When I heard that our president had decided to hold back the World Health Organization (W.H.O.) funding, I felt outraged. I adhere to the liberal belief that the U.S. has a responsibility to share our knowledge and resources with our fellow global citizens, especially in the field of public health. Caring about and promoting the well-being of others is an indelible part of my worldview. Pandemic or not!  The W.H.O. has an important mission in our world.

So, like many others, I believe Trump’s action was an attempt to shift blame from his own missteps. I immediately sided with the president of the W.H.O. when he stated that we should not politicize the Coronavirus. I also agreed with Bill Gates, Michael Bloomberg, and health professionals worldwide who emphatically stated that this is not the time to hobble W.H.O.

But, there is more than this running around in Trump’s brain. I also believe that our president is seizing on the opportunity to weaken another progressive, globally-focused institution. Years ago, when he pulled out of the Paris Peace Accord, we learned of his distaste for progressive, global cooperation and for science. We also know that Trump never supported refugees and migrants, people who are often recipients of W.H.O. services. W.H.O. has, no doubt, been a target of Trump’s disdain for some time. Just imagine his ire towards an entity with a name that includes “world” and “organization”.

And, despite what I am about to write here, I still believe in these as motivating factors in Trump’s funding announcement (which Nanci Pelosi now says is illegal). However, I started to wonder if funding/not funding W.H.O is really so black and white? I decided that I do not really know ANYTHING about the W.H.O. When I was a younger person, I worked for several nonprofits and learned that they can be bloated, wasteful, and inefficient entities. I call this the EPA Syndrome. The EPA mission is critical for our country and the world, but they have become so large and inefficient that they waste billions of tax-payer dollars and are often simply ineffective at this point.  Perhaps I should gather some facts about W.H.O and look more deeply at the controversy before I decide what I think about them. I certainly have the time for such a project!

My basic research is summarized below. However, if you are not in the mood to wade through all the details, here is how I answered my question, “Should liberals be outraged about withholding W.H.O. funding?

“I am somewhat shocked to admit it, but after spending a whole day reading endless material about W.H.O, I am now less likely to support W.H.O, in general, despite my initial outrage against Trump’s action to withhold funding. As I mentioned, I am very skeptical about large institutions because they tend to lose effectiveness, and my reading supports that this is true about W.H.O. They are due for an overhaul and, before this pandemic, they were, in fact, restructuring after many complaints of ineffectiveness. Furthermore, the W.H.O was, truthfully, behind the curve in taking action to slow the spread of Coronavirus (see below). Yes, if Trump was caught with his pants down (after dissolving the national pandemic group),then W.H.O.s pants were also down around their ankles. Perhaps withholding funding would force W.H.O. to solve their internal failings? Still, I agree with those who wonder if this is the right time. W.H.O. does have a critical mission in the world, especially now. As noted in the New York Times, António Guterres, the Secretary General of the United Nations, defended the W.H.O. in a statement on Tuesday, saying it “must be supported, as it is absolutely critical to the world’s efforts to win the war against Covid-19.” He also said it is “not the time to reduce the resources for the operations of the World Health Organization or any other humanitarian organization in the fight against the virus.”

So, not now, but maybe later?

If you want the long version, here is what I found that lead me to those conclusions:

Basic Facts About W.H.O.

The W.H.O website is amazing and has lots of information, but I wanted to hear from a third party, so I started with a fact sheet found at The Kaiser Family Foundation (KFF). KFF is a non-profit organization focusing on national health issues.

• The World Health Organization (WHO), founded in 1948, is a specialized agency of the United Nations with a broad mandate to act as a coordinating authority on international health issues.
• The U.S. government (U.S.) has long been actively engaged with WHO, providing financial and technical support as well as participating in its governance structure.
• The U.S. is currently the largest contributor to WHO.
• The WHO faces a number of challenges including a broad mandate with limited, inflexible funding, bureaucratic complexity, and a track record of poor responses to recent health emergencies; reforms have been initiated to address some of these challenges.
• Budget: $4.422 billion over two years (2018-2019)
• Member Countries: 194

The problem with a “broad mandate” (huge, no detail) raised some red flags. These are common problems in a large organization. So what is their mission? Again, from the KFF Fact Sheet:

• Its overarching mission is “attainment by all peoples of the highest possible level of health.”
• It supports its mission through activities such as: providing technical assistance to countries, setting international health standards and providing guidance on important health issues, coordinating and supporting international responses to health emergencies such as disease outbreaks, and promoting and advocating for better global health.
• The organization also serves as a convener and host for international meetings and discussions on health issues. For the most part, WHO is not a direct funder of health services and programs in countries.
• W.H.O.s objective for its work during the 2019-2023 period is “ensuring healthy lives and promoting well-being for all at all ages.” In pursuit of this objective, it will focus on three strategic priorities (the “triple-billion target”)
  helping 1 billion more people benefit from universal health coverage, ensuring 1 billion more people are better protected against health emergencies, and helping 1 billion more people enjoy better health and well-being.

Activities

W.H.O.s activities, as identified in its biennial budget 2018-2019,11 include the following:

• communicable diseases;
• corporate services and enabling functions;
• health emergencies programme;
• health systems;
• promoting health through the life course;
• non-communicable diseases; and
• other areas, including polio eradication, tropical disease research, and research in human reproduction.
• Each of these categories is made up of “programme areas.” For instance, communicable diseases has six programme areas, including HIV/AIDS and tuberculosis.

