Once again, the World Health Organization finds itself in the crosshairs — the target of harsh criticism this week from President Trump. It is a position the global health agency has found itself in frequently.

Sometimes it has deserved criticism, as when it was slow to recognize the seriousness of the West Africa Ebola outbreak in 2014. But more often, it draws blame because it’s an easy target — an international body that seems to have more power than it actually does. In fact, its actions are guided by rules written by its member countries — including the United States.

On Tuesday the president threatened to put a hold on funding for the WHO, the UN agency leading the global health response to the Covid-19 pandemic.

advertisement

Trump’s rationale was a bit confusing. Earlier in the day on Twitter, the president criticized the WHO for advising against banning travel from China to try to stop spread of the virus. That was despite the fact that the U.S. ignored the WHO’s recommendation and closed its border to people who had been in China — excepting Americans — in late January.

Trump also said the WHO downplayed the outbreak, which is untrue. The agency exhorted countries starting in January to take an aggressive approach to finding cases of Covid-19 and trying to stop transmission of the coronavirus that causes the disease.

advertisement

It seems the agency is being set up as a scapegoat, caught in the political maelstrom surrounding the virus that has affecting every aspect of the U.S. response to this crisis.

Let’s take a look at some of the president’s claims.

Did the WHO publicly criticize the U.S. government for banning travel from China?

One of the core complaints the president leveled at the WHO is that it criticized his administration’s announcement on Jan. 31 that it was closing U.S. borders to foreign nationals who had been in China in the previous 14 days. (The ban did not apply to Americans in China, who streamed back to the United States.)

“They actually criticized and disagreed with my travel ban at the time I did it, and they were wrong,” Trump said Tuesday night during the White House’s daily briefing.

The record doesn’t bear the president’s claim out, however. Senior leaders of the WHO, including Director-General Tedros Adhanom Ghebreyesus, have been holding three-times weekly press briefings for several months now. They have not overtly criticized the United States — or any other country — for instituting travel bans.

They did, however, talk about how such bans exceed the bounds of the International Health Regulations 2005.

What, pray tell, are the International Health Regulations 2005?

The IHR, as they are generally referred to, is a legally binding set of rules designed to lower the world’s risk from infectious disease threats. The regulations were adopted by the World Health Assembly, the council of 194-member states that governs and directs the WHO. The modern IHR have their roots in the International Sanitary Regulations, which date back to the mid-1800s and were aimed at preventing the spread of cholera.

The IHR were updated in 2005, after the SARS outbreak of 2002-2003. The United States was one of the principal authors of the revised IHR, noted Jimmy Kolker, a longtime U.S. diplomat and former assistant secretary for global affairs at the Department of Health and Human Services in the Obama administration.

Once more for emphasis: The U.S. government had a major hand in writing these rules.

What do the IHR do?

In short, they require countries to alert the global community — through the WHO — when they have disease outbreaks that could cross borders and threaten neighbors or the world at large.

In exchange, the IHR are meant to protect countries from being penalized for their openness, to remove the financial incentive to hide an outbreak. Unless the WHO recommends travel restrictions — which it has not done since the spring of 2003, during the SARS outbreak — other countries are supposed to refrain from imposing travel bans or trade restrictions on nations that are grappling with disease outbreaks.

The goal is to not discourage transparency.

“That’s the bargain at the heart of the revised IHR,” said Tom Bollyky, director of the global health program at the Council on Foreign Relations.

So the IHR say, “Don’t impose travel and trade restrictions.” Do countries observe that rule?

Nope. Countries often ignore that part of the IHR. During the West African Ebola outbreak of 2014-2016, many countries stopped issuing visas to citizens of Liberia, Sierra Leone, and Guinea, the countries engulfed in the crisis.

And many have closed borders in this outbreak as well. More than 100 have instituted travel bans of some sort, Bollyky said.

What does the WHO do when countries don’t follow the IHR?

There is almost nothing the WHO can do. Though the IHR are legally binding, the document has no teeth. There are no enforcement mechanisms that the WHO can exercise to bring a country into compliance. Nations are sovereign and will act in what they believe is the best interest of their citizens — a fact WHO senior leaders acknowledge publicly.

The WHO’s sole power is to “name and shame” — call out countries that are violating the IHR. But that is a tool the agency has been reluctant to use, Bollyky said. “They’ve taken a light touch on that.”

The IHR require the WHO to note when countries exceed recommended action — by imposing travel or trade restrictions, for instance. And the WHO must, under the regulations, approach each country that takes such actions and ask it to explain why it has done so.

Mike Ryan, head of the WHO’s health emergencies program, explained the requirement during a Covid-19 press briefing on Feb. 6: “The IHR does not deny or prevent, it doesn’t prevent a country from taking measures, but what it does is it requires the countries to justify the risk assessment and the value of the public health measures from their perspective,” Ryan said.

