In part one and part two of this series on the World Health Organisation, we looked at its poor response to the Covid-19 pandemic, and its history and financial mismanagement. In part three, we’ll consider its leadership and the problems that led to its failure.
The current director-general of the World Health Organisation (WHO), Tedros Adhanom Ghebreyesus, received a glowing commendation as one of Time magazine’s 100 Most Influential People of 2020.
It described him as the ‘face of hope and determination at the centre of the Covid-19 storm’, and commended him for his belief that ‘all people, wherever they are and whatever their circumstances, have the right to quality health care’.
Of course, believing in idealistic niceties can hardly be called an achievement. The pothead living in student digs, the middle-class bleeding heart, and the radical Marxist with a red beret also stand ‘firmly for equity and access’, as Tedros reportedly does.
The hagiography was written by Ngozi Okonjo-Iweala, who is hardly an objective observer. The former finance minister of Nigeria, Okonjo-Iweala is also the chair of GAVI, the Vaccine Alliance, which is closely associated with the WHO. She is also a WHO and African Union envoy on Covid-19.
Tedros had been a fairly successful minister of health in Ethiopia between 2005 and 2012, and was minister of foreign affairs from 2012 to 2016.
When he threw his hat in the ring for election as director-general of the WHO, his candidacy was strongly supported by African health ministers. He was also backed by former African Union chairperson and then-president of Zimbabwe, Robert Mugabe, and the chair of the African Union Commission at the time, Nkosazana Dlamini-Zuma.
China, Ethiopia and Tedros
China has long had very close relations with Africa and with Ethiopia in particular. Its capital, Addis Ababa, has been described as ‘the city China built’. China has been accused of bugging the African Union headquarters in that city. It is also building a new headquarters for the Africa Centres for Disease Control in Addis Ababa. Belt And Road News holds up Ethiopia’s relationship with China as a model for cooperation between the rising superpower and African nations.
Tedros’s candidacy was strongly supported by China, which has been ambitious to gain influence on the world stage. He defeated David Nabarro, the candidate supported by the UK, US and Canada, to become the first non-doctor to ascend to the helm of the WHO on 1 July 2017.
Besides not being a doctor, there are other things in his background that should have given WHO electors pause.
The Ethiopian regime of which Tedros had been a high-ranking member has been accused of torture and repression. Tedros himself may face genocide charges for his part in a regime that marginalised and persecuted certain ethnic groups, held over 13,000 political prisoners, and shot and killed protestors for demanding an end to human rights abuses.
At the time of his departure for the WHO, Ethiopia remained a cesspit of poor governance, rampant corruption, lawlessness and it continues to wallow near the bottom of the Human Development Index rankings.
His election appeared to be yet another case of the UN system elevating people and countries that reflect the exact opposite of its stated principles, such as giving Libya, Venezuala, Saudia Arabia, China and Russia seats on the Human Rights Council or seating Iran and Saudia Arabia on the UN Commission on the Status of Women.
It wouldn’t take long before Tedros confirmed those suspicions, when he named Mugabe as a WHO ‘goodwill ambassador’. The entire world choked on the effusive praise he heaped on the geriatric tyrant, who oversaw the destruction of an economy and a drop in life expectancy from 62 years to 36 years in less than two decades.
The bizarre gesture by Tedros – revoked in the aftermath of the outcry – was widely viewed as payback for Mugabe’s support of his candidacy. Some speculated that it was a political payoff to China, which had long been an ally of Mugabe’s.
China’s response to the Covid-19 outbreak was authoritarian and draconian. It was unprecedented in public health management. Nobody knew if it would work. It did not follow WHO guidelines.
Even so, Tedros has been lavish in his praise of China’s response. Even while China was delaying a WHO research team sent to discover the origins of the virus, and it was already clear that the Chinese Communist Party had not been open and transparent about its findings, Tedros stood by his praise.
SARS and swine flu
It wasn’t always thus. During the 2003 SARS outbreak, David Heyman, then executive director of the WHO’s communicable diseases cluster recounted to The Guardian how the organisation’s then-director-general, Dr Gro Harlem Brundtland, gave China a public tongue-lashing.
If only the WHO had been able to help at an earlier stage, she said, the outbreak might have been contained. She exhorted the Chinese to ‘let us come in as quickly as possible’.
China quickly fell in line, as did others who resisted WHO guidelines, such as the then-mayor of Toronto. After that, no other member countries hesitated to follow WHO instructions, even though the organisation had no formal power to monitor or censure its member countries.
Brundtland was arguably the last WHO director general with true leadership qualities.
The organisation tried to formalise its pandemic response after the SARS outbreak, but its members – led by the BRIC countries of Brazil, Russia, India and China – refused to give the WHO any real power, as the United States had proposed.
When H1N1 ‘swine flu’ struck in 2009, the WHO’s response was widely criticised. It declared a pandemic three months after the disease was first discovered, but ultimately, it reported that swine flu claimed a mere 18 500 lives.
