From an international relations perspective, the SARS-Cov-2 virus’s greatest casualty thus far might be US-China relations, as disagreements over the World Health Organization (WHO) escalate.
US President Donald Trump has threatened to defund the WHO, an agency of the United Nations, as punishment for its perceived pro-China stance.
In recent years, the WHO relied predominantly on ‘voluntary’ contributions, made at the discretion of individual governments, rather than ‘assessed’, obligatory contributions. In 2018 and 2019, (the WHO’s budgets are two-yearly) for example, 80% of the WHO’s total $5.63 billion annual revenue was ‘voluntary’.
In the last five years, the US’s average annual contribution has been $420 million, of which nearly 75% was made through ‘voluntary’ contributions. The US’s ‘assessed’ contribution has typically been capped at 22% of the assessed contributions of all other countries combined, the maximum allowed rate.
The second biggest contributor to the WHO is the Bill and Melinda Gates Foundation. More detail on the WHO’s revenue breakdown can be seen here.
Just when the WHO counted most, as the Covid-19 pandemic grew, it was accused of spreading propaganda by the Communist Party of China (CPC), and of obstructing global coordination in dereliction of its duty.
A point of principle must contextualize this charge. At time of writing, there are still major uncertainties about the true case fatality ratio and morbidity of SARS-Cov-2, the true basic reproduction number (R0) of the virus, and the full etiology of pathology (how it kills you). The principle that must be applied to all earlier Covid-19 responses is one of ‘epistemic humility’; there is a lot we don’t know now and even more we didn’t know at the start of this pandemic.
No perfect response
There is no perfect response in a state of imperfect information. Individuals, companies, nations, and super-national entities like the WHO must be evaluated on whether they acted in good faith, to the best of their abilities, given limited and often conflicting information.
Now consider this Lancet study, published in late January, which found that the first Covid-19 patient on record became sick on 1 December 2019, and another two on 10 December. Daniel Lucey, an infectious disease physician and professor at Georgetown University Medical Centre, told US publication Vox that this indicated that Covid-19 was likely spreading as early as October 2019.
No one would criticize the CPC or WHO for failing to pick up Covid-19 as early as that. But when, on 31 December, the CPC first announced the outbreak of a ‘mysterious pneumonia’, it said there was ‘no clear evidence’ of human-to-human transmission despite the fact that the above study indicates at least ten recorded cases with no exposure to the wet-market in Wuhan, starting with the very first ‘index’ case.
In addition, the CPC allegedly ordered the destruction of SARS-Cov-19 samples on 1 January 2020.
By 30 December, Dr Ai Fen and Dr Li Wenliang already had – and distributed – evidence of human-to-human transmission, but both were censured, the latter being formally charged with ‘spreading rumours’. Eight doctors in total were charged with ‘spreading rumours’, a fact that was widely broadcast as a warning in China on 2 January 2020. Dr Li subsequently died of human-to-human transmitted Covid-19, and this later earned him ‘exoneration’. Dr Ai was declared missing at the end of March, a status that chillingly remains unchanged.
Associated Press (AP) acquired internal bulletins to confirm that, between 5 January and 27 January, no new cases were registered in China despite ‘hundreds of patients’ presenting Covid-19 indications ‘not just in Wuhan but across the country’.
‘It’s uncertain whether it was local officials who failed to report cases or national officials who failed to record them,’ notes AP.
Internal documents
AP also claims to hold internal documents that ‘show that the head of China’s National Health Commission, Ma Xiaowei, laid out a grim assessment of the situation on 14 January in a confidential teleconference’ whose purpose was informing President Xi. Evidence of human-to-human transmission was presented in ‘clustered’ cases.
The CPC, however, only acknowledged human-to-human transmission on 20 January, by which time Covid-19 had already been detected in Guangzhou (China), Japan, Thailand, and, as noted, in Wuhan, among those with no contact with the zoonotic origin of the virus.
By contrast, the US Centre for Disease Control (CDC) had been screening passengers from Wuhan in the US since 16 January, on the basis of viable human-to-human transmission.
The WHO only gave its official stamp to the fact of human-to-human transmission after the CPC’s 20 January statement, following a political rather than empirical timeline in its decision to inform the world that humans are dangerous vectors for Covid-19.