“Governments are in a very difficult position. They have a very fine balance to strike. And what we try to do is make that decision transparent and we share that justification with all of the other member states, so at least other member states see what that justification is,” he added.

The criticism of the WHO this time around is not unusual.

When the original SARS outbreak was stopped and transmission of the virus was extinguished, the WHO enjoyed a period of praise for its handling of that event.

But that good will was lost in the 2009 H1N1 flu pandemic, which turned out to be mild. Countries were on the hook to buy pandemic vaccine the public didn’t really want. While there’s no way to know at the start of a disease outbreak how deadly it’s going to be, critics armed with the 20/20 vision of hindsight were scathing about what was perceived to be an overreaction to a “meh” event.

A few years later the agency was slow to recognize the scale of the peril as Ebola started to transmit in West Africa, in countries with no experience containing it. Again, the consensus was the WHO had gotten it wrong.

With this outbreak, though the WHO has been in battle mode since the day after China first alerted it to the fact it was seeing some unusual pneumonia cases in Wuhan, the knives are out again.

The right-wing media in the United States — which for several months dismissed this new disease as not even as significant as seasonal flu — is now alleging the WHO downplayed the gravity of the situation and colluded with China — or “Communist China” more commonly — to keep the world from preparing for this crisis.

The agency has been threatened; Tedros, the first director general from Africa, has been subjected to racists attacks and has received death threats.

Some Republican lawmakers are insisting the U.S. should withhold its dues until Tedros, as he is known, is unseated and the WHO is investigated.

What does the WHO say?

During the agency’s Wednesday briefing, Tedros acknowledged the WHO’s response to the novel coronavirus had not been perfect. But he warned that politicizing the outbreak will result in more deaths.

This virus “exploits the differences you have at the national level. If you want to be exploited and you want to have many more body bags, then you [politicize the crisis],” he said. “This is not the one to use for politics. It’s like playing with fire.”

He argued that China and the United States need to demonstrate leadership and find a way to work together to combat the coronavirus. “The worst is yet to come if we don’t rush to ensure unity,” he said.

Andrew Joseph and Lev Facher contributed reporting.

  • We all saw the hospital’s being built we all knew the story about Dr li telling the world how serious the virus was we watched the CCP round up millions of infected for forced quarantine we knew what was happening, what did we do? NOTHING cause we didn’t care Wuhan risked death and shared data of the virus with the world January 9 and while the rest of us just carried on business as usual Behind the scenes Scientists Doctors research groups were buzzing they had test kits in a matter of weeks vaccines were being started predictions worse case scenarios were being sent to all the very important people around the world who are supposed to protect us by coming up with a plan
    Its April We all know now it’s a terrible disease and it’s spreading fast through America The country is shut for business, and still people don’t want to stay home, it goes against there freedoms they have spent 3 months talking about China or blaming each other they ignored the stay at home message and sat in groups in parks and watched New York digging graves on their phones
    But you want people to believe that the situation would be so much better if in December they made an official statement that 44 people in a country of 1,3 billion were sick? Stop blaming China at least make the distinction, it’s CCP I live in New Zealand I’ve been on lockdown for WEEKS we knew that we had to be prepared we are not mega wealthy with unlimited medical resources like the U.S. we only had 40 50 cases no deaths some had recovered but here we are , I don’t do it because I’m scared of my government or because I’m a sheep I’m young early 20’s I do it because I’m bloody proud of my PM I appreciate the truth the facts and her support , I even got a soft spot for the opposition party leader he supported the PM he been bloody good Kiwis don’t whinge we just do it go hard go fast , I don’t think America is capable of fixing this I don’t see how this ends for them , they hate each other, they hate China reckon Italy should have acted sooner they don’t even think about the UK the only country I’ve heard them be decent about is Sweden and that’s only because Sweden isn’t doing a single thing either to fight the virus so they bring them up like it means something I heard Florida call New York CRIMINALS ! !

    New Zealand are doing fantastic thanks for asking CNN did a little story on us and kiwis go nuts when we see ourselves on the telly , hundreds of comments and they were all so happy and positive excited proud, every 20 comments you come across the American and he just wants to kill the vibe, but no one’s reacting 😂 the American doesn’t give up tho, we all know what’s coming GUN BAN 😂 I can actually see the people reading who must be cracking up laughing , and now we gonna extend lockdown we flattened the curve weeks ago new plan TOTAL ELIMINATION keep an eye out for our beef at supermarkets soon

  • Your article has not persuaded me of the conclusion you arrive at. There seems to be a problem with subjective critical thinking.

    For instance, you claim that “they have not overtly criticized the United States,” but that does not mean they have *not* criticized the US, and since you claim that “the record doesn’t bear the president’s claim out, however,” and that the president’s claim is that “ “they actually criticized and disagreed with my travel ban at the time,” I find it hard to understand your rationale to defend your premise that they may not have criticized overtly but have criticized overall.