Okay, I agree with the mission, to promote high levels of health across the globe. I can see how providing technical assistance would help. I can see how coordinating international responses to health emergencies fits with their mandate. I support their role in convening international meetings and discussions on health issues. If they can assist governments with getting universal health coverage, more power to them. However, statements like “helping 1 billion more people enjoy better health and well-being,” are worrisome. They are overly vague and bureaucratic at first glance.

So what  is something have they done in the world? KKF says,

• The agency has played a key role in a number of global health achievements, such as the Alma-Ata Declaration on primary health care (1978), the eradication of smallpox (formally recognized in 1980), the Framework Convention on Tobacco Control (adopted in 2003), and the 2005 revision of the International Health Regulations (IHR), an international agreement that outlines roles and responsibilities in preparing for and responding to international health emergencies.

Governance

• The World Health Assembly (WHA), comprised of representatives from WHO’s 194 member states, is the supreme decision-making body for the agency and is convened annually. It is responsible for selecting the DG, setting priorities, and approving WHO’s budget and activities.
• Every six years the WHA negotiates and approves a work plan for WHO (the most recent plan, known as the general programme of work, covers 2019-2023),3 and every two years it approves a biennial budget for the work plan (the current budget is for 2018-2019). The annual WHA meeting in May also serves as a key forum for nations to debate important health policy issues.
• WHO’s Executive Board, comprised of 34 members technically qualified in the field of health, facilitates the implementation of the agency’s work plan and provides proposals and recommendations to the Director-General and the WHA.5 The 34 members are drawn from six regions:

7 represent Africa,
6 represent the Americas,
5 represent the Eastern Mediterranean,
8 represent Europe,
3 represent South-East Asia, and
5 represent the Western Pacific.

Funding

• WHO has two primary sources of revenue: assessed contributions (set amounts expected to be paid by member-state governments, scaled by income and population) and voluntary contributions (other funds provided by member states, plus contributions from private organizations and individuals).
• Most assessed contributions are considered “core” funding, meaning they are flexible funds that are often used to cover general expenses and program activities. Voluntary contributions, on the other hand, are often “specified” funds, meaning they are earmarked by the donor for certain activities.

General Controversy (paraphased from NYT)

• Although the W.H.O. is broadly influential, it lacks meaningful enforcement authority and is under budgetary and political pressures, especially from powerful nations like the United States and China and private funders like the Gates Foundation.
• United States has had a sometimes contentious history with the W.H.O. on issues like breastfeeding and tobacco.
  Even supporters state that the organization has been hobbled for structural and political reasons, and become timid as a result. One stated W.H.O needs new international leadership, new health alliances, and greater control over its budget.”
• The United States has also been “a thorn in the side” of the W.H.O. over the years, blocking some of its efforts on access to medicines or watering down global action plans on migrants and refugees.
• KKF says they are undergoing reform at the moment. This means they have probably gotten too big and too inefficient.
• Some member states have undue influence over the organization’s messaging, and after the Ebola outbreak that began in 2013, regional offices were seen as having inadequate autonomy to respond to the emergency, he said.

Moving on

Next, I wondered, who does the W.H.O. actually help? Are Americans (who are the largest donating member) beneficiaries? We have a high standard of health compared to the rest of the world, but there are many issues with poor health and health care access among poorer Americans, often people of color. It is not that I am opposed to helping people around the globe but I do hope we are also beneficiaries of W.H.O activities.

• Our primary role seems to be at a leader, providing governance and technical support and as a partner during global health emergencies
• However, at the onset of the current pandemic, it offered the U.S. testing kits, which we refused. A decision was made to develop our own.
• And, I found at their website some other U.S.-focused activity:

Compiling information as part of their global database

Tracking communicable disease trends

Responding to previous health emergencies like a Hepatitis A outbreak in Europe and the Americas
Written about maternal health and the obstacles to universal health coverage in the U.S

Disseminating information on things like homeless health issues and on asthma

What did the W.H.O. do in response to the pandemic? Among other things, like traveling to China and working with its leaders:

• Throughout January, the W.H.O. issued advisories about the dangers of the virus.
• Made test kits available, which the U.S. refused
• From Jan. 22 on, Dr. Tedros Adhanom Ghebreyesus, the W.H.O.’s Director General, held almost daily news briefings to warn the world that the virus was spreading, and that the window of opportunity to stop it was closing.
• For weeks, the W.H.O. issued guidance and warnings, and it officially declared the outbreak a pandemic on March 11, calling on governments to work together to battle the virus.

Criticism of the pandemic response

• Critics said both its declarations came too late, and that earlier decisions could have mobilized governments more quickly (the same accusations have been leveled at Mr. Trump, who was warned in January about a possible pandemic and who repeatedly praised the Chinese government for its handling of the virus).
• While the W.H.O. is intended to coordinate the worldwide response, there has been little global solidarity, showing the limits of its power. The organization had a plan, but few countries have hewed to it.
• It was too trusting of the Chinese government, which initially tried to conceal the extent of the outbreak, as the country has gained influence in the organization. Actual statements:

“This is an emergency in China, but it has not yet become a global health emergency,” Dr. Tedros said on Jan. 23. “It may yet become one.” On Jan. 30, the W.H.O. made the official declaration, which often prompts governments to take action. Soon afterward, the State Department warned travelers to avoid China.

So, that is the summary so far. I may add to it as the debate continues, which it surely will! The media will probably keep this ball in the air for as long as possible. It is the perfect liberal/conservative storm!