This is a clear dereliction. One of the WHO’s constitutional mandates is to ‘provide information, counsel and assistance in the field of health’; another is to ‘assist in developing an informed public opinion among all peoples on matters of health’.
The WHO failed on both counts by spreading disinformation about human-to-human transmission risks at the pandemic’s early stages.
This is not the first such failure on the CPC’s part. Dr Jiang Yangyong, a retired general in the People’s Liberation Army, exposed the CPC’s cover-up of the SARS 2003 outbreak. He has allegedly been under extended house arrest. On that occasion, the WHO ‘rebuked’ the CPC’s handling of the pandemic, putting paid to the claim that its quiescence is a structural inevitability.
Uncovered awkward facts
In the present crisis, added to the unknown status of Dr Ai is the fact that Chinese journalists who uncovered awkward facts about Covid-19, including Chen Quishi, Fang Bing, and Li Zehua, are missing.
The CPC has also expelled journalists from major US publications like the Wall Street Journal and the Washington Post.
The WHO is, prima facia, complicit this time by its guileless kowtowing to the CPC at a time when spreading information on health speedily is a sine qua non.
The WHO has also failed another constitutional mandate – ‘to standardize diagnostic procedures as necessary’ – as several international scandals have emerged of irregular testing.
The WHO’s political commitments might have produced potentially lethal advice. On 29 February, it issued this statement advising ‘against the application of travel and trade restrictions to countries experiencing Covid-19 outbreaks’. By this date Taiwan had the most stringent travel restrictions, particularly against the rest of China, while the US had announced travel bans to be enforced shortly.
The WHO’s reasoning for advising against such travel bans was telling. ‘Travel bans to affected areas or denial of entry to passengers coming from affected areas are usually not effective in preventing the importation of cases [emphasis added]’.
The WHO has been a primary advocate of Wuhan-style lockdowns (effectively domestic travel bans) to slow down the rate of contagion, to ‘flatten the curve’. Why did it not apply this standard to evaluating the effectiveness of international travel bans, and choose instead to say that if a travel ban does not totally stop the importation of cases then it is not worth it?
This question goes unasked and unanswered by WHO supporters.
Most successful
Taiwan imposed large-scale travel bans first, on 25 January. It has since had one of the most successful records in managing the virus, with only 6 confirmed deaths despite its proximity to Wuhan and its population of nearly 24 million. If this is attributable to its early travel cut-off from CPC-controlled China, then the message is clear. Every day that human-to-human transmission was denied and travel from China was maintained made a deadly difference.
The broader context is distressing too. Hong Kong, Macau, ‘Uyghurstan’, Tibet and Taiwan are officially part of China but with special status, with each threatening to escape Beijing’s rule and break away from the CPC’s grand project. Such splinters pose an existential threat to Beijing’s seat of power, if the collapse of the Soviet Union has any historic relevance.
The CPC has insisted on using the WHO to keep Taiwan in check. Taiwan was barred from membership in the WHO, lacking sovereign status, but from 2009 to 2016, it was given ‘observer’ status. The CPC’s objections grew, as did international appeasement, so that in 2016 Taiwan was denied this status, while Taiwanese media were banned from attending WHO events by 2018.
The offence to Taiwanese people is in direct proportion to the usefulness of the WHO. The sad irony is that Taiwan’s expulsion from the WHO might be the very reason that it has arguably the most successful record of resisting Covid-19.
However, Dr Bruce Aylward, the WHO’s team leader in China, refused to comment on Taiwan. In an online interview in late March, a Hong Kong journalist put the question to him simply: ‘Will the WHO consider Taiwan’s membership?’
There is dead silence. ‘Hello?’
‘I’m sorry I couldn’t hear your question.’
‘Ok, let me repeat the question then.’
‘No, that’s okay, let’s move to another one then.’
No one who seeks to flatter the CPC wants to talk about Taiwan. You will notice that in all coverage of the WHO you read hereafter.
Politics ahead of facts
Although Dr Aylward has been side-lined since, the WHO’s stance on the CPC’s response to Covid-19 remains enthusiastic. Dr Tedros Abhanom Ghebreyesus (he goes by Dr Tedros), the head of the WHO, has been accused of putting politics ahead of facts before.
