Suspending WHO Funding Should Be Just the Beginning

President Trump has announced a suspension of U.S. funding of the World Health Organization (WHO). This suspension was long overdue: the World Health Organization has been an ineffective and wasteful organization in desperate need of reform for at least a decade. Trump should go further, going on the warpath against this organization and committing to forcing reform on it, one way or another.

The full argument against the WHO takes some explaining, but it involves several different elements: first, some education about what the WHO actually does, and, crucially, what it does not do. Second, a brief review of some of the WHO’s recent hiccups and leadership problems. And, finally, an assessment of the WHO’s COVID response.

The WHO has a long history, reaching back in various forms to international health conferences in the 1850s. These cooperative bodies were particularly interested in beating cholera, yellow fever, measles, smallpox, and bubonic plague. By setting up systems of “disease notification,” international health collaboration organizations created the building blocks of an international system of disease surveillance. This kind of system is important, because with speedy information about when disease outbreaks occur, governments can mount rapid responses, nipping epidemics in the bud before they spread. Thus, from the earliest days, the focus of international health collaboration was not on bulk shipment of supplies or anything like that, but on information: making sure every country knew about the best public health practices and making sure information about disease spread faster than the disease itself.

Over the years, these bodies became more and more formal. The League of Nations established the WHO’s immediate predecessor, and then in 1946 the United Nations consolidated several public health organizations into the WHO. The WHO’s mission was to continue the program of international disease surveillance, and also to promote public health generally.

How this has happened has varied over time. For much of the WHO’s history, it was particularly focused on actual medical care, working mostly on identifying “notifiable diseases,” and resourcing health providers and health systems to address them. Particularly in the world of the 1950s to 1980s, many countries simply lacked the most basic access to modern care, and so this mission was vital. At the same time, the WHO has always maintained very large vaccination programs, helping poorer countries access tools to reduce the spread of epidemic disease.

But today, the world has changed. In all but the remotest corners of the world, people have cell service. Health providers can simply Google for information about current best practices. Very few countries are truly devoid of functional health departments either, and so the WHO’s historic function advising about best practices is also somewhat dated: It’s far from clear that the WHO is better at recruiting top-tier talent than the U.S. or European CDCs, for example, or even than national CDCs in many developing countries. The argument that officials at the WHO are necessarily better-informed about epidemic management strategies than officials at the national CDCs of Thailand or Kenya or Brazil may have been fairly compelling in 1950, but today it seems much more debatable, if for no other reason than that public health management in those countries has greatly improved.

Meanwhile, vaccines exist for most major epidemic diseases, and in most cases are available cheaply. The WHO continues to work hard on vaccination programs: campaigns to eradicate polio are nearly complete (although they were planned to be complete by 2000), and Guinea worm is also nearly eradicated. Fully a fifth of the WHO’s entire budget is dedicated to polio eradication programs.

As a result of this focus, the WHO is simply not the organization of doctors many people envision. Of the 80 job listings currently on the WHO’s website, no more than four that I could identify apply to doctors at all. Even permanent career positions on the international professional payscale usually do not require more than a master’s degree in a health-related field. The WHO is currently hiring almost as many media and communication staffers as it is epidemiological staffers. 

When people envision the WHO, they often envision some international legion of doctors prepared to fly into crisis-hit spots and address immediate needs. But that’s not the WHO. The WHO basically provides grants to affiliates who research vaccines, it partners with national organizations to distribute vaccines, it circulates data on notifiable diseases, and it hosts conferences for experts to discuss diseases. The WHO does not have an appreciable crisis-response capability, especially for a disease for which vaccines don’t exist, at this point in history, and it has not had such a capability in quite some time. It simply isn’t that kind of organization. It’s a body for research, conferences, and grant-writing, not frontline disease-fighting. Strikingly, the WHO’s current head, Director-General Dr. Tedros Adhanom Ghebreyesu, is not a doctor of medicine: He’s a scientist. He’s the first WHO director-general to not be a physician, helping mark the organization’s gradual transition away from a focus on support for frontline providers, toward the more elite-focused mission of today. Even aside from COVID-related misdeeds, the U.S. would be justified in playing hardball with the WHO to press it to reconsider the focus of its programs in a world where most national health agencies are competent for normal public health tasks, but acute crises remain a very real risk.

