Microbes do not recognize borders. We are all safe only when everybody is safe. In a pandemic, to attack the only body we have for global cooperation, endangers everyone. That is why the US withdrawal from the World Health Organisation (WHO) is not only dangerous for the US, but for all of us.
US president Donald Trump’s decision to withdraw from the WHO is a continuation of his wielding of a wrecking ball to the international framework of treaties and organizations. Whether it is arms control, climate change, trade and now the WHO, the US sees these agreements and institutions as fetters on its hegemonic powers to shape the world. Trump may express this pathology in its most ugly form, but the disease runs far deeper.
Trump’s excuse for withdrawing from the WHO is that it did not do its job well on the COVID-19 pandemic, and was soft on China. Condemning Trump’s move, Devi Sridhar, Professor of Global Public Health at the University of Edinburgh and advisor to the Scottish government, tweeted, “Donald Trump’s withdrawal of U.S. from the WHO ignores the key role the agency plays in outbreak prevention and response. Not only for COVID, but also for polio, malaria, TB, plague, yellow fever, cholera, Zika virus, and neglected tropical diseases.”
She also pointed out that it is because of such international agreements that the WHO received information from China on the novel pathogen on December 30, 2019 and declared the highest alarm bell the world has – a Public Health Emergency of International Concern – on January 30, 2020.
Trump is trying to pass the buck to the WHO for his administration’s abject failure to prepare the US for the COVID-19 pandemic and its handling of the epidemic. The US Centers for Disease Control and Prevention (CDC), could not even prepare a proper test kit for two months for detecting SARS-CoV-2, the virus that causes the infection. China, Germany and Korea, to name a few, all had working test kits well before the CDC. One of this, the Charite Berlin’s test kit, has been supplied by the WHO to more than 129 countries. WHO delivered this test kit to 57 countries, well before the CDC, with a budget three times that of the WHO’s, could get its test kits to work.
The US has a bipartisan unity on its being the sole global hegemon. Its wars of invasion—from Korea, Vietnam, Afghanistan and Iraq—has had bipartisan support. Its right-wing, which, in any other part of the world, would be regarded as the loony right, believes that it can impose its will on the world through unilateral action, using military force and economic sanctions. The other side, the more globalist right—there are no left or centrist forces in the US leadership of either parties— believes that this hegemony can be exercised more easily using global institutions from within and action outside.
What does the WHO do and what are the risks to the world from a US pull out?
Almost all countries have reposed their faith in the WHO as the only international instrument we have in fighting pandemics and infectious diseases. So, the US action will have financial implications for the WHO, but not a threat to its existence or mandate.
The WHO has an annual budget of about $2.2-2.4 billion dollars: two-year budgets of $4.4 billion for 2018-19, and $4.8 billion for 2020-21. Eight percent of this budget is from voluntary contributions made by countries and other organizations, including private trusts and funds, and only about 20% from what are called assessed contributions of countries. The assessed contribution of the US is about $120 million for the year 2020. According to the Congressional Research Service, which provides figures from 2012-2018, the voluntary contribution of the US is not available for 2019-2020. It is estimated by the author to be about $320 million, and along with its assessed contribution, is about 20% of WHO’s current budget.
The low assessed contribution has led to voluntary contributions from countries and private funders becoming the major component of its budget. Consequently, the WHO has become progressively more dependent on private interest groups and country interests dominating the WHO’s agenda. The Bill and Melinda Gates Foundation is the second biggest contributor after the US to WHO’s total budget.
Considering its mandate of health for all, and fighting disease and epidemics across the world, the organization has a measly budget. Just to put the WHO budget numbers in perspective, the US CDC’s annual budget is roughly three times, and its National Institute of Health (NIH) has twenty times that of WHO’s budget. It also no powers over sovereign countries, and has to work with governments.
