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.
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.
It also does not correspond with the evidence Thread 1/https://t.co/pIrCQYyUTk
— Tom Bollyky (@TomBollyky) April 7, 2020
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.
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.