WHO’s on First
How will Biden administration support for World Health Organization affect clinical research?
Claiming that the World Health Organization (WHO) responded too slowly to COVID-19 and failed to confront China properly about its lack of transparency and cooperation during the outbreak, Former President Donald Trump withdrew the United States from participating in the organization. Conversely, President Joe Biden, in one of the first acts of the new administration, rejoined WHO.
Established in 1948 as an agency of the United Nations, WHO includes 194 member states. It concentrates on providing health care, coverage and protection against health emergencies. The Geneva-based organization has an annual budget of about $2.4 billion, which is contributed by its member states. Ideally, the organization can serve as a window on world health, enabling countries such as the U.S. to have access to research on diseases and potential treatments all over the world. If there is potential for a disease to spread, everybody will be aware of it.
Some people are relieved about the President’s move. According to Karen Weintraub’s article in USA Today (https://www.usatoday.com/story/news/health/2021/01/22/scientists-applaud-biden-decision-rejoin-world-health-organization/4243377001/), WHO Director-General Dr. Tedros Adhanom Ghebreyesus said, "This is a good day for WHO, and a good day for global health."
Many prominent scientists agreed. Lawrence Gostin, director of the O'Neill Institute for National and Global Health Law at Georgetown University in Washington, said, "This is very good news for America, for WHO and the world." Barry Bloom, an immunologist at the Harvard T.H. Chan School of Public Health, said, "If we want to retain leadership in global health in the world, we can't not play with the rest of the world." Jen Kates, senior vice president and director of Global Health & HIV Policy at the Henry J. Kaiser Family Foundation, explained that the gesture had both symbolic and practical implications. U.S. funding will assist WHO in balancing its budget, fulfilling its commitments to bolster public health, and protecting Americans from new strains of COVID-19 and other disease. Additionally, the U.S. was WHO’s biggest source of funding and a key figure in global health.
According to Thomas Bollyky, director of the Global Health Program at the Council on Foreign Relations and adjunct professor of law at Georgetown University, completely withdrawing from WHO “would have done tremendous damage to the international institution charged with protecting us from this pandemic and future dangerous disease outbreaks. U.S. interests are better served inside WHO than outside it."
Alexandra Phelan, a member of Georgetown University’s Center for Global Health Science and Security, added, “The U.S.’s commitment to strengthening the International Health Regulations not only reinforces the U.S.’s return to multilateralism, but is also important to rebuild the norms of acceptable conduct by countries in responding to global health security threats. Committing the U.S. to a robust and clear investigation into the outbreak’s origins is critical political weight for WHO right now."
However, scientists and others have been critical of WHO and have cited suggestions for reform and transparency. If the U.S. is going to be the primary source of income for the organization, it needs to make that investment worthwhile.
Richard Marlink, director of Rutgers Global Health Institute, explained, “In practical terms, the U.S. contributes significant funding and leadership resources to the World Health Organization. Historically, the U.S. has been the WHO’s largest donor. We are in the worst pandemic the world has seen in 100 years, and we will need all the world’s strongest resources to pull ourselves out of it. One very concrete example is that the U.S. has finally agreed to participate in the COVID-19 Vaccine Global Access (COVAX), which is co-led by the WHO. This commitment by the U.S. will strengthen efforts to distribute vaccines in countries that otherwise have no or very limited access.” (https://www.rutgers.edu/news/impact-us-re-engaging-world-health-organization)
According to that agreement, the United States will donate surplus vaccines to the global effort. COVAX has 190 member countries, which will buy vaccine and arrange to vaccinate 20 percent of the most vulnerable people in the world's low- and middle-income countries. While COVAX has obtained promises of 2 billion doses of vaccine at a lower price, countries would not be able to vaccinate the majority of their population for at least another year. This has caused some countries to seek their own sources of vaccine. They include Chinese and Russian vaccines not scientifically proven safe and effective. Some countries are also paying companies a premium to gain priority status for the vaccine. By rejoining WHO, the U.S. may benefit from getting more vaccine sales as well as protection from new strains of the vaccine that are circulating elsewhere in the world.
Another issue cited by critics is that the WHO did not force China to be more transparent about the pandemic. Now a team of scientists from the WHO has arrived in China to study and understand the origins of the SARS-CoV-2 virus, which was first detected in Wuhan, China, in late 2019. In order to be effective, scientists say that the WHO needs to be reformed to give it more power to monitor threats, including emerging viruses. If the country of origin us not sharing information or cooperating with the global community, the organization needs to address the problem. Had WHO been able to observe the origins of the virus in China in late 2019, there would have been a much better chance to prevent the global pandemic that ensued.
Critics of the desire to get back into the WHO without guidelines think that the U.S. must agree to provide more funding. While the U.S. is the WHO’s major sponsor, the budget is untenable for serious research. In order to do the kind of global research a strong WHO could offer, the effort at global health monitoring is not where some scientists think it should be.
"Right now, the world and America has the WHO we deserve," he said. "We underfund it, we don't politically support it, we turn our back when countries violate WHO norms. The fact that WHO isn't as strong as we want it is our own fault."
“Biden should have made clear that the U.S. expects better of the WHO and secured commitments from other governments on reforms prior to announcing his decision to renew funding and rejoin the WHO,” said Brett D. Schaefer, the Jay Kingham fellow in International Regulatory Affairs at The Heritage Foundation. (https://www.dailysignal.com/2021/01/21/a-rash-decision-to-rejoin-the-world-health-organization-before-securing-reforms/)
He concluded, “With the decision to reengage made, look for the WHO — and member states like China that oppose reform — to pocket U.S. partnership and money, and slow walk reform. The world deserves a WHO that is accountable and effective. By failing to tie U.S. membership and funding to reform, Biden squandered key leverage and made this outcome less likely.”