Trump vs the World Health Organisation: WHO will win?

The decision by the US President to withdraw from the World Health Organisation may look like a done deal, but the chances of it happening are beginning to look slim. Bette Browne reports

President Donald Trump’s decision to withdraw the US from the World Health Organisation (WHO), which would deprive the agency of much of its funding and US expertise, sparked global concern amid the Covid-19 crisis. However, there are some doubts about whether such a withdrawal would come into effect.

If President Trump is voted off the political stage in the election in November, the issue becomes a moot point since his opponent Democrat Joe Biden has vowed to reverse the move. But the world learned four years ago that polls, which are now showing Biden ahead, are not necessarily an accurate barometer when it comes to President Trump. If he defeated the odds in 2016, he could do so again in 2020.

Diversion

Indeed, some political observers contend that the reason the WHO became a target of the President’s ire in the first place was because it was part of his plan to divert blame over his handling of the pandemic that sent his approval slumping to an all-time low.

Two-thirds of Americans in a poll in late July said they disapproved of how the President has handled the pandemic. In the ABC-Ipsos poll, 67 per cent said they disapproved of his efforts during the pandemic, while 33 per cent said that they approved.

It is the highest level of dissatisfaction with the President’s response to the pandemic since it began its deadly march across the US at the beginning of this year.

More than 150 US medical experts, scientists, doctors and nurses signed a strongly worded letter at the end of July, which was sent to the Trump administration, Congress, and governors, calling for the country to basically start over because reopening plans have failed in so many States and the novel coronavirus was spreading unchecked.

“The best thing for the nation is not to reopen as quickly as possible, it’s to save as many lives as possible,” they wrote. They also criticised the lack of preparation, the time wasted during the shutdown and the failure to build stockpiles of protective equipment and tests.

“Right now we are on a path to lose more than 200,000 American lives by November 1. Yet, in many States people can drink in bars, get a haircut, eat inside a restaurant, get a tattoo, get a massage, and do myriad other normal, pleasant, but non-essential activities. If you don’t take these actions, the consequences will be measured in widespread suffering and death,” the letter warned.

Even as the US death toll continues its tragic climb, it would be foolhardy to underestimate President Trump’s ability to bounce back before the November election. If he sees his criticism of the WHO and its attitude towards China, where the virus originated, yielding results, then it can be expected to become a running election issue.

It is no accident that the President rounded on the WHO when the US death toll began to soar back in April. He announced on 14 April that he would suspend funding to the global public health agency pending an investigation into what he called its “role in severely mismanaging and covering up the spread of the coronavirus”. He said the review would last 60 to 90 days.

The announcement was greeted with alarm in the US and in much of the rest of the world. Ten days later, on 24 April, more than 1,000 organisations and individuals, including medical experts and healthcare companies, called on the administration in a letter to reverse course and keep funding the agency, saying the coronavirus pandemic could not be brought under control without the WHO.

“The United States cannot rid this insidious virus from the country, nor around the world, without WHO,” according to the letter addressed to President Trump and sent to the White House.

“WHO is the only organisation with the technical capacity and global mandate to support the public health response of all countries during this critical time.”

It was also pointed out that crucial global public health programmes, such as polio eradication, increasing access to essential health and nutrition services and combating vaccine-preventable diseases, would also be imperiled by a US withdrawal.

Signatories included the American Academy of Paediatrics, the American Public Health Association, the American College of Nurse-Midwives, the American College of Obstetricians and Gynecologists, and the American Society for Clinical Pathology.

Nevertheless, President Trump didn’t change course. Instead, he upped the ante. On 18 May he sent a letter to the WHO saying the US would permanently pull funding if the agency did not “commit to major substantive improvements in the next 30 days”. In that letter, he also accused the agency of ignoring “credible reports of the virus spreading in Wuhan in early December 2019 or even earlier, including reports from The Lancet medical journal”.

The Lancet said the next day, however, that it “published no report in December, 2019, referring to a virus or outbreak in Wuhan or anywhere else in China. The first reports the journal published were on January 24, 2020.”

The United States cannot rid this insidious virus from the country, nor around the world, without WHO

Then, on May 29, the President announced the US was ending its WHO membership. It was widely seen as a catastrophic move, which also threatened the future of several vital health programmes funded in part by US contributions. These included the agency’s emergency fund to help at-risk countries across the world fight the pandemic.

China

For his part, President Trump accused the Organisation of being too quick to accept the information China provided in the early days of the pandemic and too quick to praise China for its response.

The WHO has repeatedly defended its relationship with China, asserting that it is essential to obtain vital information and access, and denied accusations it was imbalanced in its praise of that country’s response. Indeed, back in January, President Trump himself had praised China’s handling of the pandemic.