As Ethiopia’s minister of health, Dr Tedros allegedly denied three separate outbreaks of cholera, characterizing them instead as ‘acute watery diarrhoea’. See here for more on this scandal and take note that, since Ethiopia has subsequently admitted cholera outbreaks, Prime Minister Abiy Ahmed could play an important role in shielding Dr Tedros from criticism or exposing him.
Criticism of Dr Tedros has already been obstructed by social identity politics in South Africa. The EFF ‘condemns’ attempts to remove him. Whether leaders across the continent will respond as a bloc to maintain the kind of race solidarity that protected the dictator Mugabe is yet to be seen.
This is not just another spat between the CPC and the US. Unlike the US-China trade war of 2018-2019, there is no apparent off ramp from the confrontational line both nations are taking related to Covid-19. China hit the US hard in the information war, when, on 12 March, a spokesperson for the CPC’s foreign ministry said: ‘It might be US army who brought pandemic to Wuhan…US owe us an explanation!’ After this, the US president started referring to the ‘China virus’.
It will not be easy for either government to ‘walk back’ these statements. But it will be even harder to find common ground on Taiwan in the WHO after the latter’s political failures during the Covid-19 pandemic.
Unmatched success
The CPC will be concerned about this. As embarrassing as Hong Kong riots were to Beijing, Taiwan has even more humiliating tools in its arsenal if it can draw the world’s attention both to its own cruel expulsion from the WHO at the CPC’s behest, and then its own unmatched success precisely because it ignored the WHO’s politically aligned timeline of ‘information’ and ‘advice’.
Moreover, Taiwan’s response highlights the deeper, structural failures of the WHO. In retrospect, one thing is clear. If reports on human-to-human transmission had been frankly assessed from the beginning and travel from Wuhan to the rest of China, and China to the rest of the world, had been banned promptly, hundreds of thousands of lives would have been saved and a UN-estimated 42-66 million children would have been saved from entering ‘extreme poverty’ due to coronavirus-related shutdowns around the globe.
This is not the first pandemic, nor is it the last. If future pandemics are to be slowed down by such international cooperative isolation, the WHO would be the obvious institution to set such protocols in place. But since the CPC is most opposed to that, there is little hope of developing such a protocol as long as the WHO’s leadership bends its knee to CPC authority.
In the Anglosphere, many commentators have responded with concern to Trump, or ridiculed him on the basis that the WHO cannot go on doing good work without full US funding. Trump’s enemies overestimate his power relating to the WHO.
Outside of combating polio, the largest item on the WHO’s budget has been travel expenses, mostly for elite conferences. As this NBC story put it, ‘WHO Spends more on Travel Than on AIDS, Malaria and TB’? combined. The WHO spends an average $200 million on travel expenses every year, mostly to conferences, which is more than the US’s ‘assessed’ spend, and about half as much as the US’s total annual contribution. Although the numbers are not yet clear, there is no doubt that health-spending to tackle Covid-19 will overwhelmingly be spent by national governments around the world.
In short, if the US hopes to shut down the WHO, it will fail, especially since China has pledged to increase its support if the US steps out. (China’s ‘voluntary’ contributions have been less than miniscule until now). That is for the best, since some of the world’s best doctors, virologists, and epidemiologists are connected to the WHO, which is currently conducting (already funded) international clinical trials to fight Covid-19 and save lives.
Chance of success
But if the White House, more plausibly, hopes to use pressure to force new leadership and policies from the WHO, there is a chance of success, both for the WHO and for the world. A change is certainly needed. For the top tier of WHO leadership to have squandered its own credibility in an effort to save face is disgraceful. The objective of the WHO, in line with its constitution, must be to save lives. Spare a thought for WHO workers who follow that objective and have their hard work undermined by poor leadership.
Reprogramming a more politically neutral WHO will depend on coordinated international pressure, which will depend on world opinion, much of which goes heavily against the US incumbency.
Garry Kasparov (the former chess grand master turned political figure) said the following on this matter: ‘It would be a dangerous blunder for those who oppose Trump, and I am proudly in their number, to disregard China’s malign behaviour here just because Trump also criticizes China.’
And yet, if recent reports from the Anglosphere’s left-leaning media are anything to go by, this is a blunder many are willing to make.
[Picture: By Iecs, https://commons.wikimedia.org/w/index.php?curid=5089110]
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