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SINGAPORE — In a few
awkward seconds, Bruce
Aylward, a senior official at
the World Health Organiza-
tion, laid bare the flaws and
pressures faced by the glob-
al health agency charged
with leading the response to
the worst pandemic in more
than a century.
A video that’s since gone
viralshows the distin-
guished Canadian epidemi-
ologist dodging a reporter’s
question about why Taiwan
is not a member of the
WHO. Aylward twitches and
blinks. He says he cannot
hear the journalist. When
she offers to repeat the
question, he asks her to
change the subject. When
she persists, he hangs up on
the video chat with a Skype
chime thud.
Aylward is a veteran of
the United Nations’ health
agency, responsible for
preventing millions of chil-
dren from contracting polio
and stanching the Ebola
epidemic in West Africa. But
the agency’s limitations
were starkly sketched at the
mention of Taiwan. An
island of 24 million crucial to
the fight against the co-
ronavirus, Taiwan has been
blocked from joining the
WHO because China con-
siders it a renegade prov-
ince.
The video exchange,
health experts say, re-
inforced how powerful na-
tional interests are over-
shadowing shared interests
at a time when the agency is
needed to marshal a global
response to an outbreak
that emanated from China
and is threatening to kill
millions.
Even before the Aylward
interview, the WHO was
under fire for taking weeks
to raise its highest warning
about the novel coronavirus
despite its spread globally —
a decision widely viewed as
deference to China.
Leading a medical re-
sponse on a wide scale is a
volatile mix of politics,
disease, money, science,
second guesses and lost
opportunities. The WHO
was blasted for taking too
long to sound the alarm over
the 2014 Ebola outbreak in
West Africa. Five years
earlier, though, it was criti-
cized for overreacting to the
H1N1 swine flu.
But the WHO’s position
today is arguably more
fraught than at any time
since the end of the Cold
War. As COVID-19 ravages
more countries, the agency
has to navigate political
tensions between the two
most powerful nations, the
U.S. and China. It is also
encountering growing na-
tionalism and, in some
cases, a rejection of science
fueled by populism and
social media.
The WHO risks becom-
ing a bystander in the un-
folding crisis as countries
make unilateral decisions
about emergency measures,
treatment and distribution
of medical resources. There
are parallels between the
organization and the blue-
helmeted U.N. peacekeepers
dispatched to stop wars and
conflicts but are eclipsed by
national self-interests that
undermine their missions.
The fractious climate
could result in renewed
disease outbreaks and
inequities, experts say,
especially if an eventual
vaccine leads to a free-for-all
in which nations hoard
supplies. It also raises ques-
tions about how the WHO,
in an increasingly divided
world, could handle an even
swifter and more deadly
virus, such as what scien-
tists term as a Disease X.
“The WHO has been
sidelined from the biggest
pandemic of the century,”
said Lawrence Gostin, a
Georgetown law professor
and director of the World
Health Organization’s
Collaborating Center on
National and Global Health
Law. “The powerful forces of
sovereignty, nationalism
and populism have literally
overwhelmed the WHO as
an institution for no fault of
its own. At a time when the
world should be coming
together under the WHO
banner, solidarity is unrav-
eling.”
That wasn’t the intent
when the U.N. body was
formed in 1948 after World
War II to guide international
health policy impartiallyand scientifically. The
agency counts among its
successes the eradication of
smallpox, the suppression
of polio and the devel-
opment of standards for
essential medicines.
The end of the Cold War
in 1989 gave the WHO more
freedom to introduce
sweeping initiatives such as
a global campaign to fight
the spread of tuberculosis, a
convention on tobacco
control and a revision of the
agency’s so-called Interna-
tional Health Regulations
to give it broad authority to
declare pandemics, which
were renamed Public
Health Emergencies of
International Concern.
The first time such an
emergency was invoked was
in 2009 for the swine flu,
which initially appeared in
Mexico and the United
States and turned out to be
significantly less deadly
than the seasonal flu.
Nevertheless, countries
reacted in panic: banning
pork imports and forcibly
quarantining travelers. The
WHO was criticized as
alarmist and faced un-
founded accusations that it
deliberately declared the
emergency to benefit vac-
cine manufacturers.
The backlash appeared
to make the WHO overly
cautious about similar
interventions. In 2014, it
took the agency 138 days
after Ebola’s first detection
in West Africa to call an
emergency. The mishan-
dling of the outbreak ex-
posed the divisions between
the WHO’s headquarters in
Geneva and its regional
offices, which often operate
like fiefdoms. It also high-
lighted the agency’s rela-
tively small budget.
The WHO’s annual
budget, which stood at $4.
billion last year, often
doesn’t leave enough to
prepare poor countries for
disease outbreaks like
Ebola. That’s about one-
quarter the budgetallocat-
ed to fighting opioid addic-
tion in the U.S.
Only 18% of the agency’s
funding consists of assessed
contributions from its 194
member states. The rest is
provided voluntarily, often
from private donors such as
the Bill and Melinda Gates
Foundation, which have a
say in how their money is
spent.
The U.S. has long been
the body’s biggest benefac-
tor, providing hundreds of
millions of dollars in as-
sessed and voluntary con-
tributions each year. China,
by comparison, contributes
in the tens of millions.
