Trump at war with the WHO

President Trump has announced his administration will stop funding the WHO (World Health Organisation), while a
review is conducted into the way the organisation has handled the coronavirus pandemic.

Speaking at his evening press conference in Washington, Trump accused the WHO of mismanaging and covering up the spread of the coronavirus.

The Trump administration has been seeking to cut US contributions to global health programmes since he took office, and Trump had been been threatening to take such action over the past week. Still, the announcement will be a shock for those inclined to dismiss the claims as the usual Trumpian bluster.

Trump stated that there was credible evidence of human to human transmission in December and said that the WHO had failed to respond to it appropriately.

In this case Trump is also guilty of downplaying the risk posed by coronavirus. When the WHO said it was serious and then declared a pandemic, Trump was still dismissing concerns about the spread.

It may not be possible for Trump to end – rather than temporarily halt – the $500m dollars of annual funding the US sends to the WHO. Congress, if it feels so inclined, may block the move. Although with many American voters likely to be angry with China over its responsibility for a global catastrophe killing Americans and shuttering the economy the targeting of the WHO could be popular.

There are also serious questions for WHO to answer about its excessive closeness to the Chinese government. It was apparently informed that a novel strain of coronavirus was spreading in Wuhan, and was capable of human-to-human transmission, in late December. The problem is that the country that claims to have told them this – Taiwan – for the WHO officially doesn’t exist.

Taiwan has taken out adverts in US newspapers today, highlighting that it reacted early and was ignored. The treatment of Taiwan is likely to be a central feature of the spiralling row between the US, the WHO and China.

Taiwan’s anomalous status, a relic of the Chinese civil war and Cold War politics, has long been something of a diplomatic headache. The island was the last redoubt of the nationalist Kuomintang after it lost mainland China to the Chinese Communist Party (CCP). To this day the CCP views Taiwan as nothing more than a rogue province.

Geopolitical realities also meant that over the course of decades the government in Taiwan, officially called the Republic of China, slowly lost global diplomatic recognition – even though it clung on to China’s seat on the United Nations Security Council until 1971. In practise Taiwan has unofficial relations with almost every country in the world, but China is sensitive about anything that smacks of official diplomatic recognition.

This is partly due to deeply felt nationalist sentiments. These have only grown more vocal and jingoistic under Xi Jinping who apparently dreams of securing a spot in history as China’s reunifier. Equally important is paranoia among the Chinese ruling elite that China might follow the path of the USSR and disintegrate along regional lines, hence the persecution of Tibetans and Uighurs. While it might seem that Taiwan no longer poses any serious threat to the CCP’s domestic or international legitimacy for the CCP the prospect of Taiwan being recognised as a separate sovereign nation keeps them up at night.

As such, China stubbornly refuses to accept Taiwanese participation in international organisations. From 2008-2016 China finally allowed Taiwan to participate in the WHO inviting it to be an observer under the name Chinese Taipei. Even then a leaked WHO memo in 2010 revealed that it had to be called the Taiwan Province of China in all publications, and it was excluded from the International Health Regulations which allows quick sharing of information in emergencies.

Even this limited participation ended when Taiwan’s 2016 presidential election was won by Tsai Ing-wen, whose Democratic Progressive Party considers Taiwan to be an independent state. In 2017 China withdrew the invitation that allowed Taiwan to participate in the WHO, and blocked subsequent Taiwanese attempts to join the organisation.

This alone doesn’t explain why the WHO failed to at least take note of Taiwan’s warning about the potential looming catastrophe. Indeed, in January the WHO far from raising the alarm seems to have uncritically accepted CCP reports that everything was under control.

On 14 January 2020, some two weeks after the warning from Taiwan, the WHO issued a now infamous statement on Twitter. “Preliminary investigations conducted by Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus.” The statement mirrored China’s official statement on the issue nearly perfectly, and even toned it down by removing caveats.

The WHO would not admit that human-to-human transmission was possible until 20 January, the day China confirmed it publicly (top Chinese officials apparently having come to this conclusion 6 days before). Even then the organisation dragged its feet. It did not declare Public Health Emergency of International Concern (PHEIC), the highest level of alarm short of a pandemic, until 30 January. Even as the warning was issued the WHO Director-General Tedros Adhanom was keen to reassure the world it did not represent “a vote of no confidence in China” and that WHO had “confidence in China’s ability to control the outbreak”.

Tedros subsequently made a point of repeatedly praising China’s draconian efforts to contain the virus. Defenders of the WHO say this was a necessary to coax China into cooperating more fully. Yet when the US and Italy moved to ban flights from China on 4 February, he warned that this would have “little public health benefit” and risked promoting “fear and stigma”. Notably China was promoting much the same rhetoric due to it being deeply worried about how the outbreak might hurt its international image.

The WHO’s willingness to ignore early warnings in favour of pumping out the bromides uncritically based on Chinese reports, and continuing to closely echo official Chinese rhetoric even as the outbreak spread globally, seems incredible now with much of the world in lockdown.

Perhaps even more incredible is the fact that the WHO’s determination not to work with Taiwan is still damaging the coronavirus response.

Taiwan forewarned. It has an epidemiologist as its vice-president and conducted its own fact-finding mission in China. It promptly implemented some of the most effective containment measures in the world. As a result, despite being one of the nations initially assessed to be most at risk from the virus its comprehensive testing it has only recorded 393 cases, and 6 deaths. It has also sought to help other countries as best it can, sending tens of millions of masks to countries struggling to contain coronavirus outbreaks.