Speaking of those conferences, a common line of criticism against the WHO is worth examining now: It spends from $200 to $600 million on travel expenses each year, making up between 5 percent and 20 percent of its total budget. This is more than the WHO spends on any specific disease other than polio. Some of that expense is due to WHO leaders booking themselves helicopters instead of jeeps to reach clinics. High-ranking WHO official and Canadian scientist Bruce Aylward racked up $400,000 in travel expenses helicoptering around West Africa during the Ebola epidemic, even as many African countries could not afford basic medical supplies or body bags. Some of it is due to swanky hotel bookings.

But much of it is far more mundane: The WHO pays for the travel costs of experts they invite to conferences. A huge part of the WHO’s budget is simply buying plane tickets and booking hotel rooms for prestigious experts to give speeches and present papers at conferences.

This exchange of knowledge is useful. It benefits society. But one has to wonder, in the age of the internet and Zoom conferences, whether we really need to spend quite so much flying superstar medical researchers around the world. In practice, much of what the WHO does is serve as a financing body for the conference-and-TED-talk crowd’s habit of, well, conferences and TED talks. The same WHO official mentioned above, Bruce Aylward, famously gave a TED talk watched by a million people about his experiences fighting Ebola.

Again, the issue here is not that having conferences is bad. It’s that a multi-billion-dollar organization that conceives its mission as being apparently primarily about convening physical meetings of experts to discuss papers they’ve already published online is a bit of a dated model. Perhaps it made sense when these conferences began in the 1850s. It does not make sense today. And when physical conferences are necessary, such as when U.N. member delegates need to meet for official functions, they can be conducted much more affordably. I have personal experience with this: I was the alternate U.S. delegate to the conference of a U.N. affiliate body of which the US is a member, and my travel was billed to the United States, not the U.N. organization, and my economy-class ticket, basic room rate, and per diem ran the taxpayer less than $5,000 for two weeks of travel (which cost I paid out of pocket up front, and was reimbursed for later after providing receipts). But alas, for many around the world, jobs at such international organizations are cushy sinecures with nice perks and little accountability for spending. The WHO is no exception to this. The US should absolutely use whatever tools it has at its disposal to pressure the WHO into adopting more stringent accountability for travel expenses, including a reconsideration of the entire structure of its programs.

I mentioned Ebola earlier. It turns out, after the 2014-16 Ebola epidemic in West Africa, experts around the world panned WHO’s response, saying it was too slow and lacked accountability. After its disappointing response to Ebola, it was hoped that the WHO would be better prepared for the next major epidemic. That hope was obviously misplaced. The WHO simply did not get the memo that the demand right now around the world is primarily for an international epidemic crisis-response strike team, not a swanky conference host.

However, the perception that the WHO’s poor response to Ebola was related to leadership problems did make it through to delegates. Thus, when Margaret Chan’s term was up (she is a Canadian born in Hong Kong, but served in the WHO representing the People’s Republic of China), the WHO got its first African director-general: Dr. Tedros Adhanom Ghebreyesu (he prefers to be called Dr. Tedros). Tedros served as Ethiopia’s minister of health in the 2000s, and was supported by China and its allies, as well as most African countries, while most of the Western world and U.S. allies supported a different candidate.

Dr. Tedros’ leadership was cause for concern from the start. He continues to assert to this day that three separate outbreaks of cholera in Ethiopia under his watch were not cholera at all, but simply “acute watery diarrhea.” His active complicity in covering up not one, not two, but three separate outbreaks of an extremely dangerous notifiable disease raises enormous questions about his fitness as leader of an organization whose primary job is disease surveillance. In service to an authoritarian government in Ethiopia, Dr. Tedros buried the truth about cholera in Ethiopia, and in the process probably buried many of his countrymen and their children. 

It gets worse. Cholera outbreaks in the region began in Sudan. Ethiopia asserted that it was no problem, and so extra precautions were not taken. But after Dr. Tedros headed to the WHO, cholera appeared in Somalia, apparently having “hopped over” neighboring Ethiopia. It has since spread, with incredibly lethal consequences, to Yemen. Today, Ethiopia has finally acknowledged the presence of cholera. But it’s too late: Thousands are dead in part because of Dr. Tedros’ coverup.