That could change. The
Trump administration in
February proposed cutting
U.S. funding to the WHO by
53%— a move consistentwith the president’s distaste
for multilateral
organizations. The pro-
posed cuts make China’s
growing commitment to the
agency all the more impor-
tant at a time when Beijing
has been cultivating greater
influence in the United
Nations and its agencies.
It was against this back-
drop that WHO Director-
General Tedros Adhanom
Ghebreyesus stunned some
observerswith his praise of
China’s handling of the
coronavirus in late January.
This, despite revelations
that China suppressed
information about human-
to-human transmission of
the disease by muzzling
whistleblower health work-
ers, including Dr. Li
Wenliang, who died in Feb-
ruary after contracting the
disease.
The delay in reporting of
the disease’s severity was
catastrophic, allowing the
outbreak to fan across the
globe, where it’s now in-
fected more than 1 million
people and killed more than
52,000.
Tedros was reluctant to
admonish China, experts
say. In fact, he praised Bei-
jing in January for its
“transparency” and said the
“Chinese government is to
be congratulated for the
extraordinary measures it
has taken to contain the
outbreak.” China’s size and
history of epidemics meanit
will always occupy a central
place in global health policy
—especially as growing
populations and intercon-
nectivity breed new and
deadlier viruses.
“The agency has to play a
diplomatic role and keep all
countries at the table,” said
Devi Sridhar, a global
health expert at the Uni-
versity of Edinburgh in
Scotland. “Throughout this
outbreak it is better to keep
China cooperating and at
the table.”
Criticism of the WHO
also ignores the fact that it
can’t compel China to dis-
close relevant information,
though it’s required to as a
signatory of the Interna-
tional Health Regulations,
said Kelley Lee, an author of
a book about the WHO and
a professor of global health
at Simon Fraser University
in Canada.
“The WHO doesn’t have
the authority to walk into a
country and demand that
information,” Lee said. “It
can cite the IHR and say it’s
obligated to cooperate, but
it can only rely on diplo-
matic channels, not sanc-
tions. One thing that needs
to be looked at in the future
is how to ensure countries
are more timely and fulsome
with information sharing.”
The WHO didn’t declare
a pandemic-level co-ronavirus emergency until
March 11. By then, nearly
120,000 cases had been
reported in 114 countries.
The agency had spent the
preceding weeks warning
countries to prepare for the
inevitability of transmis-
sions within their borders.
“We must focus on con-
tainment, while doing
everything we can to pre-
pare for a potential pan-
demic,” Tedros said Feb. 24.
That same day, the WHO
was reminded it has little
sway with Washington.
President Trump tweeted
that the virus was “very
much under control” in the
U.S. It appeared the WHO
could not persuade the
White House to mobilize a
more serious response to
the virus, which was viewed
as overblown by many of the
president’s supporters
despite scientific evidence
to the contrary.
Complicating matters
was Washington’s and Bei-
jing’s tepid cooperation.
Rather than lead the world
toward a solution to the
crisis in conjunction with
the WHO, the two govern-
ments embarked on a war of
words to deflect blame.
Trump and other U.S.
officials promoted terms
such as the “Chinese virus”
and “Wuhan virus,” a refer-
ence to the disease’s epicen-
ter in China, that contrib-
uted to a wave of racism.
Chinese officials pushed a
conspiracy theory about the
disease being released by
the U.S. military in Wuhan.
The WHO tried to quash the
spat by naming the disease
COVID-19.
The agency has since
returned to its more tradi-
tional functions, such as the
sharing of global health
information and coordinat-
ing trials for coronavirus
drugs. It did, however, have
to warn against using un-
proven medicine to treat the
disease last week after
Trump and others touted
the malaria drug chloro-
quine.
The interview with Ayl-
ward prompted the WHO to
release a statement Sunday
saying the question of Tai-
wan’s membership was not
for staff to discuss, but
member states.
The controversy comes
after Taiwan’s Centers for
Disease Control said last
week the WHO failed to
share with other countries
information it provided on
Dec. 31 about an “atypical
pneumonia” it was alerted
to by doctors in Wuhan.
David Fidler, an adjunct
senior fellow for cybersecu-
rity and global health at the
Council on Foreign Rela-
tions, said the WHO has
demonstrated throughout
this outbreak that it has
little interest in assuming
political authority.
That clears the way for
the organization’s most
powerful members to treat
global health “through the
distorting lens of the bal-
ance of power, reducing the
potential for common
ground,” he said.
“The post-Cold War
golden age of global health
is over,” Fidler said. “The
COVID-19 disaster marks
the turning point into a
different, more difficult
future.”Special correspondent
Ralph Jennings in Taipei,
Taiwan, contributed to this
report.BACK STORY
WHO’s crisis of authority
Nationalism, geopolitics undercut U.N. health agency at crucial time
By David PiersonTHE POSITIONof the World Health Organization, led by Tedros Adhanom Ghe-
breyesus, is perhaps more fraught than at any time since the end of the Cold War.Fabrice CoffriniAFP/Getty ImagesANURSEin a unit for COVID-19 patients in Wuhan,
China, in February. Tedros stunned some observers
with his praise of China’s handling of the pandemic.AFP/Getty ImagesPERSPECTIVES