We once lived in a world in which the World Health Organisation (WHO) could brag of great successes, such as the eradication of smallpox. In recent decades, however, it has been taken over by nannies and petty tyrants, and its record of responding to epidemics is woeful.
The world was shocked last week when US president Donald Trump announced that he would halt funding to the WHO on the grounds that it was in China’s pocket and helped to cover up or minimise the extent of the coronavirus pandemic. It is the single biggest contributor to the WHO, accounting for 12% of the $2.3 billion in contributions it received in 2018.
What Trump says should never be mistaken for truth, of course. His action appears to be a characteristic tactic designed to distract from his own perceived bungling of the coronavirus response in the US. (In his defence, it should be noted that the WHO itself praised his response.)
Still, Trump’s public statements on the outbreak can most charitably be described as inconsistent in themselves, and with the facts. He is also being extraordinarily hypocritical, since both he and his vice-president lauded China’s ‘transparency’ and its authoritarian response. Cutting off the WHO’s funding at the height of a global pandemic seems vindictive and dangerous, at best.
The WHO has been played
That only Trump’s die-hard fans believe a word he says does not, however, exculpate the WHO.
Wittingly or otherwise, it has certainly been played by the Chinese Communist Party, and has made serious errors as a result. As we shall see, this is a pattern with the WHO.
Until its director-general, Tedros Ghebreyesus, visited China on 30 January, eight days and 8 000 cases after that country declared a health emergency, the WHO happily parroted the official Chinese line – first that the coronavirus wasn’t transmissible between humans, and second that it wasn’t a ‘public health emergency of international concern’.
It also refused to hear remonstrations from Taiwan that pointed out these mistakes, on the grounds that Taiwan was not recognised by China, and therefore, could not share information with the UN or the WHO.
It continued to accept, uncritically, China’s reported infection and fatality numbers, even when it became clear that China had ‘disappeared’ journalists, silenced doctors and censored news and social media warnings about the outbreak, and suspicion began to emerge that its statistics were seriously understated.
The WHO praised China’s response to the coronavirus, and Tedros sycophantically commended it for ‘setting a new standard for outbreak control’. (At the time, so did Trump, in case he reads this and seeks vindication for his recent actions.)
A new standard it certainly was. China’s response was brutal and totalitarian. Despite this, the WHO made China’s response the basis of its own recommendations to governments around the world.
When Cyril Ramaphosa in South Africa and Narendra Modi in India instituted two of the world’s most draconian lockdowns, closing all businesses not deemed ‘essential’, censoring doctors and other experts, and confining citizens to their homes on pain of beatings by security forces or imprisonment, the WHO was fulsome in its praise.
All this is quite in character for the organisation, which has yet to see an authoritarian public health intervention it didn’t like.
Ballooning budget
In days gone by, the WHO’s mandate was to coordinate global responses to communicable diseases, like plague, cholera, smallpox, poliomyelitis, typhoid and malaria. In this mission, it has enjoyed great success, mostly through promoting vaccination programmes and better sanitation. Smallpox has been entirely eradicated, and polio remains endemic in only a few countries.
Since then, however, its budget has ballooned. If the WHO was a country, it would be the second-richest in the world, after Monaco. Its 7 000 staff accounted for 40% of its expenditure in 2018, earning a total of $931 million for an average of $133 000 per capita. That is more than twice the average annual US income of $63 000, and 23 times South Africa’s average per capita income of $5 750 per year.
Its travel expenditure, at $191 million in 2018, exceeded what it spent on medical supplies and materials, exceeded its spend on combating HIV, hepatitis, malaria, tuberculosis and neglected tropical diseases, combined, and is equal to its spend on health emergencies and emergency preparedness. Perhaps it isn’t surprising, when such emergencies account for only 8.5% of its budget, that it now solicits donations from the public to fund its coronavirus response.
It is a bloated, inefficient bureaucracy, whose primary purpose appears to be paying its staff exceedingly generous salaries.
Legislating health
In recent decades, it has expanded its remit far beyond communicable diseases and health emergencies. It now recommends legislative and regulatory interventions designed to combat non-communicable ‘lifestyle’ diseases and advocates for socialised healthcare systems.
Some of this work is easily justifiable, such as improving childbirth outcomes in poor societies. Much of it, however, is rooted in the desire to legislate health, and includes campaigns against tobacco, alcohol, sugar, salt and any other small pleasures people might wish to permit themselves.
In all these cases, its default position is to deny people the right to manage their own health and lifestyle, and instead to recommend authoritarian measures such as mandatory health warnings, prohibition legislation, advertising bans and excise taxes.
In some cases, such as the campaign to reduce dietary salt, there isn’t even a good scientific basis for justifying the end goal, let alone justifying the means of achieving it.
In others, like its draconian anti-tobacco campaign, it flatly refuses to recognise the dramatic harm reduction that can be achieved by promoting vaping, and instead encourages countries to treat vaping just like tobacco.
It has even expanded into ‘building climate-resilient health systems’.
Pandering to member countries
In pandering to the political sensitivities of its member countries, the WHO has sometimes stooped to promoting outright quackery. It advocates integrating ‘traditional medicine’ practices within healthcare systems, even though any use of ‘medicine’ with an adjective in front of it means that it has either not been proven to work, or been proven not to work.