Yet due to perverse politics Taiwan still remains excluded from the organisation that would most benefit from its advice on how to handle the crisis, and be best situated to disseminate it globally, despite calls for it to be admitted by the EU, Japan, Canada, and Australia.

Behind this institutional failure lies a long-running campaign by China to build its influence in the organisation, and America’s recent pullback from it.

The difference between the WHO’s actions in 2003 on SARs, when it was willing to stand up to China, and now are striking. During the SARS outbreak Director-General Gro Harlem Brundtland did not hesitate to criticise China’s lack of transparency in its response, or issue travel warnings despite government preferences against this. The bold response even convinced the Chinese government to admit it had made mistakes in handling the situation, and apparently also convinced it to ensure it didn’t have to endure such public criticism again.

Since then China has deftly built up its political influence in the WHO. In 2006, following the death of Brundtland’s successor Lee Jong-wook during an operation, China managed to secure the post of Director-General for its nominee Margaret Chan.

Chan did not come to office with the best of reputations. When she had served as Director of Health in Hong Kong she had been roundly criticised, and even censured by the Legislative Council, for her lackadaisical response to an outbreak of avian flu. Her slow response was widely seen as in large part due to her uncritical acceptance of misleading information provided by mainland Chinese authorities.

At the helm of the WHO Chan would go on to face persistent criticism for being too deferential to national governments’ wishes. Outbreaks of polio in Syria and MERS in Saudi Arabia recieved little comment as Bashar al-Assad assured the world things were alright, and the Saudi monarchy remained quiet. In 2014 the WHO took months to declare a global emergency in response to an outbreak of Ebola in part due to fears of offending the government of the three West African countries affected.

The one occasion Chan sounded the alarm, over the 2009 swine flu outbreak, it proved to be a false alarm for which she was roundly criticised. Perhaps this added to her caution.

The WHO’s ongoing funding issues means that even offending relatively small donors is best avoided. Nevertheless, the image one gets is of a Director-General unwilling to do anything that might offend the sensibilities of national governments, led by China. Chan even managed to praise North Korea’s medical system. Apparently, there was also little sign of obesity in a country which suffered a devastating famine from 1994-1998 and where chronic malnutrition remains a major problem.

Nevertheless, when Chan retired as Director-General in 2017 her replacement was once again the Chinese backed candidate Tedros Adhanom.

Tedros did have a fairly impressive record. His tenure as Minister of Health in Ethiopia’s, admittedly authoritarian, government involved impressive efforts to expand the general population’s access to basic healthcare. His time as Foreign Minister gave him diplomatic chops.

Under a new system the Director-General was to be elected by the World Health Assembly (WHA), a body made up of representatives from the WHO’s 194 member states. Here Tedros’ emphasis on expanding healthcare access attracted the support of not just China but also developing countries, particularly African states keen to see the first African head of the WHO, and the Obama administration.

With the election of Trump, US backing shifted. Universal healthcare likely had limited appeal to the Trump administration. Furthermore, his Health and Human Services Secretary Tom Price, perhaps presciently, preferred rival British candidate Dr David Nabarro’s focus on global health security i.e. pandemics, bioterrorism, and the like. The election turned ugly with a last minute accusation that Tedros had helped cover up a cholera outbreak while serving in the Ethiopian government.

Nevertheless, Tedros, assiduously courting and courted by China, became Director-General. That the US should have been so out-manoeuvred in the WHO is in some ways startling.

The US contribution to the WHO’s budget dwarfs that of China. The US share is 14.67% against 0.21% for China. Even the Rotary International contributes more to the WHO than China. However, while this funding has – so far – been relatively safe due to strong bipartisan support for it Congress Trump had repeatedly tried to reduce it.

Adding to concerns about US involvement was Trump’s America First style which saw the US pullback from international organisations. The US representative’s seat at the WHO has sat empty since 2018 and its involvement in global health initiatives has been rolled back.

Meanwhile, China quickly reaped the rewards of having backed the winner in the WHO leadership race. The day after his election Tedros went on Chinese TV to assure his audience he would respect the “One China” principle i.e. that there was no independent Taiwanese state.
In this context, the WHO’s failure to raise the alarm promptly about coronavirus seems to be the result of a decision to prioritise not offending China over its public health mission. How else to explain why it so blithely accepted CCP assurances everything was under control and so blindly stuck to its bureaucratic non-recognition of Taiwan in the face of potential catastrophe?

This distortion of the organisation seems to have been partly enabled or encouraged by US failure to effectively make use of the leverage it had within the organisation.

Diplomatic failure or pullback on the part of the US seems to have enabled, or even encouraged this distortion of WHO priorities.

Once again Trump’s instinct to lash out will likely only make the situation worse.

Whether he can actually unilaterally end US funding to the WHO is unclear, but congressional Republican anger directed at the organisation has grown over the past few weeks with senators calling for it to be investigated.

If he gets his wish withdrawing money from an organisation at the heart of the global coronavirus struggle, whatever its flaws, could have severe consequences.

Furthermore, by withdrawing funding, Trump may be throwing away the US’s best tool to force the WHO to reform, and leave it ever more under the influence of China.