When US President Donald Trump announced on 15 April he was cutting his country’s funding contribution to the World Health Organisation (WHO), he defended his action in terms of a punishment for the UN institution being beholden to China — which Trump claims is responsible for “severely mismanaging and covering up the spread of the virus”: Worldwide Confirmed Coronavirus Cases Top 2 Million.

On 23 April, China responded by promising the WHO $30 million in new funding: China pledges additional $30 million funding for World Health Organisation.

While this game of blame is bipolar and geopolitical in this instance, it is far more a broader reflection of a more nefarious emerging competition: that of nationalism versus multilateralism.

Though nationalist China is pledging money to a multilateral WHO, it is not a triumph of multilateralism, but rather a return of nationalism.

The tenor in the US

The Trump administration’s shifting of blame onto the WHO comes after his government’s failure to gauge and engage with the severity of Covid-19 and its slow and disorganised response.

Yet, at a broader level, the US’s withdrawal of funding is just another turn in the wider game of nationalistic political chess in US-China relations; a game riddled with vitriol, self-serving agendas and one-upmanship as both countries deploy their political currency on the global stage.

Clearly, there are some indications of this in early responses to Covid-19 in both countries. It partly explains why Trump now wants to punish the WHO.

Blaming the WHO for the US’s current predicament is another instance of poor leadership in the context of a crisis. By all accounts, Trump’s administration was slow to respond in spite of internal calls from key advisors to act as early as January 2020. Instead, the administration only began to act six weeks later — at the end of January.

Then, its first concrete action was to limit travel from China; though this was not coupled with the necessary follow-up to make a real dent in the spread of the virus. The administration repeatedly played down the seriousness of the virus; the most significant efforts being directed at protecting gains in the US economy.

Decision-making in the US administration was also complicated by a long-running dispute over trade talks with China, which seemed to be the overriding priority. The political heat on China has increased with Missouri, a US state, now suing China over its handling of the coronavirus.

The current in China 

China’s early response to the coronavirus threat has also been widely criticised — both by the international community and its own citizens — for silencing doctors in Wuhan, where the outbreak surfaced in late December. The government was also seen to be guilty of not promptly sharing details about the discovery of a new coronavirus, suppressing information and even punishing those who raised the alarm (China was slammed for initial COVID-19 secrecy, but its scientists led the way in tackling the virus).

However, for the Trump administration, the virus initially took a backseat, with a desire not to upset the applecart in ongoing trade talks, even though these were yielding little. In February, Trump repeatedly praised Chinese President Xi Jinping’s response to the virus crisis, saying he had handled it “really well” and that was doing “a very good job with a very, very tough situation”: Trump repeatedly praised China’s response to coronavirus in February.

China did in late February welcome a team of international scientists, organised by the WHO, to tour the country and learn about the spread of the virus and the government’s response — which led to a widely shared report. Since then, China’s scientists have won acclaim for hitting several key milestones in understanding the fast-moving virus.

Yet, as political tensions mount on home fronts, countries like Australia are calling for a probe into the origin of Covid-19, signalling suspicions about the accuracy of China’s early reporting on the coronavirus, with diplomatic rifts now also been seen in Euro-China relations (China’s Coronavirus Diplomacy Has Finally Pushed Euro…). This is a growing concern for China as it tries to take leadership on the global stage in responding to Covid-19.

 The role of the WHO

The politicisation of the Covid-19 pandemic has inevitably cast a spotlight on the WHO, the international agency mandated by the UN to deal with international public health emergencies.

The organisation was sounding alarm bells in early January, amid growing anxiety about the global threat, and the disease was declared an international health emergency on 30 January, with pandemic status declared on 12 March.

Since 2017, the WHO has prioritised disease outbreak “preparedness and response” after painful lessons learnt during the Ebola crisis, during which the agency was seen as not nimble enough for rapid responses to fast-moving outbreaks. Some of this was attributed to tensions in relationships between headquarters, regional and country offices.