It recently faced an outcry over its inclusion of 400 traditional Chinese medicine (TCM) diagnoses in its influential International Classification of Disease list, by activists who believe this ‘rubber-stamps the extinction of endangered species’ such as pangolin.
Since a leading theory about the origin of the SARS-CoV-2, the coronavirus that causes Covid-19, is that it is a chimera virus that found its way to humans via bats and pangolins, one wonders whether the WHO’s endorsement of TCM indirectly contributed to the spread of the pandemic.
It took the WHO nine years after the Lancet in 2010 retracted Andrew Wakefield’s infamous 1998 paper linking vaccines to autism, to officially recognise ‘vaccine hesitancy’ as a top threat to global health. While the WHO was dithering, vaccination rates continued to fall worldwide, as confidence in health authorities was eroded by fake news.
Dropping the ball
With the bulk of its focus now having shifted to health issues other than communicable diseases, it has often dropped the ball on its original mandate of responding to global outbreaks.
During the 2009 H1N1 influenza pandemic, and again during the 2014 Ebola outbreak, the WHO came under widespread criticism. One of the factors singled out as a cause of its mismanagement of these crises was its aversion to offending member states, in exactly the same way that it is now loath to offend China.
In the case of H1N1, it erred by forgoing the usual geographic description of the virus, and instead of offending Mexico by calling it Mexican flu, it named the new strain swine flu. This led to widespread, and unnecessary, culling of pigs, as well as trade bans on pigs, pork and pork products. Some countries, like Egypt, destroyed their entire population of pigs, causing irreparable harm to their economies. These measures were introduced without any scientific basis.
It went on to declare H1N1 a pandemic, despite the fact that it had not met the severity criteria in its own pandemic guidelines. In response to media questions on this point, the WHO summarily deleted its pandemic guidelines from its website, compounding the confusion about the seriousness of the outbreak and the proper response.
It further kept the identities of the committees that advised it secret, leading to speculation about conflicts of interests involving pharmaceutical companies.
This led to widespread confusion. Although H1N1 was the same virus that was responsible for the Spanish flu outbreak between 1918 and 1920, the new strain was far less deadly. Between 700 million and 1.4 billion people contracted it, but its death toll, of between 150 000 and 575 000, was no worse than that of any seasonal flu. (By comparison, the Covid-19 death toll to date stands at 167 000, and the seasonal flu typically claims between 250 000 and 500 000 victims each year.)
During the 2014 Ebola outbreak, the WHO was again believed to have failed the international community. As with the Covid-19 pandemic of this year, the WHO was accused of acting far too slowly, declaring an outbreak fully three months after it first started in Guinea, by which time it had already crossed international borders.
Its reliance on unreliable data, just as with Covid-19, made it unclear how the epidemic was unfolding, and where resources were most needed. As with Covid-19, it accepted government statistics at face value, and failed to contest the Guinean health ministry’s declaration that the epidemic was under control. It was wrong. The outbreak was only just getting started.
At the time, the WHO’s structural division into regional offices with high degrees of policy autonomy – ironically caused by the demands of the US when the WHO was first established – was identified as the cause of a range of inefficiencies, duplication of effort, poor health outcomes and obstructive infighting.
As with the H1N1 debacle five years earlier, numerous recommendations were made, but many were poorly implemented, if at all. Its structural weaknesses still exist, as do vulnerabilities in its funding mechanisms, its habitual kowtowing to member countries, and deficiencies in the information on which it bases decisions and recommendations.
Ignoring Taiwan
In the current pandemic, perhaps the most obvious sign of the WHO’s failure is that Taiwan was the single best-prepared country in the world, having mobilised its emergency response on 21 January, a day before China declared an emergency and a day before the WHO held its first emergency meeting on the new coronavirus.
Taiwan, the US and Italy reported their first cases within days of each other, but unlike the US and Italy, the Taiwanese nation of 24 million people has had only 422 cases and six deaths at the time of writing.
Yet the WHO has completely ignored Taiwan and excluded it from its emergency meetings, which is, frankly, criminal. It exchanges no information with the island nation. It claims that Taiwan’s membership of the WHO isn’t up to the WHO, but up to member countries, and of course, China has successfully blocked such a move for decades.
Rebuild the WHO
Between the organisational failures that come with running a vast, overpaid global bureaucracy, and the authoritarian instincts of its public health experts and many member countries, it is perhaps no surprise that the world now finds itself at a juncture where entire economies have been sacrificed on the altar of ‘flattening the curve’, so that unprepared public health systems – the very socialised health systems for which the WHO advocates – can scramble to get ready.
If nothing else, the catastrophe that has befallen the world, for which the WHO is in no small measure to blame, should lead to a complete overhaul of the institution. Instead of meddling in the personal lives of the world’s people, it should be reconstructed around its original mandate.
It should have an effective ability to combat communicable diseases. It should support the emergency preparedness of public health systems so they don’t rely on draconian lockdowns for their basic functioning. And it should be able to respond timeously and effectively to disease emergencies. These, not salaries or travel, should be its biggest budget items.
It should do all of these things well before even thinking about giving advice about our personal choices and lifestyles. And before its staff draw any salary at all, perhaps they should be required to read George Orwell.
The views of the writer are not necessarily the views of the Daily Friend or the IRR
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