How the “Bureaucratic” World Health Organization found itself in the hot seat for its COVID response

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The United States announced this week that it is officially withdrawing from the World Health Organization – ending more than 70 years of participation and cutting its financial contribution, which is the largest among agency members. .The move comes after weeks of criticism from President Donald Trump for what he called the WHO’s inadequate response to the COVID-19 pandemic and its promotion of China’s “disinformation” about the virus.

The reaction to the withdrawal was both rapid and strongly divided. Health officials and critics of the US administration have called him dangerous – House Speaker Nancy Pelosi describing him as “an act of the real fool” – while Vice President Mike Pence, when Asked him in an interview with Fox News Tuesday if it was the right time to break up with the WHO, replied that it was “absolutely the right time”.

“The World Health Organization has let the world down … It must have consequences,” he said.

The American decision to withdraw does not take effect until July 6, 2021 and could be reversed under new administration or if circumstances change.

With so much conflicting information, it can be difficult to discern what’s going on behind the scenes. Here, CBC News explains how WHO really works.

How is WHO funded?

WHO began operating in 1948 as a specialized agency of the United Nations, succeeding a number of similar organizations established in response to the epidemics of cholera and other diseases around the world. To operate, it relies on two main sources of funding: statutory and voluntary contributions.

“WHO is ultimately a membership organization,” said Steven Hoffman, director of the Global Strategy Lab and professor of global health law at York University in Toronto. “It’s just that the members are from countries. ”

Instead of paying a predetermined amount, each Member State – of which there are 194 – pays contributions according to the size of their economy, or an “assessed” amount. Beyond that, members and individual donors can make voluntary contributions, which currently account for more than three-quarters of total funding, according to WHO.

These funds are often used for specific purposes which, according to Hoffman, “can create a lot of rigidity”.

As the organization tries to direct responses to a variety of health threats, it can become difficult to move funds when the consensus changes, “because 80% of its budget is linked to specific issues that its donors have,” did he declare.

The United States is currently the main contributor to the organization, although it still owes WHO some US $ 200 million in current and past contributions. In June, China was behind about 30 million dollars, WHO documents indicate this.

How does the organization make decisions?

“It’s a complicated bureaucratic monolith,” said Raywat Deonandan, associate professor and epidemiologist at the University of Ottawa.

Deonandan, who has consulted for WHO in the past, said that while the organization engages in education, research and general orientation campaigns, it is particularly effective in bringing together experts from around the world. across international borders.

This represents a large part of the way it reacted to the COVID-19 pandemic – setting up working committees to determine how to approach a scenario, then publishing documents and opinions on how to proceed, a- he declared.

Still according to Deonandan, the general criticisms against the WHO have merit. Since it attracts scientists and healthcare professionals from around the world, “they are deeply rooted in the medical paradigm,” which can cause them to respond slowly to urgent threats, he said.

“There is a distinction between a clinical and medical way of thinking and a way of thinking in public health and in population health,” he said.

In general, WHO waits for scientific consensus before issuing recommendations, which is more typical of clinical practice and can take years to achieve.

A child wearing a protective mask waits to be tested in May for the coronavirus in Bela Vista do Jaraqui, in the Amazonian city of Manaus, Brazil. Brazil is behind only the United States in confirmed COVID-19 cases and deaths. (Bruno Kelly / Reuters)

“In a public health emergency such as a pandemic, you stand on a railroad track and a train heads for you,” said Deonandan. “You can’t really stop and understand things the way you want. You must jump off the track immediately. ”

The agency’s approach led to criticism, for example, of waiting too long before declaring COVID-19 a pandemic and slow recommendations to change on the wearing of masks, and inspired an open letter from hundreds of scientists. asking WHO to approach the airborne transmission of COVID-19.

“What we see with the WHO is that they are so stuck in this first evidence-based and evidence-based paradigm,” said Deonandan.

Who has the most influence on WHO?

With so many different members, private donors and international health concerns, it is difficult to determine the greatest influence on the organization. Officially, the World Health Organization is chaired by the Director General – currently Dr Tedros Adhanom Ghebreyesus – who is elected by the Member States for a five-year term.

During the COVID-19 pandemic, he and the organization as a whole were strongly criticized for allegedly taking too much direction from China, where the disease was first identified.

Ghebreyesus announced Thursday that the WHO will set up an independent panel to review its management of the pandemic. He also said the review was not related to the United States’ withdrawal decision.

The WHO Ghebreyesus addresses journalists in Geneva in January, at the very beginning of the new epidemic of coronavirus. He announced Thursday that the agency will set up an independent panel to review its response to the pandemic. (Denis Balibouse / Reuters)

But there is a widespread belief that China currently exerts a disproportionate influence on the WHO, said Deonandan. At the same time, he noted, the United States has exerted considerable influence over the agency because of its financial contributions.

Hoffman also identified the United States as the country with the most direct influence on WHO’s actions.

“It is somewhat surprising that the United States says that China has exercised an undue influence on the organization,” said Hoffman, “while most commentators have expressed the same concern about the United States. ”

Despite the policies of the wealthiest countries, the decision on which issues to address is most often made by low-income countries, where resources are most needed, said Deonandan.

“To say that these are the puppets of the Americans, or the puppets of the Chinese – it’s not really how it works. “

How is he held accountable?

WHO is primarily held accountable by its member states. The organization monitors itself through its governing bodies, such as the World Health Assembly, the Executive Board and regional committees.

It is common for the World Health Assembly to conduct a post-pandemic review of “if things have gone well,” like the one recently announced, said Hoffman. Ultimately, however, it is still fundamentally up to member states to act if they feel the organization is failing in its mandate.

“In the end, of course, the check stops with who writes the checks,” said Deonandan. “So, member states, you still have the option, as the Americans are now showing, to stop writing checks. “

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