The World Health Organisation appears ineffectual and is muddling its way through the greatest health crisis in a century.
By PAUL MALEY
If critics of the World Health Organisation needed any more proof that the global body responsible for disease prevention is itself seriously ill, it came, as if on cue, from the under-fire authority itself early this week.
Having argued for months in its official guidelines that China’s so-called wet markets provided an essential source of income to some of the world’s poorest citizens, the WHO’s special envoy for COVID-19, David Nabarro, performed an apparent about-face.
“There’s very clear advice from the Food and Agriculture Organisation and WHO that there are real dangers in these kinds of environments,” Nabarro told the BBC. “Seventy-five per cent of emerging infections come from the animal kingdom. It’s partly the markets, but it’s also other places where humans and animals are in close contact. Just make certain that you’re not creating opportunities for viral spread.”
Wet markets have been the source of huge contention since the coronavirus emerged from the Huanan Seafood Wholesale Market in Wuhan late last year. Their vast array of livestock and exotic animals, combined with poor hygiene, has long made them vectors for new disease. As one observer bluntly puts it, they are “cesspits of blood, entrails and excrement”.
With COVID-19 infecting more than two million people and killing almost 135,000 people so far, closing them would seem a no-brainer, despite whatever cost it might have on local economies.
The WHO’s change of position — if it was one — has deepened concerns that the body charged with ensuring global health is muddling its way through the greatest health crisis in a century.
Instead of leading the response to the coronavirus outbreak, the WHO has been accused of toeing the Chinese government line, ignoring information about the true extent of the virus and opposing early moves to contain the spread of disease, such as travel bans from China. Worst of all, it appears ineffectual and irrelevant in the face of a pandemic, one in which the expertise of the world’s premier health advisory body should be at the forefront.
“The WHO has not covered itself in glory,” Lowy Institute Director Michael Fullilove tells The Australian. “And the director-general himself (Tedros Adhanom Ghebreyesus) looks seriously compromised.”
On Wednesday, Donald Trump announced the US would suspend funding the organisation over what he said was its mismanagement of the pandemic. “The reality is the WHO failed to adequately obtain, vet and share information in a timely and transparent fashion,” the US President said.
It was widely seen as an attempt by Trump to deflect attention away from his own poor handling of the crisis, which has come under harsh scrutiny and which threatens to derail his bid for re-election in November. But the move also illustrates the extent of the frustration — in the US and beyond — with the WHO’s approach to the pandemic.
Trump’s decision drew a careful response from Tedros, who on Thursday said his organisation would review its operations in light of the US decision, which will deprive the WHO of $707m in annual funding, about 15 per cent of its budget. (By way of comparison, China has donated just $133m to the WHO in the past two years).
“No doubt, areas for improvement will be identified and there will be lessons for all of us to learn,” Tedros said.
Trump is not alone in questioning the effectiveness of the WHO. Scott Morrison has been critical of the organisation’s performance, particularly its insistence that wet markets can be made safe.
“I sympathise with (Trump’s) criticisms and I’ve made a few of my own,” the Prime Minister said. “I mean, we called this thing weeks before the WHO did. If we were relying on their advice, then I suspect we would have been suffering the same fate that many other countries currently are.”
Former foreign minister Julie Bishop is among those questioning whether the wildly different approaches taken by countries to suppress the virus reflects a lack of faith in the WHO. “That may be because of all sorts of variables, but the way it impacts on populations is the same,” she said last month.
Like the Bretton Woods agreement or the UN, of which the WHO is a smaller part, the WHO was created in a fit of international idealism after World War II. It was formally constituted in 1948 with the relatively straightforward goal of stamping out disease and promoting global health.
The organisation’s standout success was the eradication of smallpox in 1979, a stunning feat credited to a mass vaccination campaign conducted across many years. Boosters say its hand is strongest in poorer states where the state is weak and health authorities lean heavily on its advice.
But in recent years, the WHO’s mission has drifted into blander terrain. Its strategy last year outlined the lofty goal of providing health cover to a billion people, protecting a billion more from health emergency, and ensuring better health and wellbeing to a billion more still.
But the WHO’s response to the coronavirus contagion has provoked criticism that it is too beholden to powerful members. In January, when COVID-19 was taking flight in the city of Wuhan and, it now turns out, spreading like wildfire across the world, the WHO’s advice mirrored that of the Chinese authorities.
In a now notorious tweet posted on January 14, the WHO dismissed concerns the COVID-19 virus was jumping from human-to-human. “Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus,” it said. Not only was this wrong, it went beyond what the Chinese authorities themselves were saying at the time. The Wuhan Health Commission acknowledged in one of its bulletins that the possibility of limited human-to-human transmission “cannot be excluded”.
