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Covid-19: Trump threatens to stop funding WHO amid “China-centric” claims

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1438 (Published 08 April 2020) Cite this as: BMJ 2020;369:m1438

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Rapid Response:

Why funding the World Health Organization is in the Self-Interest of USA

Dear Editor

The recent announcement by the President of the United States on 14 April 2020 that funds for the World Health Organization (WHO) will be suspended pending an investigation into its performance regarding the COVID-19 pandemic has been received with surprise, suspicion, and criticism. Notwithstanding the legal discussion of who in the country has (or not) the authority to grant or withhold funding from the United Nations (UN), this move is truly an existential threat to the WHO and potentially to the UN system. [1] The WHO is an inter-governmental organization with the primary mandate for health affairs in the UN system and operates at the behest of member states represented by their ministers (or secretaries) of health. [2] It has a major normative role in global health, provides critical technical assistance, and responds to requests from members states; but it has no authority to overrule or mandate that governments act in any particular manner, or to go into countries without their permission. In other words, it operates within the constraints and rules approved by those member states – including the United States, which was instrumental in its creation and who sits on the Executive Committee of it governing board, the World Health Assembly.

We agree that there is room for critical analysis of the WHO, to assist in improving efficiency and performance across a number of domains, but we firmly believe in its role and existence to support the global health community. We also believe that the United States needs to critically reflect on its own role in the performance of WHO and willingness to build systems that would have supported response to a pandemic like COVID-19. [3] We also agree that the dues structure for core funding of WHO could use revision, but we argue that there is strong self-interest for the United States to not only continue to fund the WHO but to also play a stronger leadership role in promoting its work and leadership on the global level.

First, the health of Americans in the United States is better with a stronger WHO. This is fundamental for policy makers, professionals, and the lay public to understand, especially within the context of a pandemic. WHO is the only organization that monitors and alerts all member countries, including United States, of health issues arising in any part of the world. Viruses like COVID-19 cross borders easily and national health systems have no jurisdiction outside their boundaries. It is only WHO which can play that role and the stronger it becomes in early detection and reporting, the quicker the United States will know of impending threats. Once a threat is detected, it is only WHO which can provide technical and operational assistance to all member states using its mandate. Individual donor countries may provide selected assistance but it is only WHO that has official relations with all 192 member countries, staff in country offices, and technical support in 6 regional headquarters. The United States cannot replicate or mimic this global resource even to protect herself from imminent health threats.

Second, the health of Americans abroad is better with a stronger WHO. Each United States citizen leaving its shores is dependent on the international health regulations promulgated by WHO related to disease reporting and health security and the health systems of other countries where they may visit, live or work; these Americans die from all causes including HIV/AIDS, malaria, non-communicable diseases, road injuries, trauma and more. And it is only the care provided in those countries that can prevent, treat and save these American lives; and thus it is deeply in our interest to have minimum standards of medical care across the global as mandated by WHO.

Third, the economy of the United States is better with a stronger WHO. By supporting nations through health, countries are able to prosper as health is deeply connected to economies of nations. WHO provides critical assistance to both larger (China, Brazil, India, Russia) and smaller economies that are critical trading partners for the United States. The connection between healthy populations abroad and the economy of the United States needs explicit recognition.

Fourth, a stronger WHO is politically good for the United States. It is important for the United States to continue as a critical leader in global health and engender the good will of both national leaders and their citizens. Health is an arm of a strong positive diplomatic agenda and helping others in times of need provides a strong basis for international reciprocity for the country.[4] WHO ensures both a trusted mechanism and resource for such health diplomacy for the United States.

Finally, a stronger WHO is good for United States science and development enterprise. WHO is an important mechanism for the best science and health evidence from the United States to reach other countries. It is also a key vehicle for the United States to engage with health professionals and researchers from around the world on helping solve major health issues for the country and the world. Moreover, leading scientists in the United States have either come from, spent time at, or have ongoing exchanges with WHO professionals and offices around the world to enable top quality science to support public health and medical care in the country.

It is important for all organizations to be accountable and transparent – and that is also true for WHO – and its leader has reiterated that since taking the helm.[5] It is also important for the global community to support the only global health organization created to support public health systems around the world – especially in the middle of a pandemic. It is more important for the United States leadership to not use blame as a deflection for national failures and understand that a strong WHO is good for the country and for the world.

References
1. Klein B, Hansler J. Trump halts World Health Organization funding over handling of Coronavirus outbreak. Available at: https://www.cnn.com/2020/04/14/politics/donald-trump-world-health-organi... (Accessed 15 April 2020)
2. United Nations. Constitution of the World Health Organization. New York, USA: 2 July 1946. Available at: https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1 (Accessed 15 April 2020)
3. Burkle FM. The World Health Organization Global Health Emergency Workforce: What Role Will the United States Play? Disaster Med Public Health Prep. 2016 Aug;10(4):531-5. doi: 10.1017/dmp.2016.114.
4. Chattu VK, Knight A, Reddy KS, Aginam O. Global Health Diplomacy Fingerprints on Human Security. Int J Prev Med. 2019 Nov 28;10:204. doi: 10.4103/ijpvm.IJPVM_11_19
5. Ghebreyesus, TA. Healthcare for all: every country can do it—an essay by Tedros Adhanom Ghebreyesus. BMJ 2019;367I6790. doi: https://doi.org/10.1136/bmj.l6790

Competing interests: No competing interests

04 June 2020
Adnan A. Hyder
Senior Associate Dean for Research, Professor of Global Health
James Tielsch
Milken Institute School of Public Health, George Washington University
950 New Hampshire Ave. NW Suite 700 Washington, DC 20037