President Trump also contends the US pays a disproportionate share of the WHO’s operational budget in comparison to China. The US is required to cover 22 per cent of overall mandatory contributions, while China is expected to cover 12 per cent in 2020/21.

But America itself is already behind in paying its contribution to the WHO’s annual budget of about $5 billion. No country owes the WHO more in annual dues than the United States. The $118 million that Washington is supposed to pay the agency this year amounts to nearly a quarter of the annual fees the WHO assesses to all 194 of its member states. On top of this year’s overdue payment, according to the WHO, the US also still owes $81 million from last year.

While the US has fallen behind before on its payments to the WHO, according to Mr Jimmy Kolker, who was an assistant secretary for global health affairs during the Obama administration, it has never been to the degree than during the Trump administration. It should be noted, however, that the US did send $30 million to the WHO for its Covid-19 response fund.
Such mixed signals on payments were characterised by Dr Ashish Jha, Director of the Harvard Global Health Institute, as an indication that the President is simply seeking to make the WHO a scapegoat.

“I don’t think that there is any real appetite in the US government to walk away from WHO for the long run,” Dr Jha noted in a webinar organised by the US Council on Foreign Relations.

“This is much more political posturing, so part of me just sort of says we should take the President and his bluster a little less seriously.”

Withdrawal

But on 6 July, President Trump made the withdrawal official. “The United States’ notice of withdrawal, effective July 6, 2021, has been submitted to the UN Secretary-General, who is the depository for the WHO,” according to a US statement, sparking an immediate chorus of condemnation from the country’s leading medical organisations.

The heads of the American Medical Association, American Academy of Paediatrics, American Academy of Family Physicians, and American College of Physicians said in a joint statement it was a dangerous move and put the health of the country at grave risk.

“This dangerous withdrawal not only impacts the global response against Covid-19, but also undermines efforts to address other major public health threats,” they said.

“We call on Congress to reject the administration’s withdrawal from the WHO and make every effort to preserve the United States’ relationship with this valued global institution. Now is the time to invest in global health, rather than turn back.”

The move was also criticised in Congress by members of both parties.
Democratic House of Representatives Speaker Nancy Pelosi called it “an act of true senselessness”. Senator Bob Menendez, the top Democrat on the Senate Foreign Affairs Committee, tweeted that the formal withdrawal move left Americans isolated.

“To call Trump’s response to Covid chaotic and incoherent doesn’t do it justice. This won’t protect American lives or interests – it leaves Americans sick and America alone.”

A senator from President Trump’s own Republican party also slammed the move.

“I disagree with the President’s decision,” said Senator Lamar Alexander in a statement.

“Certainly there needs to be a good, hard look at mistakes the WHO might have made in connection with coronavirus, but the time to do that is after the crisis has been dealt with, not in the middle of it.”

Legal?

But the withdrawal is far from being a done deal. For a start, questions are being raised as to whether the President even has the legal authority to withdraw the country from the agency since it is the US Congress that approves such funds.

The money for the WHO was approved by Congress last year in its annual appropriations and Democrats in Congress say that the President can’t simply decide to withhold the money.

“He can do it temporarily, but he cannot do it as a policy,” House Speaker Pelosi said.

“If he wants to hold up some money, that is questionable in terms of its legality. But he cannot stop the money ever from going.”

Ms Rachel Sachs, an expert on health law at Washington University in St Louis, Missouri, also questioned whether the President can unilaterally withdraw the United States from membership in the WHO.

“The WHO constitution is a treaty that the United States has ratified with the consent of Congress,” she said on the university’s website. “It’s not clear that the executive can withdraw us from the agreement without Congress’ consent.”

Even if the President does have the authority to do so, Ms Sachs said, “when the United States ratified the WHO Constitution, it agreed that it would pay all outstanding dues before withdrawing.” This would mean paying the estimated $200 million the US owes in current and past dues, which would not go down well with President Trump at the same time that he is criticising the agency.

Timing

Then there is the question of timing. The United Nations, which co-coordinates the work of the WHO, has already pointed out that it will take a year for the withdrawal to come into effect on 6 July 2021.

A spokesperson for UN Secretary-General António Guterres said after confirming receipt of the withdrawal notice on 6 July the agency “is in the process of verifying with the World Health Organisation whether all the conditions for such withdrawal are met”.

Those conditions “include giving a one-year notice and fully meeting the payment of assessed financial obligations”.

In that year, the political map of the US may have radically changed and a Democratic administration would not favour withdrawal, as Trump opponent Joe Biden made clear immediately after the withdrawal announcement.

“Americans are safer when America is engaged in strengthening global health. On my first day as President, I will rejoin the WHO and restore our leadership on the world stage,” he tweeted on 7 July.