You might think this terrible behavior would be strange in a WHO director-general: but far from it. The WHO continues to assert that fewer than 10,000 people died in the 2010s Haiti cholera outbreak, an outbreak caused by infected U.N. peacekeeping forces. Yet, yet detailed research from Médecins Sans Frontières (Doctors Without Borders) has shown that true deaths may have been anywhere from three to 15 times as high. The previous WHO director-general, representing China, called North Korea’s health care system “something other countries would envy” and, in a country in the throes of starvation, lauded North Koreans’ lack of obesity.Meanwhile, Chan also widely promoted the idea that the 2009 flu season would be a massive global pandemic: a claim that failed to come true, with 2009 flu deaths in many countries coming in lower than either the year before or after. One wonders if this panicky reaction was motivated by the fact that early reports wrongly suggested that swine flu began in the United States (it began in Mexico).

Of course, even before COVID, Dr. Tedros made Robert Mugabe a “goodwill ambassador” for the WHO in Africa. Meanwhile, under his watch, the WHO has begun to include scientifically unproven “traditional Chinese medicine” remedies in its international diagnostic manuals. What’s particularly galling about this is that the ingredients for traditional Chinese medicine often include the very wild animals that are over-hunted and endangered around Africa, and from which so many novel zoonotic diseases originate. For the WHO to tacitly endorse these practices is absurd and dangerous.

Under both the current and previous WHO director-generals, the WHO has done everything it can to support the propaganda of authoritarian regimes and cover up embarrassing epidemics. The U.S. has sat complacently and allowed the organization to be captured by Chinese lobbying for dangerous, unscrupulous, and unscientific ends. We should fight back hard.

The case of COVID-19 has particularly illuminated problems with the WHO. Bruce Aylward, of Ebola fame, headed the WHO’s joint mission with China to investigate COVID-19. That mission produced a tidal wave of misinformation, informing the wider world that human-to-human transmission was not a great risk (false), that masks were not very helpful (false), and that China’s efforts successfully prevented spread of the disease (look at the world around you: clearly false). The WHO repeatedly parroted China’s false claims about the disease, while not criticizing the communist government’s suppression of information about COVID-19 in December and January. What is most galling about this is that the speedy provision of information is supposed to be where the WHO excels. This is the original purpose of the organization, and as I’ve argued on The Remnant, information is the most powerful tool we have for fighting epidemics.

Instead, WHO leaders slow-walked information. They hesitated and waffled. They accepted China’s word as good, when it clearly wasn’t. Dr. Tedros spent his major speeches urging the world not to blame China, and claiming that stigmatization was as big a problem as COVID-19. As a result of the WHO’s delay, many countries delayed their responses by anywhere from one to three weeks: a crucial difference that epidemiologists say may have doubled the total death toll.

This raises a vital point about the WHO’s disease notification system. Most countries report notifiable disease on a monthly basis. But given the massive scale of rapid international air travel, this pace is probably too slow for the modern world. The WHO has simply not kept pace with the modern world, and the cost has been thousands of lives in a preventable pandemic. This problem has been obvious for a long time: WHO didn’t begin notifications about Zika until well after the peak of infections, and Ebola had been raging in West Africa for several months before the WHO began tracking it aggressively. But COVID-19 has shown how lethal this sluggishness is now. Major data-tracking groups, like Our World in Data, have eschewed the WHO-reported COVID data, in favor of data from the European CDC or Johns Hopkins University, because the WHO’s COVID data is so unreliable.

If nothing else, the US should absolutely question the utility of a disease surveillance system which is so slow to update that it cannot track actual epidemics as they occur.

One country chose to consciously distrust the WHO from an early stage: Taiwan. The saga of Taiwan and the WHO is painful and embarrassing. From 2009 to 2016, Taiwan was allowed to participate in the WHO as an observer. But China’s objections to this arrangement grew increasingly loud over time, and after 2016, Taiwan was kicked out. By 2018, Taiwanese media weren’t even allowed to attend WHO events to cover them.

Taiwan imposed the earliest large-scale travel ban of anywhere in the world, on January 25th, just as lockdowns were beginning in Wuhan. As a result, their travel ban was in place before the wave of people fleeing lockdowns in China spread COVID around the globe. Singapore and Hong Kong also had fairly early travel restrictions, and they also saw much more modest outbreaks. Over the last two months, Taiwan’s handling of COVID has been exemplary: large scale testing, good contact tracing, etc.

But it’s not just that. Taiwanese health officials notified the WHO that they believed COVID to have human-to-human transmission weeks before the WHO accepted that possibility. Their communication was ignored, as Taiwan is not a member of the WHO.

