to be called COVID-19, where we’re picking up signals, we seek to discovery of human-to-human transmission, verify the existence of an epidemic with the and the number of cases and deaths. The country. We seek further information, but we criticism generally follows that WHO should always, on each and every occasion, offer the have known from its previous experience with country assistance with investigation, diagno- SARS that China’s information was not reli- sis and response, and respond immediately to able, and that WHO should have investigated requests from our member states to do that. … further and reacted more quickly—including We’ve launched in excess of 80 search team declaring an international health emergency missions to support our member states already sooner. in this response. … At any one time around the “There’s a valid debate to be had whether it world we are responding to at least 30 graded took them too long to react to this,” Zimmer emergencies in which we have teams in the said. “But the idea that declaring an interna- field at the request of our member states.” tional public health emergency is this panacea that will cause everyone in the Western world Key phrase: “at the request of our member to just focus on this and come together and get states.” it done, it’s just not how it’s ever worked.” “It’s a member-state organization,” Wenham At a briefing on May 6, when the global toll said. “When governments are like, ‘Oh, WHO of COVID-19 had passed 250,000, Michael is not doing anything,’ well, that’s because you Ryan, head of the WHO Health Emergen- didn’t give it that capacity. You didn’t give it cies Programme, addressed the limitations on that power. You didn’t give it that authority. WHO’s ability to discover and respond to out- You didn’t give it that money. breaks: “Is it making bad decisions on its own? Or is it “WHO has no special powers of investigation because it’s in a structure where it’s not able to or deployment. … There are thousands of make independent decisions?” these events every year all around the world

Director of the WHO Health Emergen- cies Programme, Michael Ryan, and WHO Director-General Tedros Adha- nom Ghebreyesus at a live-streamed COVID-19 briefing on May 6, 2020. (WHO/YouTube)

thebulletin.org 13 The United States versus who? tle, if any, explanation of how the withdrawal will work. Even less attention has been given The COVID-19 pandemic is extraordinary in to the fact that the International Health Reg- its global impact. As of this writing, the glob- ulations constitute a separate agreement that al death toll exceeds half a million worldwide, does not itself require membership in WHO, with more than 130,000 in the United States. but certainly demands close cooperation with Trump and other national leaders continue to it. To truly sever all ties with WHO, would the blame someone other than themselves—from United States have to abandon the entire body China generally to WHO to governors of of international health rules it has observed American states. for well over a century?

“It was not WHO that did not learn lessons Even if Trump remains in the White House from previous outbreaks,” Lee said, “but that and follows through with a total withdrawal, member states turned to other priorities af- it’s not at all clear what the move would ac- ter the many reviews that followed the Ebo- complish. “Trump thinks that we’re still in the la outbreak. The political climate over the ‘80s,” Wenham said, “and the US is still the past decade has shifted decidedly to the right, only possible superpower, and if they pull out, which has traditionally meant less support for you know, everything’s going to come crashing multilateralism and the UN system and an in- down. No. It’s not. We saw China respond- creased focus on national interests.” ing that they are going to put in more money into the World Health Organization. [Other On July 7—as Tedros was announcing WHO’s countries] up their contributions to the World mission to China to investigate the origins of Health Organization, Gates ups his contribu- the virus—members of Congress and a UN tion to the World Health Organization. So spokesman confirmed that the White House the money can be filled. And the normative had sent a letter officially giving notice of its leadership can be filled, because quite frankly, intent to withdraw the United States from the US administration at the moment is not WHO. While Trump has shown little hesi- demonstrating any type of leadership in terms tation about cancelling hard-won treaties on of how to respond to an outbreak. So I think arms control and discarding important envi- it’s only going to backfire on Trump. And I ronmental regulations, experts and legisla- don’t think he’s figured that out yet.” tors have questioned the legality of his move against WHO. The joint resolution in Con- “Ironically, we might see less money going gress that authorized joining WHO in 1948 into global health security … if it’s not led by requires one year’s notice—well beyond the Western actors,” Wenham said. “The whole November presidential election—and full pay- framework of security, the whole concept of ment of US financial obligations to the orga- health emergencies as we talk about them now nization. is a Western-centric concept… And the whole thing has been about preventing outbreaks As of this article’s writing, US government of- from getting to the US.” ficials and scientists continue to cooperate with WHO on a daily basis, and there has been lit-

14 Bulletin of the Atomic Scientists But that effort did not translate into prepared- public of the Congo since the virus was first ness for outbreaks once they breached US and detected there in 1976. European borders. Wenham noted the 2019 Global Health Security Index, which mea- For audiences in the US, the entire episode sured countries’ preparedness to respond to barely registered. outbreaks, ranked the United States at first place overall. Of course, the United States “We didn’t learn anything from Ebola—or now also ranks at the top for COVID-19 cases rather we did learn, but we didn’t implement. and deaths. How many of these reviews do we need to have before something changes? I do think from It bears remembering that epidemics affect that perspective COVID is a game changer,” hundreds of millions of people every year, Wenham said. “The scale of it and where it’s even when the Western media don’t cover affected is going to push for some sort of re- them and WHO’s member states don’t focus vision or review of the International Health on them. Cholera, which was at the heart of Regulations in some capacity.” European concerns back when international health regulation began in 1851, is estimated Even critics of the WHO—from the red-bait- to infect up to 4 million people worldwide ev- ing congressmen who nevertheless voted for it ery year, killing as many as 143,000. In 2018, in 1948, to Reagan in the 1980s, to the many malaria infected 228 million people, mainly in experts today who share concerns about fu- Africa. Of the 400,000 who died, two-thirds ture pandemics—ultimately acknowledge were children under five. And HIV/AIDS has that if something like WHO did not exist, the infected more than 30 million people world- world would have to invent it. What its inven- wide over the last four decades. tors choose to do with it is the question.

Then there’s Ebola, which struck the Demo- “It’s not up to WHO officials to make us care cratic Republic of the Congo (DRC) begin- about something,” Zimmer said. “Right?” ning in August 2018. The WHO declared a public health emergency of international concern in regard to that epidemic in July 2019. The timing and rationale for that decision was controversial, too, as the emergency committee delayed the declaration until it was unable to deny criteria like regional transmission (the virus reached Uganda in April 2019) and the potential for further international travel (after infections were identified in Goma, a densely populated transportation hub). The outbreak was declared over on June 25, after 2,287 had died. A separate, new Ebola outbreak began June 1, the eleventh in the Democratic Re-

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