WHO has had remarkable success in eradicating small pox, bringing down polio infections from the scourge it once was to small numbers now, and interventions in other infectious diseases. While its controlling of the Ebola epidemic had some critics, it required multi-country and multi-agency efforts, which would have been impossible without the WHO. It is the only agency which has technical competence drawn from different regions, which can coordinate the efforts of different countries and their agencies.
Sure, we can criticize the WHO for its mistakes, initially on not advising the wearing of masks and not emphasizing the role of airborne fine droplets or aerosols in closed spaces. However, it raised the pandemic flag early, came out with clear recommendations on testing and tracking, and its multidisciplinary team worked with China to bring out how the country had controlled the epidemic.
It was this report, made public on February 24, that made countries aware that they had to follow not a flu protocol but a more stringent one of SARS, that made countries like New Zealand change its policies. Countries such as Vietnam and South Korea, who had experienced the 2003 SARS outbreak, were already following SARS protocol of using masks, extensive testing and isolating those infected. Vietnam, in spite of a shared border with China, has controlled the epidemic completely and has not had a single COVID-19 death.
Why is the WHO’s coordinating role so important? Unlike human populations, microbes have no borders. They travel not only locally through water and air, but also, in an interconnected world, via passengers, traveling through air, water or land. They infect animals and birds, both domesticated and in the wild. That is why quarantining the infected, isolating countries from others is only a short-term measure. The only long-term way to fight epidemics is either to eradicate it completely, or confine it to small pockets of outbreaks, through vaccines and other public health measures. This battle cannot be won by one country. That is why gutting the WHO, the only instrument of global cooperation we have, is a road to disaster.
While the warning of a new pandemic has been given by many, the flu virus was thought to be the major threat. Its ability to mutate rapidly and with reservoirs in domesticated animals—chickens and pigs—and in migratory birds, and with memories of the 1918 influenza epidemic, has been recognized as a long-term pandemic threat.
One of the major tasks of the WHO has been to create a global network and infrastructure that can monitor flu outbreaks all over the world. The WHO has a monitoring system, Global Influenza Surveillance and Response System (GISRS), which has been functioning for the last 65 years and monitors flu strains from all over the globe, and alerts countries to new strains of flu and novel pathogens. It also identifies the likely strains and therefore, the vaccine composition for the coming season. It is the only global platform that allows countries to share virus strains so that they can receive vaccines through the WHO’s programs at concessional rates, and not at market rates which would be prohibitively expensive for the poorer countries.
There is nothing that exists globally which can be used to monitor seasonal change of flu viruses and share its genome, apart from the WHO’s GISRS surveillance system. Which countries benefit from such a virus sharing platform? The bulk of influenza vaccines are used in the US and Western Europe, and the US has by far the highest share as a country. With 50% of the global population—Africa, West Asia, South South-eastern Asia—use only 5% of flu vaccines, even though the bulk of flu samples come from these countries.
Walking out of the WHO leaves at risk not only the global flu program, but also a large number of deaths, with many experts predicting a new flu pandemic that can rival the one in 1918. At that time, it killed an estimated 50-100 million people, with British India’s casualties at 15-20 million. Since the world’s population was one-fourth our current numbers, this could mean casualties between 200-400 million at today’s count.
Stopping diseases at the source in Asia or Africa also protects its own population from pandemics. Why then would the US pull out when it is the net beneficiary of the WHO’s disease monitoring program?
The right-wing opposes public health policies in favor of individual-centric, privatized health care with Big Pharma mopping up huge profits from pills. The every person for themselves, and every country for itself, is a part of this world view, even during a pandemic, which can only be fought at the global level. Public health yields ‘profits’ for society but not for private hospitals or Big Pharma.
The WHO, warts and all, still stands for global cooperation and fostering public health policies, and is the only instrument we have for global cooperation. It is hated by the right-wing precisely for these reasons. That is why the right-wing friends of Trump—Bolsonaro, Boris Johnson and Modi—are also quiet on the US quitting the WHO. Even if their countries need the WHO as much as the rest of the world.