By Malcolm Baalman, Senior Policy Advisor, Public Health Association of Australia.
Now is not the time to cut funding to the world’s leading public health support agency.
US President Donald Trump recently criticised the World Health Organisation (WHO) for not leading on the issue, even though the WHO had no authority over border policy. The WHO is a United Nations agency. WHO‘s expert staff operate 150 in-country field offices around the world, collect information and data, analyse emergencies, and formulate advice.
As the spread of COVID gathered pace in late January and February, governments, expert advisers and the general public around the world went through increasing levels of response. This included imposing travel restrictions, which eventually led to the closure of national borders.
WHO’s public declarations are important, but they don’t close borders. Only governments are accountable for border decisions and other disease control measures that are taken, or fail to get taken, and when.
Let’s briefly go over the recent history of WHO actions. The organisation released an initial notification of the existence of the virus (then unnamed) on 5 January, issued guidance on how to test for it on 10 January, confirmed the first case of the disease outside of China on 13 January, and notified that it was capable of transmission between humans on 20 January.
WHO Director-General Dr Tedros Adhanom Ghebreyesus travelled to China to meet Chinese President Xi Jinping on 28 January, securing agreement for an international expert team to visit China urgently.
WHO officially declared the disease a “Public Health Emergency of International Concern” (the highest WHO emergency status) on 30 January.
On 3 February the WHO issued a response plan aimed at helping nations with weaker health systems, and on 12 February it established an international forum to fund research on the outbreak. During mid-February a joint WHO-China mission of international experts travelled within China, and quickly (28 February) published its key report on the nature and origins of the disease.
WHO did not at any point make declarations regarding international travel because it has no authority over travel. In early February, WHO public statements indicated scepticism of the need for travel bans when balanced against their potential economic impacts. With the benefit of hindsight, that may have been an error. But that was also the position then held by many governments.
Strong world border controls emerged progressively without specific international coordination from mid-February through to late March. According to the Pew Research Centre, over 91% of the world’s population were subject to some travel restrictions by the end of March.
On 31 January the US President ordered partial limits on travel into the US by non-US citizens who had recently been in China. But this limited policy did not extend to a full border closure of the kind that might hope to exclude COVID from the US.
In fact general international border constraints did not happen in the US until late March, a week after the WHO’s “pandemic” statement. The US government issued a “Level 4 global travel advisory” statement advising against all non-essential travel (19 March), followed by declarations of general closure of the land borders with Mexico (March 20) and Canada (March 21).
In practice, ‘essential travel’ including cross-border worker movement continues across the US-Canadian border, and some ‘essential’ travel by US citizens is still continuing. As the Pew report above indicates, the US is currently only in a state of ‘partial closure’.
President Trump has also criticised the WHO for its relationship with China. In recent years the WHO has needed to build trust with China precisely to cajole it into greater transparency and cooperation with the world health system. The WHO‘s difficult diplomacy has helped prepare for a more open-focused Chinese government response, and worked hard to urge transparency as events unfolded. If that result had not been accomplished, the current situation might have been far worse than it is.
A report on the Trump-WHO controversy by the New York Times on April 16 has presented the WHO’s actions in a more positive light:
“… a close look at the record shows that the WHO acted with greater foresight and speed than many national governments, and more than it had shown in previous epidemics. And while it made mistakes, there is little evidence that the WHO is responsible for the disasters that have unfolded in Europe and then the United States.
The WHO needs the support of its international members to accomplish anything — it has no authority over any territory, it cannot go anywhere uninvited, and it relies on member countries for its funding. All it can offer is expertise and coordination — and even most of that is borrowed from charities and member nations.”
Nonetheless, last week President Trump declared that he would hold up the US’s US$400 million share of the organisation’s funding – around 10 percent of its annual Budget – for 90 days. The actual impact of such financial pressure is unclear, but it can’t be helpful when the world’s governments need the WHO to be operating above and beyond normal expectations.
In striking contrast to Trump’s move, by 8 April the WHO had been pledged around $800 million by other governments and donors to fund its COVID Strategic Preparedness and Response Plan.
Every public entity deserves ongoing scrutiny, as well as the occasional special inquiry into its affairs from time to time. This is true of the complex UN agencies no less than it is of national governments and agencies.
Moreover, as the COVID outbreak is arguably the most serious public health emergency since the WHO was founded in the 1940s, a comprehensive review of its capability, preparations and actions will make sense – once the crisis stabilises.
But playing politics with the WHO and its resourcing right now may have real-world effects in hindering the fight against the virus.
In current conditions, we need more, not less, from the World Health Organisation, which means maintaining resourcing is essential.