And while the President’s supporters may not be overly concerned about a move that would harm global health, they may balk at the prospect of doing something in the Covid-19 era that could further negatively impact their own health. Withdrawal from the agency, for example, would mean the US would no longer have access to the WHO’s system for sharing information about new outbreaks, making it more difficult for the country to both respond to Covid-19 and to respond to future outbreaks of other diseases. So, for all its perceived faults, the more Americans understand the key role of the WHO in responding to this virus and other diseases, the more they may be wary of leaving the agency.

Underscoring this point, Dr Sandro Galea, Dean of the Boston University School of Public Health, said cutting ties with the WHO is exactly the wrong move, at the wrong time.

“It adds fuel to the public health fire we have been collectively dealing with over the past several months,” Dr Galea told the STAT research journal. She also added her voice to those questioning whether the President has the legal authority to implement the withdrawal.

“There has already been some bipartisan pushback against his decision, and Congress has ultimate sway over federal spending.”

She said the decision was “shortsighted at best and at worst willfully destructive. It places global public health at needless risk and leaves us vulnerable to the next pandemic. It helps ensure that when the next virus comes – and we know it will, just like we knew we would one day face something like Covid-19 – the conditions will be ripe for it to be even worse than the present challenge.”

If he wants to hold up some money, that is questionable in terms of its legality. But he cannot stop the money ever from going

Covid-19 has been a reminder, she said, of how health is linked person-to-person, group-to-group, and country-to-country.

“In an age where a virus can spread in a matter of weeks from a one seemingly isolated locality to nearly everywhere on earth, international coordination is necessary to safeguard health. This coordination depends on global organisations like the WHO, which can help guide actions, deploy resources, and engage experts toward the goal of improving health for all.
“We need this kind of integrated work now more than ever. Now is the time to lay the foundation for a world where threats like Covid-19 can no longer take hold.”

Politics

This is by no means the first time that humanitarian principles and commitments have become enmeshed in US politics to the detriment of global needs. Back in the 1980s, the US temporarily stopped paying the United Nations, charging that it was inefficient, wasteful and contrary to American interests. In 2011, Washington also froze its funding to the UN Education Scientific and Cultural Organisation (UNESCO) after the organisation granted the Palestinian territories full membership.

Indeed, President Trump’s decision to end the US relationship with the WHO follows a long pattern of railing against global organisations, which he contends take advantage of the US. He has frequently questioned US funding to the United Nations and NATO, withdrawn from the Paris climate accord and repeatedly criticised the World Trade Organisation. The WHO is just his latest target – but not necessarily a popular one among many Americans, who generally trust the global agency and see it as having played a key role in shaping a healthier world by helping to eradicate smallpox and fighting global crises like HIV/AIDS and Ebola.

A poll by the Pew Research Centre found that 59 per cent of Americans overall trust the information coming from the WHO on the novel coronavirus, with the numbers higher among Democrats and independent voters. For example, 86 per cent of Democrats and independents say they trust information from the WHO, compared with 27 per cent of Republicans.

“The WHO is the one entity whose main mission is to enable a global vision and issue guidelines and workable frameworks geared towards health equity for the world,” Dr Michele Barry, Chair of the US-based Consortium of Universities for Global Health, said in a statement. The consortium groups 170 academic institutions and organisations around the world engaged in addressing global health challenges.

“The WHO is our wake-up sentinel alarm to health threats.”

The consortium’s Director, Dr Keith Martin, went even further, saying the US move would increase the number of deaths around the world, especially among the poor.

“This decision will increase death and disability rates around the world, particularly amongst the world’s poor. These cuts pose an existential threat to the health and economic wellbeing of every country including the United States. Diseases know no borders and eliminating the US’ relationship with the WHO will severely compromise its capacity to address the current pandemic as well as the many other public health challenges the world faces.”

Some have warned that withdrawal in the current environment could also interfere with clinical trials essential for developing vaccines, as well as efforts to trace the spread of the virus globally.

“Abandoning our seat at the table leaves the United States out of global decision-making to combat the virus and global efforts to develop and access vaccines and therapeutics, leaving us more vulnerable to Covid-19 while diminishing our position as the leader in global health,” Dr Thomas File, President of the Infectious Diseases Society of America, said in a statement.

It is possible that President Trump will begin to listen to these alarm bells. Indeed, after abandoning White House briefings on the pandemic in April he has now resumed them and admitted on 21 July, despite previous statements to the contrary, that Covid-19 will “get worse before it gets better”.

Like the rest of the world, the US President is desperate to find a vaccine against the virus and the WHO is crucial in this mission. So regardless of who wins the White House race in November, the outcome may be positive for the WHO – if Biden wins, he will reverse the withdrawal and if President Trump is re-elected he will likely focus less on playing to his base. He could come to see that he needs the WHO on his side if he is to win the battle against this brutal pandemic.