The World Health Organization has come under fire for its response to the global coronavirus pandemic, with threats of funding cuts and investigations into its conduct.
But experts say that while the WHO may have made some missteps in its handling of the crisis, the organization is only as powerful as its weakest link.
The United Nations agency was founded in 1948 with a mandate to act as an authority on international health.
Its 194 member states fund the agency and set Its policies, and it is accountable to them. Conversely, it has discretionary power to investigate members’ handling of public health crises, but it relies on their co-operation and information sharing.
“An organization like the World Health Organization can only be as strong and as effective as its member states want it to be,” said Steven Hoffman, director of the Global Strategy Lab and a global health law professor at York University in Toronto.
“So one of the challenges that the World Health Organization has faced over the last decades is that it keeps on getting new responsibilities and no new resources.”
In 2005, its responsibilities increased with the adoption of the International Health Regulations (IHR), a legal agreement signed by all members that requires countries to report emerging disease outbreaks that are at risk of spreading worldwide.
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In doing so, experts say the WHO took on a more political role in juggling the domestic interests of its individual members with the interests of the rest of the world.
“They have never performed well in that function — not once,” said Amir Attaran, a professor in the Faculties of Law and School of Epidemiology and Public Health at the University of Ottawa, who told CBC’s Sunday Edition the WHO should never again preside over a pandemic.
“They cave to diplomatic pressure. Or even if there is not diplomatic pressure, they self-censor.”
Attaran said an agency entrusted with ensuring compliance with an agreement like the IHR cannot also operate with the “attitude of a diplomat.”
Tedros shakes hands with Chinese President Xi Jinping before a meeting in Beijing on Jan. 28. Amir Attaran says the WHO will consistently ‘cave to diplomatic pressure.’ (Naohiko Hatta/Reuters)
“It cannot simultaneously be constantly begging countries for co-operation in certain areas where it’s expected at the next moment to turn on them severely and possibly fault them for hiding an epidemic.”
Hoffman says the agency is “doomed by its institutional design.”
“The criticisms that WHO has faced are not fair in the sense that WHO is not an independent entity, it’s essentially acting on behalf of its member states, who control it,” he said.
“So the criticism is really a criticism of those national governments’ inability to create the kind of strong public health agency that the world needs in this globalized era.”
Early response to pandemic criticized
On Dec. 31, China alerted the WHO to a mysterious outbreak of pneumonia in the city of Wuhan, in the central Chinese province of Hubei.
But it would be weeks before the WHO declared the situation a Public Health Emergency of International Concern on Jan. 30, a key designation that determines whether a country’s response to an outbreak has been effective and if more resources are needed.
The timing of that emergency declaration is critical at the beginning of an epidemic and can have ripple effects on how quickly countries around the world respond.
“I think that happened probably a week too late,” said Hoffman, adding that the organization was “hung” over whether the outbreak constituted an emergency.
While the WHO considered the emergency declaration, Chinese officials acted swiftly to silence early informal releases of information from health care workers sounding the alarm in Wuhan, opting instead to carefully manage the release of information in the weeks before the WHO would be allowed on the ground.
Former Canadian ambassador to China David Mulroney said that information was put through a “political prism” in China and delayed as local officials determined how to put the best possible face on the crisis before sending it up the line to Beijing.
“You never want to give bad news to your boss in China,” he said.
Health care workers attend to COVID-19 patients at the intensive care unit of a designated hospital in Wuhan, China, on Feb. 6. The WHO was quick to praise China for its efforts to contain the coronavirus outbreak but has been criticized for not declaring a public health emergency of international concern quickly enough. (China Daily/Reuters)
Mulroney said that problem highlights an inherent issue within the WHO: it can be “stonewalled” by a member country on the release of information — posing a “significant risk” at a critical time in an outbreak.
Lynette Ong, an associate professor of political science at the University of Toronto and a China specialist, said the WHO needed to maintain a diplomatic relationship with China in order to encourage the conducting of investigations and the sharing of key data.
When Chinese health officials quickly genetically sequenced the virus from an infected patient, the WHO lauded the effort, calling it a “notable achievement” that “demonstrates China’s increased capacity to manage new outbreaks.”
“But you do not also want to overdo it, to be too deferential and too friendly to the extent that you cannot take a step back and then question the things that they share with you,” she said.
“WHO is being criticized, rightly so, and a lot of the criticism is justified to my mind because they have probably gone a little too far to the other side of being too deferential.”
Ong said that while the WHO was “outwardly praising” China for its capacity to build hospitals and put in place strict lockdown of millions of its citizens that helped flatten their epidemic curve, the country did so by casting aside privacy and human rights with Draconian restrictions on citizens.
Health care workers walk a patient into a hospital in Wuhan on Jan. 27. Former interim Liberal leader and Canada’s special envoy on humanitarian and refugee issues Bob Rae says there is no evidence to suggest the WHO actively suppressed the release of any information on the pandemic. (STR/AFP/Getty Images)
“The other side of the criticism, which I also think is justified, is the cover-up at the beginning, which I don’t think the WHO has actually addressed at all,” she said, adding the world lost two to three weeks at a “very crucial time” in tackling the outbreak.
“Had there not been any cover-up, I think the world probably, we would be in a different position.”
Should the WHO be held accountable?
Calls for the WHO to be held accountable for its response to the global coronavirus have been been growing. Australia says it will call for an international investigation into the origin of the pandemic at next month’s annual meeting of the World Health Assembly, the decision-making body of the WHO. And U.S. President Donald Trump has already cut funding to the organization, saying it “failed” in its duty.
Still, the U.S. is working with the agency. The Centers for Disease Control and Prevention has, since late January, had a member on the WHO’s emergency committee, which also includes Canada’s Chief Public Health Officer Dr. Theresa Tam as an adviser.
Tam said that while she would welcome a review of the pandemic advice provided by the WHO, she does not fault it for its initial response because health experts all over the world “underestimated where this could go.”
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Prime Minister Justin Trudeau said Canada would continue to work with the WHO because the virus “demands a global, co-ordinated response.”
He added there will be “plenty of time to reflect on challenges” in the future.
Former interim Liberal leader Bob Rae and Canada’s special envoy on humanitarian and refugee issues said that while the WHO does act as a source of information, alert and guidance for countries in a pandemic, that doesn’t take away the responsibility of governments to take the steps they feel necessary.
“You could never say, ‘Well, you know, [the WHO] didn’t tell us how serious it was.’ Of course they did,” Rae said. “The question as to how each country should respond to the information is entirely up to each country. It’s not up to the WHO.”
The WHO doesn’t issue directives “to say you should carry out a lockdown, you should limit transportation, you should cut off all flights.”
Rae said that while it can be difficult for the WHO to navigate the challenges of the Chinese political system, there’s no evidence to suggest the organization actively suppressed the release of any information on the pandemic.
He says the criticism of the WHO is “completely misguided” and that cutting funding to the organization at a critical time is a strategic “mistake.”
“I think every crisis such as this one will prompt every governmental agency, both domestic and international, to reflect on what happened and to see how it can be improved,” he said.
“That is an issue that is going to be quite legitimately placed at the doorstep of the WHO.”