United States back in WHO boardroom

WHO director general Dr Tedros Adhanom Ghebreyesus at this week's executive board meeting. (credit: Health Policy Watch)

The United States appears to be back in the WHO boardroom - despite the fact that President Donald Trump had announced in July that he would leave the global health organisation due to its alleged China bias in the handling of the Covid-19 pandemic.

Why is this important? The US presence in the chambers of WHO decision-making is important both geopolitically as well as financially to the organisation. In past years, United States contributions have represented between 15-20 per cent of WHO’s budget, and even though funding was sharply cut by Trump for 2020-21, it still represents hundreds of millions of dollars for the organisation.

Politicisation of pandemic response. The executive board, is WHO’s core governing body. Made up of 33 member states, it sets agendas, priorities, reviews and approves budgets before decisions go to the wider World Health Assembly (WHA), which includes all 194 WHO member states. The EB held its first session since the May WHA meeting, when geopolitical sparring between China and the US - as well as impromptu declarations by Trump to the media - disrupted the normal decorum of the meetings - and worse yet the focus on combatting the pandemic.

Return to decorum.This time around, US deputy secretary of health and human services, Brett Giroir, not only joined the WHO Executive Board meeting (5-6 October) but even referred positively to the “progress” being made by a series of independent panels and committees that are reviewing the WHO’s pandemic response — as well as that of WHO member states.

“We appreciate the progress made,” said Giroir, asking that EB members be briefed again in November and in early 2021. Significantly, he also made no reference to Trump’s earlier announcement that the US would withdraw from WHO altogether.

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US Secretary of Health and Human Services, Brett Giroir (Credit: Health Policy Watch)
While Giroir did pointedly refer to the “billions” of people impacted by Covid-19, as well as the “failure” of some member states to quickly respond, he refrained from attacking China by name:

“Despite the many advances in technology, international cooperation and instantaneous communication, and the positive steps in response outlined this morning,… we cannot overcome the failure of any member state to provide accurate, complete and timely information on outbreaks and potential health emergencies,” Giroir said.

China’s EB representative, Zhang Yang, was similarly restrained. Sidestepping the simmering debate over the timing of China’s alerts to the global community on the virus, he focused on the role that the various review panels could play in recommending measures that could “further support countries with weak health systems.”

He also called about the review panels to “inform members states of their work in a timely manner and use their platforms to enhance direction with member states.”

Overall, such exchanges represented a kind of “return to decorum” that is the traditional hallmark of WHO member-state meetings.

Perhaps member states were also reflecting on the interim findings of the Independent Oversight Advisory Committee (IOAC), which were presented at the EB meeting. The committee, charged with reviewing WHO’s Health Emergencies response, also pointedly noted in its summary findings that:

“The politicization of pandemic response is a material impediment to defeating the virus.”

Europe steps forward. Although US and Chinese remarks were subdued, European Union flexed its muscles.

Germanýs EB representative Björn Kümmel (Credit: Health Policy Watch)

Germany, speaking on behalf of the European Union bloc on Tuesday, said member states need to consider “strengthening WHO’s perogative in terms of access to information”:

“We look forward to discussing ideas such as increased accountability of member states on preparedness, for example, through the establishment of a periodic review mechanism, as proposed by the African Union, and all strengthening WHO’s prerogatives in terms of access to information… Emphasis must also be placed on development of proper and unified health data collection at all levels.” Björn Kümmel, Germany’s EB representative.

Criticis have said that one of the main shortcomings of the current legal frameworks in which WHO operates is that it has no real legal perogative to demand access to information from a sovereign nation - that may be vital to coping with an emerging global health crisis. Regardless of whether China really did delay the release of data about the emergence of the mysterious virus in Wuhan by days or weeks in late 2019, as the US has claimed, European member states and other nations are deeply concerned that more transparency be built into emergency alert systems, so that delays in reporting don’t occur and such questions don’t arise again.

In that light, Kümmel’s frank appeal to the three panels that are now exploring the pandemic response from various angles is also particularly striking:

“In your evaluations, do not be afraid to tell uncomfortable truths. In your recommendations, do not be afraid to challenge…member states, to questions current modes of operation and to show boldness and vision. You can count on the full support of the EU and its member states.”

Weathering the pandemic storm. If the WHO organisational boat seemed to be riding through rough waters in May, with major leaks in the budget engine, the meeting signalled a kind of stabilisation, and back to business approach. And so far, WHO director general Dr Tedros Adhanom Ghebreyesus, who faces re-election in May 2021, seems to be weathering the storm while also remaining firmly at the helm himself, despite the blistering criticism directed at him in past months by WHO’s most powerful member state: the US.

Bright spots on horizon. There are also some bright spots on the horizon - however distant they still may be. The pandemic continues to expand daily, with some 36 million reported infections and over one million deaths worldwide, and China or not, many insiders say that WHO’s early guidance on issues such as masks or travel restrictions was clumsy and delayed - saying neither would be useful when in fact both proved to be essential as containment strategies used by countries worldwide.

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At this week’s EB meeting, Austria asked the organisation to develop more detailed and up-to-date guidance about how airlines and countries can safely organise travel now as countries seek to revive their airline industries - using a patchwork of testing and quarantine approaches. It is often precisely around such guidance that WHO is particularly hesitant - either lacking the in-house expertise or else fearing that it might tread on the sovereign toes of member states.

But on the more positive side, the organisation has in fact, been key to the mobilisation of an unprecedented global response.

This has included everything from bolstering Covid lab test capacity across Africa and doling out millions of pieces of protective gear for health workers in the early days, to far more sophisticated initiatives: such as the massive “Solidarity” trial that is pooling methods and results for the hundreds of clinical trials going on around the world to test Covid-10 therapies. WHO in partnership with the Global Fund and others, is also now rolling out the procurement of hundreds of millions of rapid tests in low-income settings, where they could make a huge difference. And WHO has ramped up its daily reporting on pandemic trends and issues.

Perhaps its most stunning achievement to date is the co-creation with Gavi, The Vaccine Alliance of a massive “Covax” vaccine procurement pool, to which some 168 high and low-income countries have formally committed, and which is intended to help rationally distribute available supplies of the most effective vaccines, as soon as they become available, to health workers, older people, and other groups most at risk. The Covax pool has so far drawn over $16bn in donor support and World Bank finance.

So while the recent EB meeting was largely dominated by diplomatically-framed debates centred around the independent reviews of WHO’s performance and ideas for improvement going forward, Dr Tedros and his team also had their moment in the sun to explain what they have accomplished so far. The list certainly looks impressive - and member state reactions were largely supportive.

And speaking at the GLOBSEC 2020 forum, the day after the EB meeting, it was clear that Dr Tedros was clear about what he thought the overall conclusions of the external reviews and evaluations should be:

“We look forward to the findings and recommendations of these reviews. But there are several lessons that are already staring us in the face.

“First, we must learn from this pandemic, and make political and financial commitments now, to address critical gaps in national and global preparedness. We must renew our determination as a global community - that never again will a new pathogen be allowed to spread with such destructive impact on our populations.

“The time to prepare for emergencies is before they occur. WHO support for country preparedness is rooted in the idea that the best defence for health emergencies is strong health systems based on universal health coverage and primary health care. So we need to have a real and strong commitment to universal health coverage.”