Had the WHO listened to Taiwan, had the WHO advised countries to follow Taiwan’s policy example rather than the deeply unsound “strategy advice” it ultimately gave, tens of thousands of lives could have been saved, and a global economic recession avoided. But the WHO chose to ignore Taiwan; to pretend like it didn’t exist, even.

This policy came to a head in a now-infamous video, an interview of Bruce Aylward by a Hong Kong publication. When asked about Taiwan, Aylward first said that they’d already discussed China, then pretended not to hear the question, then abruptly ended the interview. His bio was subsequently removed from the WHO’s website, but the damage was done: the leader of the WHO’s COVID task force had revealed that the WHO’s attitude to Taiwan was exactly what everyone feared—completely ignoring Taiwan’s very existence, and at huge public health costs.

So what is to be done?

The WHO has been dominated by shills for the Chinese Communist Party for nearly a decade and a half, and in that time it has systematically suppressed information about numerous epidemic outbreaks, incompetently mismanaged multiple major outbreaks, and actively advanced propaganda for authoritarian regimes at great cost to public health. The WHO’s operations have drifted over time, failing to modernize its most essential disease surveillance functions while doubling down on the most dubiously-useful activities like physical conferences. 

Meanwhile, the popular image of the WHO is simply wrong. It is not a crisis-response organization. In a moment of crisis, the crack team of doctors flying to the rescue will come from Doctors Without Borders (which has 5 times as many staffers and yet a travel budget less than a third as big), not the WHO. The WHO will send a team of suits to stay in a nice hotel and act as government consultants, and then show up with a new vaccine a year after the epidemic is over. 

And yet, the US has enormous leverage over the WHO, because the US government and private US foundations contribute about a quarter or more of the WHO’s total budget. If the US government were to ban US persons from connection with the WHO, it would immediately lose a huge share of its funding and its expertise. 

President Trump is right to suspend funding to the WHO, but he needs to make specific demands. My suggestion for these demands is short and to the point: First, Dr. Tedros must resign, as must all of his assistants and deputies. Second, Taiwan must be returned to the observer status it held from 2009 to 2016, and Taiwanese media given press credentials for WHO events. Third, the WHO must formally state that COVID-19 originated in China, and that its pandemic spread could have been greatly reduced had the Chinese government not actively concealed information about the disease. Fourth, the WHO must repudiate the report of its joint mission with China. And fifth, the WHO must commit to improving existing disease surveillance systems, creating a global standard of weekly reporting of notifiable disease and symptomatically similar cases lacking laboratory confirmations, which project should receive funding priority ahead of projects related to noncommunicable diseases.

Until these demands are met, the United States should undertake an escalating series of measures intended to degrade the WHO’s capacity to function. Suspending funding is simply a first step. If the WHO refuses to adopt any of these demands in a reasonable time frame, the United States should announce that any US government personnel detailed to the WHO are immediately recalled. US participation in research collaborations should be suspended. At the extreme, if the WHO doubles down on its practice of systematically misreporting and even concealing epidemics, the United States should consider complete withdrawal of membership and denial of visas to WHO staff. 

There are many diplomatic battles which the United States will not win even if we throw all of our resources at them. But we can win this one. Our demands are clear and attainable and entirely consistent with the mission of the WHO. Our mechanisms for achieving those demands are clear and provide us with numerous tools we can apply sequentially over a long period of time if necessary. Our list of demands is sufficiently long that we can negotiate down one or two of them, if necessary, to achieve a workable compromise. We can win this fight if we make a clear, public commitment to using these “nuclear options:” the WHO will blink first.

The only question is whether Trump actually has the guts for such a fight. To achieve a victory for the United States and the world, President Trump and his administration will have to commit to doing work, to proving to our allies that, for all the bombs we are throwing, we sincerely desire the best for the world: we are redirecting funds to good health organizations, and we are prepared to restore all funding (and more!) if changes are made. More to the point, the extent of our demands amount to demanding that the WHO do its job as effectively as it was before the last two Directors-General ruined a once-noble organization’s credibility. If we lead with decisiveness, clear goals, and a real pathway to victory, our allies will follow.

Lyman Stone is the chief information officer of the consulting firm Demographic Intelligence, a research fellow at the Institute for Family Studies, and an adjunct fellow at the American Enterprise Institute.

Photograph of a WHO daily briefing in Geneva, Switzerland by Fabrice Coffrini/AFP Getty Images.