    I was expecting more from your critical thinking.

  • Your article is idiotic.
    So in your opinion Trump shouldn’t have banned traveling from China??
    So more viruses to come into the US??
    That’s stupid crazy.
    Your statements are confusing and opposite.

  • I read the article carefully and must have missed the “rule” created by the US that requires the WHO to lie, obfuscate and shill for China.

  • I’m a Chinese living in mainland China. I know a little English and I won’t hide my disagreement with some comments below the news, so I post my view here.

    The infected people’s numbers report by China cannot be accurate due to the unprecedented chaos and the intentional concealment by some local bureaucrats–anyone with a common sense will know that.
    I cannot believe Mr Trump’s administration was so gullible that its decision was solely based on the numbers reported by China, because U.S. has long been skeptical about every number reported by China, from military expenditure to economic output.

    China is not impeccable. But as early as the end of January, every province, city and community in China was locked down to make up the terrible mistake of Hubei’s government. Every people in China learned the gravity of the situation from televisions, the internet, and loudspeakers outside our apartments.
    In our eyes, United States has FBI in every continent and her wealthy and well-educated citizens enjoy full access to the internet. U.S. should know earlier and know more about the virus than us Chinese commoners, who in some prejudiced eyes are brain-washed by Communist Party’s propaganda.
    Sadly, the intelligence about the virus only served as a reminder for some U.S. riches to sell stocks, but not a warning for U.S. people to brace for the incoming pandemic.

    U.S. government’s mishandling of the crisis shocked and disappointed many of my friends. After all, U.S. has always been the most economically powerful and technologically advanced country on this planet. U.S. could have done better in containing the virus. It’s a real shame for a great country’s President like Mr.Trump to desperately find a scapegoat for his own failure.

    I whole-heartedly wish U.S. could recover from this epidemic sooner.

    • I really appreciated your insight here. I’m finding level-headed full opinions (even if I don’t agree) quite rare these days.

      WHO is an international organization which means it is involved in international politics. It is not exempt from this and must balance how to placate its Member States as best it can while they disagree with one another. I honestly don’t know where people’s ideas come from of what WHO is and can do.

  • Why would anyone defend the WHO in this case. Regardless of your feelings toward Trump and his mishandling the WHO Director was wrong.
    1. China blatantly hid the truth. The spreading virus with overcrowded hospitals was playing all over WeCHAT, Weibo and other Chinese social media for anyone to see. In fact, Chinese government controlled digital media was also telling the truth, not censoring themselves as usual. China would let the information stay up for 3 days before deleting. Highly unusual Chinese government behavior.
    2. Chinese physicians knew there was human to human transmission. A few brave medical and scientists shared that information so it became publicly available. Chinese government told WHO Director NO human transmission and he accepted it 100%. The WHO then proceeded to advertise this mis-information to other countries with the U.S. health experts also accepting it. These experts informed the U.S. leadership of same.
    3. China well aware of the problem informed people in WUHAN they would close it off. Everyone living in Wuhan a city with a population of 20M was well aware of the situation before that pronouncement. Many had already fled. With the announcement 5M people, 25% of the population of WUHAN FLED the city, flying all over the World and other parts of China. These people did not leave for Chinese New Year since it had not officially begun.
    4. The WHO director then proceeded to claim that the virus was contained ( never using the word epidemic) . Clearly that was wrong and misinforming.
    5. The real number of infections was being updated every evening by Tencent. Then an hour later they would be replaced by lower official numbers. This occurred several times. Asian papers and netizens in China caught the disparity and posted it for all the world to see….several times. Why would the WHO Director choose to ignore these widely available sources?
    6. The WHO ignored information from Taiwan and Hong Kong who both had prior experience with China during the SARs epidemic. Why would he ignore health experts even if Taiwan was not “recognized?”

    There were further lapses of preparedness and missteps on the part of the Federal Government, the CDC (testing), the FDA (misguided regulation in the face of a pandemic) as well as many State and Local Governments (particularly in NY and NYC). None of the several U.S. entities failures to act forgive the grave actions of the Chinese PRC or for the subject of this article, the Director of the WHO.

    There will be plenty of time to have recriminations at a later date, but the Foundation was clearly built by the Chinese government and exacerbated by the WHO. If not, for the CDC testing failures, the U.S. would have been much further ahead of the pandemic serving to inform decision makers at all levels of government.

    What we do from this point both in the short term and long term are most important. However, I can not think how anyone of any persuasion could defend the actions of the WHO Director or possibly think that keeping him as the head of the dysfunctional WHO, could possibly be the right thing to do.

Comments are closed.

A roundup of STAT’s top stories of the day in science and medicine

Privacy Policy