Michael Merson, a professor of global health at Duke University and visiting professor of global health at New York University, directed the Duke Global Health Institute from 2006 to 2017. He was dean of the Yale School of Public Health from 1995 to 2005. He directed the World Health Organization Global Program on AIDS from 1990 to 1995 and is the author of “The AIDS Pandemic: Searching for a Global Response.”
The White House alleges that the World Health Organization in Geneva is partially to blame for the covid-19 pandemic and has suspended U.S. funding pending a review of its actions. It accuses the WHO of being China-centric and slow to criticize China for not reporting early cases of the disease. The administration is angry at the WHO’s criticisms of early travel restrictions the U.S. government imposed on foreign travelers coming from China and, later, Europe.
These accusations are unjustified and dangerous. In early January, six days after being informed about cases of mysterious pneumonia in Wuhan, China, the WHO began to prepare for an emergency. It informed and started giving advice to countries, and it organized the visit of a technical team to Wuhan. By the end of January, the WHO declared a “public health emergency” of international concern. Furthermore, its caution against travel restrictions was directed broadly, not solely at the United States, and was based on data. Sound, evidence-based research had demonstrated that travel restrictions were ineffective in most situations in keeping viruses out of countries, that such restrictions could interrupt needed aid and technical support, and that they might inflict social and economic harms on countries. Recall that the United States faced some of these consequences when other countries imposed bans against travelers from North America during the 2009 H1N1 pandemic.
This is not to say that the WHO has not had its problems. It did not declare the coronavirus outbreak a pandemic until mid-March. Its response to the Ebola outbreak in West Africa in 2015 was delayed, and justified concerns have been expressed over the years about its expenditures, organizational structure and governance. However, the election in 2017 of Tedros Adhanom Ghebreyesus as its director general, the organization’s first leader from Africa, was viewed by many as a turning point in setting the WHO on a better path. In a short time, the Ethiopian physician greatly improved the WHO’s pandemic response capabilities and emphasized the importance of strengthening national health systems, which are a vital component of such a response. The organization has also acknowledged the need to make the International Health Regulations — the guidelines designed to prevent, control and respond to public health emergencies were last updated in 2005 after the severe acute respiratory syndrome (SARS) outbreak — more effective and timely. This should include creating a stronger mechanism to hold countries more accountable for reporting.
The covid-19 pandemic has had a profound impact on the world’s wealthy countries. The United States has by far the greatest number of cases and deaths to date. But the potential for much worse outcomes looms as the virus spreads to lower- and middle-income countries in Africa, Asia and Latin America. Populations in many of these countries lack water — as well as soap — to wash their hands, and many live in crowded conditions that make social distancing impossible. Moreover, their health systems have insufficient numbers of community workers to practice contact tracing and insufficient staffing, vital supplies or personal protective equipment to treat covid-19 cases in their hospitals. Those living in refugee camps are particularly vulnerable.
The World Health Organization is the main lifeline for these countries to avoid many millions of cases and deaths. The organization’s support is vital to provide accurate information on prevention and treatment, diagnostic tests and supplies. Its help is critical to strengthening surveillance systems and designing locally appropriate containment and mitigation strategies. Once there are an effective therapy and vaccine, the WHO will be responsible for certifying their use in these countries and ensuring adequate amounts are made available. With the advice of experts, the WHO has already laid out a comprehensive agenda for research that is needed to rapidly advance knowledge about the virus and the pandemic. The WHO is providing technical and other support for this research. No other organization in the United Nations system, or elsewhere, can fulfill these functions.
Abrupt suspension of U.S. government funding to the WHO would severely compromise its operations, exacerbating the pandemic and its global impact. This is wrong not only in humanitarian terms but also would make the world less safe for Americans, as the continued presence of many covid-19 hot spots would likely result in our experiencing second or third waves of the virus. This action by the U.S. government would, ironically, also guarantee China’s predominance in global health and development for years to come. Already having sent supplies to dozens of countries fighting covid-19, China has stepped into a leadership role traditionally filled by the United States.
Rather than withdrawing its support, the United States should gladly share with the world, through the WHO, the lessons we have learned from our considerable experience in prevention and treatment of covid-19 and in that way help to prevent much suffering and death.