While many crucial lessons have been learnt since then, improvements in relationships alone cannot make up for long-standing concerns that the funding of the WHO – much of which is earmarked for specific programmes by donor countries — is not commensurate with the global role it is supposed to play. The annual budget for the WHO is about $4.2  billion, with the money coming from member countries around the world and the US contributing a significant $553 million.

As the Covid-19 outbreak shows, countries’ expectations for the WHO – particularly to coordinate an international response to a pandemic — are not aligned with the limitations on its funding. This becomes painfully obvious when the WHO is put under political and legal pressures by its critical funders, on whom it depends: www.sciencemag.org.

The WHO has faced a number of institutional challenges before, including an increased scope of responsibility that has grown over time in the context of a stagnant budget; a less flexible budget with much greater reliance on voluntary contributions, often earmarked for specific activities; a cumbersome, decentralised and bureaucratic governance structure; and a dual mandate of being both a technical agency with health expertise and a political body where states debate and negotiate on sometimes divisive health issues. Even so, the agency has done much more than many expected during this world health crisis, with the agency’s resources being stretched like never before.

Given that the world is uncertain when Covid-19 will end, it is crucial that WHO continues to remain fully operational. In order to do this, it must pass two tests:

First, as an agency whose authority is based on the consensus of 193 national states, with only a few being large donors, it has to manage high-level and sensitive political relationships with countries and other multilateral agencies precisely because it depends on their largesse.

Though the agency has been criticised for not been tough enough on China during the early outbreak of Covid-19 in Wuhan, it has thus far played a constructive role by “holding the centre” in managing the global response while tensions on home fronts across the planet mount as countries feel the weight of Covid-19.

The agency has produced timely situation reports and come to the aid of countries in need. Its first solidarity flight (First UN solidarity flight departs Addis Ababa carrying vital COVID-19 medical supplies to all African nations) to Ethiopia carrying medical supplies to help that country fight Covid-19, is an example. This WHO cargo included a million face masks and other personal protective equipment — enough to protect health workers treating more than 30,000 patients across the African continent — and laboratory supplies to support surveillance and detection. More efforts of this nature will be undertaken in the coming months to low-resourced regions of the globe. A key concern for the international community is that if the WHO is entangled in a political and funding crisis its leadership will be compromised in taking urgent action at this time, with low- and middle-income countries being the major losers.

Second, WHO donors have historically earmarked their contributions for particular uses. This has decimated the WHO’s core budget, leading it to curtail many of its epidemiological and infectious disease – pandemic – response programmes. One outcome of the post-Ebola review was to reform this practice, but it has not happened to a serious enough extent.

Such reform is challenging, made more so under global emergency conditions. The operational capacity of the Health Emergencies Programme (HEP) has been severely affected. While it is doing the best it can, a real test for the HEP will come as the virus takes root in Africa and in the context of prevailing diseases HIV/AIDS and TB, not to mention outbreaks of Ebola and yellow fever.

Given the rising geopolitical tensions between the major powers, the WHO needs to meet this challenge with keen diplomatic savvy, strong technical capacity and, above all, hold its independence despite pressures to do otherwise. Multilateral institutions, the WHO chief among them, are crucial to any response to a global pandemic. However, to meet the challenge of geopolitical finger-pointing, a successful multilateral response hinges on three imperatives:

• A narrative that elevates not just individual human health and protection, but one of global solidarity and human – all human – security
• An end to earmarked contributions in favour of a centralised budget under the equal decision-making of each member state in the World Health Assembly
• The issuing of globally accessible pandemic bonds conditioned to implementation of the International Health Regulations (IHRs, universally agreed to in 2007)
• A re-examination of the IHR metrics given that countries like the UK and US, who currently score high on health systems preparedness to respond to public health emergencies, have not adequately coped with Covid-19.

This is not a time to pull the plug on the WHO; the consequences for countries fighting Covid-19 would be dire. To bridge the gap between the US and China, but more importantly for human health and human security, Africa and Europe should step up and support the WHO. DM

Kaymarlin Govender is research director of the HEARD Institute at the University of KwaZulu-Natal. Annamarie Bindenagel Šehović  is an honorary research fellow in politics and international studies at the University of Warwick in the UK.