In mid-April President Donald Trump announced that the US would halt its funding of the World Health Organisation (WHO), and in late May he announced that the country was breaking all ties with the organisation. While this may be simply a deflection tactic – the US now has the highest COVID-19 death count of any country in the world, giving plenty of motivation for the US President to shift the news cycle away from his administration – this is hardly the first time the WHO has been subject to political criticism.

Political objections to the operations of the WHO aren’t new. From 1949 to 1956 the Soviet Union boycotted WHO meetings on the grounds that the United States had too much influence over the organisation, and claims that the WHO is subject to political interference persist. To understand how the World Health Organisation could be subject to political interference, and why Trump claims to think an American boycott of the WHO is a good idea, it’s necessary to take a look at how the WHO is funded and how it operates.

First, a little history. The World Health Organisation was established in 1948, as an apolitical division of the United Nations (UN) that would focus on promoting public health. It has been responsible for many success stories over its seventy-year history, including the eradication of smallpox and near eradication of polio. While a large part of its remit is in countering public health crises such as outbreaks of emerging diseases, it has also broadened the concept of “health” to include wellbeing, which goes beyond a mere absence of illness.

Fast forward to the present day, and the WHO’s current director general, Tedros Adhanom, was selected for the role in 2013 following admitted failures of the WHO during the Ebola outbreak. The WHO had attracted criticism after it had taken the organisation five months to declare a public health emergency during the outbreak in West Africa. Adhanom was selected in part as he promised to establish a new health emergencies plan aimed at tackling emerging outbreaks of newly emerging diseases.

While the WHO was established to be an apolitical organisation, in reality its work demands it forges diplomatic relations with many nations, and this can sometimes create conflicts. Many of the WHO’s administrative decisions are made by a committee called the World Health Assembly (WHA). The WHO’s director general, for instance, is selected by meetings of this committee. The WHA comprises representatives from some WHO member states – but which states are entitled to membership, and which aren’t, has attracted controversy. Since 2017, the WHA has not included a representative from Taiwan, primarily because of lobbying from the Chinese government, which does not recognise Taiwan as a separate entity to the state of China. This conflict, between Taiwan and Beijing, has become increasingly relevant to the work of the WHO since the advent of COVID-19. More on this later in the explainer.

The WHO’s funding, as with anything, is fundamental to how the organisation operates. The WHO is funded almost entirely by its member states – which may seem fair – but member states donate different monetary amounts at their own discretion. Donations to the WHO are voluntary, so individual countries’ governments decide exactly how much to donate and when. This naturally gives some developed nations heightened financial clout in the organisation compared with developing nations, as they have greater means to donate. The WHO’s highest donors include the UK, the Gates Foundation, South Korea, the UN and the European Commission. The US was previously its top donor. So in reality, some member states have more diplomatic or financial clout over the organisation than others, despite the aim of the WHO to be apolitical.

Much Ado About China

Trump’s calls to defund the WHO are, he claims, based in part on what is perceived as the organisation’s cosy relationship with the Chinese government. China has strong economic ties to the US, but ideologically differs from Western democratic states, favouring state control of the press and being subject to criticism for its human rights record compared to Western democracies.

The WHO does have a history of praising the Chinese state, despite international scepticism. For example, the WHO issued praise of the Chinese government’s early handling of the COVID-19 pandemic, despite the authoritarian state’s imprisonment of whistleblower medics early in the outbreak, and evidence that the state had understated its death count. In late January the WHO’s director general Tedros Adhanom commented: “we appreciate the seriousness with which China is taking this outbreak, especially the commitment from top leadership, and the transparency they have demonstrated.” Prior to this statement being made scientists from Imperial College London had calculated the number of COVID-19 cases they suspected then existed in Wuhan, based on the number of reported cases in other countries. Their approximation (1,723) differed wildly from the Chinese government’s official figures (41), which may indicate the Chinese government has underestimated (or, possibly, deliberately hidden) its death count in international reporting. China has form when it comes to disease reporting cover-ups: during the 2003 SARS outbreak, the Chinese state did not report the many cases of unexplained pneumonia to the WHO for several months, and only did so when faced with strong international pressure, long after the disease had spread beyond its borders. The pneumonia cases in China at the beginning of the COVID-19 outbreak were reported to the WHO using a protocol that was established following failures during the SARS and MERS outbreaks in Asia and the Middle East.

The actions of the WHO are also influenced by the conflict between China and Taiwan. Taiwan ostensibly operates separately to China, in that it has its own independent, democratically elected government, but the Chinese state does not recognise the territory as existing separately to China. Since the late 1970s the Chinese state has operated a “one China” principle, meaning that Taiwan can sometimes be represented separately to China in international bodies on the proviso that Taiwan is labelled as a part of the Chinese state. This principle has allowed Taiwan to compete in the Olympics as “Chinese Taipei” from 1984. However, this clash between Taiwan’s separatist ideals and politicians and Beijing can have major impacts on Taiwan’s ability to operate effectively with international bodies.

During the COVID-19 pandemic, Taiwan’s representatives have been excluded from WHO emergency meetings on the novel coronavirus, allegedly due to lobbying from the Chinese state. On 12th February, however, Taiwanese experts were permitted to participate in an online WHO forum on the outbreak. The Chinese foreign ministry claimed this was permitted as Beijng had granted them permission, although the Taiwanese leadership claimed China had had no involvement in their invitation and that their participation was the result of direct negotiation with the WHO. If Beijing did have an involvement in inviting Taiwan to these proceedings, it wouldn’t be the first time the Chinese state had influenced the issuing or blocking of invites to Taiwan to public health meetings. Taiwan was excluded from important public health meetings during the SARS outbreak in 2003, and this in part led to Taiwan’s relatively high death count in the region.

In the COVID-19 pandemic, Taiwan has been particularly effective at combatting the disease, and this is a point of apparent political embarrassment for the Chinese government. While this tension between the two governments often doesn’t reach all of the mainstream western press, a video of a journalist asking a WHO representative why Taiwan is not acknowledged by the organisation gained online traction on Western social media in late March. During the interview with Canadian epidemiologist and senior WHO official, Bruce Aylward, the interviewer asked if the WHO should reconsider Taiwan for WHO membership. The WHO official claimed he couldn’t hear the question, and when the interviewer asked her question a second time the call was disconnected. After reconnecting, Aylward claimed that if he had contracted COVID-19 he would want to be treated in China. While the WHO official may have been attempting to remain neutral in response to what would be seen as a political question, the video is worth a watch and can be seen here:

While China isn’t a major financial donor to the WHO, the compliance of the Chinese state with international bodies such as the WHO is vital in managing the COVID-19 outbreak. The Chinese government could have opted to withhold its scientific, epidemiological and clinical information if the WHO had not ostensibly supported the Chinese state, and the WHO’s actions may be understood though this lens.

Whether the WHO has become subject to partisan interference is one thing, but the US’s separation from the WHO may have a damaging effect across the globe during the current COVID-19 outbreak. It may prevent other nations benefiting from research undertaken there, and will limit the US’ ability to receive timely information from other states via the WHO. This may cause a problem in curbing the current pandemic. Time will tell, but reduced international cooperation during a global pandemic is unlikely to be a good thing.

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