{"id":47222,"date":"2020-04-17T13:55:38","date_gmt":"2020-04-17T12:55:38","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=47222"},"modified":"2020-04-21T13:34:24","modified_gmt":"2020-04-21T12:34:24","slug":"trumping-the-world-health-organization-what-does-it-mean","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/trumping-the-world-health-organization-what-does-it-mean\/","title":{"rendered":"Trumping the World Health Organization\u2014what does it mean?"},"content":{"rendered":"<p><span style=\"font-weight: 400\">We all know Donald Trump is impulsive. His sudden decision to stop funding the World Health Organization just days after calling it \u201cvery China-centric\u201d and \u201c<\/span><a href=\"https:\/\/www.whitehouse.gov\/briefings-statements\/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-briefing-april-7-2020\/\"><span style=\"font-weight: 400\">wrong about a lot of things<\/span><\/a><span style=\"font-weight: 400\">\u201d is the latest example. And this in the midst of the worst global pandemic since Spanish flu in 1918 and a looming economic crisis compared by some to the 1930s.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">But the decision is not really just about what WHO might or might not have done wrong. It is more about the ongoing geopolitical wrangle between the US and China, and about diverting attention from US failings in its own response to covid-19 in the run-up to the US presidential election. It clearly also derives from Trump\u2019s deep antipathy to almost any multilateral organization. WHO has been chosen as the fall guy in this political maelstrom in a way that might please Trump\u2019s supporters who will have read or heard little about WHO\u2019s role in tackling this crisis. And the decision has been widely condemned in almost all other countries and by many in the US.<\/span><\/p>\n<p><span style=\"font-weight: 400\">So what is it likely to mean in practice for WHO? Calling a halt to funding for an unspecified time is an unsatisfactory half-way house. A so-called <\/span><a href=\"https:\/\/www.whitehouse.gov\/briefings-statements\/president-donald-j-trump-demanding-accountability-world-health-organization\/\"><span style=\"font-weight: 400\">fact sheet<\/span><\/a><span style=\"font-weight: 400\"> put out by the White House talks about the reforms it thinks necessary \u201cbefore the organization can be trusted again.\u201d This rather implies that the US wants to remain a member of WHO if it can achieve the changes it wants. Whether those changes are feasible is another question\u2014they include holding member states accountable for accurate data sharing and countering \u201cChina\u2019s outsize influence on the organization.\u201d Trump said the funding halt would last while WHO\u2019s mismanagement of the coronavirus pandemic was investigated, which would take 60-90 days.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The US is the single largest funder of WHO, providing about 16% of its budget. It provides funds to WHO in two ways. The first is the <\/span><i><span style=\"font-weight: 400\">assessed contribution\u2014<\/span><\/i><span style=\"font-weight: 400\">the subscription each country pays to be a member. In 2018\/19 the US contribution should have been $237 million, but as of January this year it was <\/span><a href=\"https:\/\/www.who.int\/about\/finances-accountability\/funding\/account_statement\/2020\/usa_en_2020.pdf?ua=1\"><span style=\"font-weight: 400\">in arrears<\/span><\/a><span style=\"font-weight: 400\"> by about $200 million. Much bigger are US <\/span><i><span style=\"font-weight: 400\">voluntary contributions<\/span><\/i><span style=\"font-weight: 400\"> provided to WHO for specified activities amounting in the same period to another $650 million. These are for a <\/span><a href=\"http:\/\/open.who.int\/2018-19\/contributors\/contributor\"><span style=\"font-weight: 400\">wide variety of projects\u2014<\/span><\/a><span style=\"font-weight: 400\">over a quarter goes to polio eradication, but a significant portion also is for WHO\u2019s emergency work.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The US assessed contribution represents only 4% of WHO\u2019s budget. Losing that would certainly be a blow to WHO but a manageable one. Given the arrears situation it is not certain that the US would have paid any of this in the next three months in any case.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">More serious would be losing the US voluntary contributions which account for about another 12% of WHO\u2019s budget\u2014but whether this could be halted all at once is very unclear. First Congress allocates funds in the US, not the President, raising questions about how a halt could be engineered domestically. Secondly, US contributions to WHO come from about 10 different US government agencies, such as the National Institutes of Health or USAID, each of whom have separate agreements with WHO. Will they be prepared to cut funding for ongoing projects with WHO? And does the US want to disrupt ongoing programmes such as polio eradication and, indeed, emergency response which contribute to saving lives?\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Given the President\u2019s ability to do 180 degree<\/span><span style=\"font-weight: 400\">\u00a0<\/span><span style=\"font-weight: 400\">U-turns we shall have to wait and see what will actually happen in the medium term. If it presages the US leaving WHO, this would only facilitate growing Chinese influence in the WHO and other UN bodies. Perhaps in the end wiser advice will be heeded and a viable solution found.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Most of President Trump\u2019s criticisms of WHO do not bear <\/span><a href=\"https:\/\/www.bbc.co.uk\/news\/world-us-canada-52294623\"><span style=\"font-weight: 400\">close scrutiny<\/span><\/a><span style=\"font-weight: 400\">. WHO may have made mistakes\u2014it may have given too much credence to information coming from the Chinese. China has just <\/span><a href=\"http:\/\/www.xinhuanet.com\/english\/2020-04\/17\/c_138984653.htm\"><span style=\"font-weight: 400\">announced<\/span><\/a><span style=\"font-weight: 400\"> that the death toll in Wuhan was 50% higher than previously revealed. It may have overpraised China\u2019s performance and system, but this was part of a deliberate strategy to secure China\u2019s active collaboration so that it could help other countries learn from China\u2019s experience.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The chief message from this sorry story is that two countries are using WHO as a pawn in pursuing their respective political agendas which encompass issues well beyond the pandemic. China has been very successful in gaining WHO\u2019s seal of approval, in spite of concerns about events prior to it declaring the problem to the WHO and the world. This, in turn, has invited this retaliation from the US.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">When this is over will be the time to learn lessons about what WHO should have done better. But China, the US, and the global community of nations also need to consider their own responsibility in contributing to this terrible unfolding tragedy.\u00a0<\/span><\/p>\n<p><em><strong><span class=\"il\">Charles<\/span>\u00a0<span class=\"il\">Clift<\/span><\/strong>\u00a0is a Senior Consulting Fellow at the Centre for Universal Health at Chatham House. He has previously been a staff member at the World Health Organization as well as consulting for the. In 2014 Chatham House published a report he wrote on the WHO \u201c<a href=\"https:\/\/www.chathamhouse.org\/publication\/what-s-world-health-organization\" target=\"_blank\" rel=\"noopener noreferrer\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=https:\/\/www.chathamhouse.org\/publication\/what-s-world-health-organization&amp;source=gmail&amp;ust=1587213712953000&amp;usg=AFQjCNG-pNwCBDnCm1NCMNDDZQjIEjRWTg\">What\u2019s the World Health Organization For?<\/a><\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: None declared.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>We all know Donald Trump is impulsive. His sudden decision to stop funding the World Health Organization just days after calling it \u201cvery China-centric\u201d and \u201cwrong about a lot of [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/trumping-the-world-health-organization-what-does-it-mean\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":46578,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263],"tags":[],"class_list":["post-47222","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-global-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trumping the World Health Organization\u2014what does it mean? - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/trumping-the-world-health-organization-what-does-it-mean\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trumping the World Health Organization\u2014what does it mean? - The BMJ\" \/>\n<meta property=\"og:description\" content=\"We all know Donald Trump is impulsive. 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