Many critics accused it of crying wolf. Others accused it of underestimating the impact of the virus, which may have caused between 150 000 and 500 000 deaths worldwide.
The huge discrepancy in death toll estimates served to underscore the inadequacy of the global health emergency reporting system, as well as the inability of the WHO to mount an appropriate response based on factual information.
At the same time, the organisation’s funding was under pressure from constrained global economic conditions and the need to pay salaries that kept its employees living in the lap of luxury.
The Ebola crisis
Five years later, in 2014, these factors led to disaster when the largest Ebola hemorrhagic fever outbreak in history swept through Guinea, Liberia and Sierra Leone. It was spread by bodily fluids and killed about 40% of the people who were infected.
According to a Harvard Kennedy School case report published in 2020, the WHO had made changes which deemphasised epidemic and disaster response in the years leading up to the Ebola crisis. Instead, they increasingly redirected resources to advising member countries on dealing with chronic disease, including cardiovascular and respiratory diseases, diabetes, cancer and other illnesses that took far more lives than the occasional outbreak.
The WHO’s new focus on non-communicable ‘lifestyle’ diseases and tobacco control undermined its original purpose, of limiting the cross-border spread of infectious diseases and helping member countries combat these diseases within their own borders.
The organisation’s changing focus was evident in how its budgets changed. For the two-year period of 2012 and 2013, it slashed its infectious disease budget and boosted its budget for non-communicable diseases. Its allocation for ‘outbreak and crisis response’ was eviscerated, with a 51% cut from $469 million to $228 million, while increasing its budget item for ‘preparedness, surveillance and response’ by a much smaller amount of 32% to $287 million.
Its next budget, for the biennium of 2014 and 2015, prepared before the Ebola outbreak, continued the trend. It reduced funding on communicable disease by 10%, increased funding for non-communicable disease and health promotion activities by about 20%, increased funding for member country surveillance and preparedness a little, and drastically cut the WHO’s own funding for outbreaks and crisis response.
As a result, its ability to deliver on its mandate to track infectious disease outbreaks across the globe and coordinate appropriate outbreak responses was poor and getting worse.
It took the WHO eight months to declare the Ebola outbreak to be an international public health emergency, long after the virus had crossed international borders and established itself in multiple countries. Its concern was largely political, worrying that such a declaration might be considered a ‘hostile act’, and might be a ‘death sentence’ to developing countries.
The Harvard report quotes Ambassador Jimmy Kolker, then Assistant Secretary for Global Affairs in the United States Department of Health and Human Services, saying: ‘They have a broad mandate but very little ability to carry anything out.’
The sluggish and ineffectual response by the WHO exposed an organisation in crisis. Its director general at the time, Margaret Chan, tried to explain that the responsibility for combating the disease fell on national governments. As a result of this abdication of responsibility by the WHO, much of the response fell to other organisations, such as Médecins Sans Frontières and the World Bank. The latter committed a total of $500 million to the effort to contain Ebola.
Experts called the WHO’s response to the Ebola epidemic an ‘egregious failure’.
‘Major reform of national and global systems to respond to epidemics are not only feasible, but also essential so that we do not witness such depths of suffering, death, and social and economic havoc in future epidemics,’ said Peter Piot, director of the London School of Hygiene and Tropical Medicine and co-discoverer of the Ebola virus.
Lessons not learnt
When an internal WHO memo was leaked that suggested incompetent staff and a lack of information had hampered efforts to stop Ebola from spreading, Chan brushed off the criticism, saying that history would be the judge, and that the immediate priority should be to focus on containing the outbreak rather than carping about the WHO’s response.
This would have echoes in the reaction when the US announced the suspension of funding to, and membership of, the organisation in April 2020 over the WHO’s mishandling of the Covid-19 pandemic. ‘We are still in the acute phase of a pandemic, so now is not the time to cut back on funding,’ Dr Hans Kluge, the WHO regional director for Europe told the media.
The WHO ultimately admitted to its failures in responding to the Ebola outbreak, and listed numerous lessons learnt. However, there has been little or no corrective action since that admission. This was painfully exposed when the Covid-19 pandemic struck, and many of the very same problems surfaced again. The balance of its budget allocation between infectious and ‘lifestyle diseases’ has been virtually unchanged since the Ebola disaster.
The Ebola episode demonstrates that left to its own devices, the WHO will not reform. It did not implement the corrective actions it proposed itself in the aftermath of its bungled response. There is no reason to believe that it will somehow shape up after the Covid-19 pandemic is over either, especially not when China appears to have the organisation in its pocket.
The WHO will have to be reformed from the outside. While the US decision to suspend its funding and membership might seem callous in a time of crisis, it might be just the kick that the organisation needs.
In the next and final instalment of this series, I will consider proposals that might make the World Health Organisation more effective and more responsive to the needs of a world faced with recurring infectious disease pandemics.
The views of the writer are not necessarily the views of the Daily Friend or the IRR