“They never called this out, and that’s what we needed,” Liberal MP and former diplomat Dave Sharma tells The Australian. “They (the WHO) were there to praise China when China did the right thing, which I don’t have a problem with, but they were absent when they should have been expressing doubt about some of the assurances and data coming out of China.”
Need for reform
The credulity of the WHO staff in China points to a structural weakness of the organisation. The WHO survives on the goodwill of its member nations. It relies on member states for information on disease outbreaks as well as access to them. As WHO staff moved through Wuhan in the early days of the crisis, they were accompanied at all times by Chinese officials, raising further questions about their independence.
In the case of the WHO, there is a second problem. The directors of the organisation’s six regional offices are all elected by local member states. Bishop says this has resulted a series of WHO “fiefdoms” in which political power is vested locally rather than in Geneva, which is supposedly the seat of its global policy.
“For the WHO to be effective, it needs to narrow its mandate to the areas of which it has direct control,” Bishop says. “That is in setting frameworks of international co-operation and developing models on how to respond to disease.”
Josh Frydenberg touched on this earlier in the week when he said “what happens at a regional level is not necessarily what happens back in Geneva”.
“The practical solutions provided by the WHO locally are much more beneficial than some of the political positions they’ve taken centrally,” the Treasurer said. “But what (Australia) will do is leverage off our membership to make these points, very clearly within the WHO and the need for reform.”
The Lowy Institute’s Fullilove says the problem runs deeper. He argues the WHO suffers the same inherent weakness common to all multilateral institutions.
“They’re flawed because they’re the children of a 150-odd nation-states,” he says. “If Western countries like the US and the Australia leave, that will only make them more flawed because countries like China will have more influence. The way to enhance our national interest is to engage with them, not walk away.”
Fullilove says the WHO’s clumsy handling of the coronavirus outbreak makes the need for reform obvious, but he is opposed to extreme measures of the sort favoured by Trump and other US hawks. “I think defunding it, as Trump proposes to do, is the wrong move,” he says. “The right move is to reassert US influence on the WHO.”
In the near term there seems little prospect of that. Trump has shown no appetite for the sort of Wilsonian consensus-building that would be required to fix the WHO. But this potentially leaves a vacuum that others may fill.
As Adam Ni and Yun Jiang point out in their newsletter, China Neican, Trump’s disdain for international activism comes as Beijing is seeking to play a larger role in multilateral forums.
“The challenges that WHO is facing also highlights a two-sided story,” they write.
“On the one side there is China’s increasing influence in international organisations … on the other side, the Trump administration lacks a deep commitment to multilateralism and international organisations.”
Even if Trump were to take on the job of fixing the WHO, Herve Lemahieu, director of the Asian power and diplomacy program at the Lowy Institute, says the organisation has fallen victim to the same general malaise that has stricken the rest of the UN system.
“It’s not the UN of old, in the 1990s, when it really had its heyday,” Lemahieu says. “The period of benign US hegemony is over. I think now we’re moving into contested geopolitical terrain.”
Lemahieu agrees the WHO badly needs reform.
“But the pandemic has also shown we can’t do without it, particularly in the developing world. The WHO serves a critical global public good in that respect.”
Sharma says what is needed is a more intrusive monitoring system, similar to the Treaty on the Non-Proliferation of Nuclear Weapons, where members are subject to spot checks. “Nuclear material is exceptionally dangerous but on the scale of international peace and security, this (the coronavirus outbreak) is one of the largest threats we’ve seen in several decades,” he says. “I think there’s a case to be made that you need a WHO with a stronger reporting and compliance process.”
Lemahieu is also of the view that the focus must be on improving the integrity of the WHO’s reporting mechanism. As it stands, the WHO is dependent entirely on member states for information on the spread of disease.
Lemahieu proposes a new disease surveillance facility within the WHO but with a separate governance structure ensuring its independence.
Assistance would be contingent on member states meeting stringent reporting guidelines, in the same way as the International Monetary Fund acquires information about the health of the global economy.
“It would verify or flag where there are concerns,” Lemahieu says. “But it would need some teeth to be effective.”
The good news is that the scale of the COVID-19 pandemic may have created a consensus on the need for change. Just as World War I saw the birth of the League of Nations and World War II gave us the Bretton Woods agreement and the UN, so too might the coronavirus lead to profound and beneficial international reform.
“In the world of health, COVID-19 is probably the equivalent of a war,” says Fullilove. “So yes, this is a moment.”