Trump's critique of WHO may be a diversion, but it resonates beyond the White House

On Tuesday, in the middle of a global pandemic, Trump announced that he is freezing funding to the United Nations agency, pending a review of its novel coronavirus response. The decision shocked even some who have been critical of the organization's handling of the crisis, particularly in relation to China. 

To many, Trump's allegations sound like an opportunistic effort to divert attention from his own early plaudits of China and the WHO and to deflect criticism of his sluggish response to the virus - even after the WHO eventually declared a pandemic.

But criticism of how the WHO handled China is resonating well beyond the White House.

In the early days of the crisis, the WHO amplified Chinese claims and figures without signaling that they could be inaccurate. The organization was slow to address the risk of human-to-human transmission, slow to declare a public health emergency and slow to use the term "pandemic." 

And it was quick to praise Beijing. As evidence mounted that China silenced whistleblowers and undercounted cases, Tedros Adhanom Ghebreyesus, the WHO's director general, continued to heap compliments on Beijing and dodged questions about worrying problems with the Chinese response.

"You had the authority, you had the ability to challenge China, to question China as to what they were doing, and you needed to do that for global health," said David Fidler, an adjunct senior fellow at the Council on Foreign Relations who has written about and worked with the WHO for years, referring to the organization. "You failed to do it." 

Japan's deputy prime minister recently called the WHO the "China Health Organization." As of Wednesday evening, nearly 1 million people had signed an online petition calling for Tedros to resign.

This is partly a problem of expectations. The Geneva-based organization does many things well, but it is not particularly well equipped to guide the world through a pandemic.

The agency, founded in 1948, was designed to promote global health, and it typically has been praised in its efforts - particularly in the developing world - to expand vaccination programs for tuberculosis, polio and other infectious diseases. It is less adept in the kind of crisis currently gripping the world.Inan emergency - when decisive action is necessary - the WHO can coax and cajole, but it cannot compel its members to do much. It also cannot issue fines for noncompliance, for instance.

Since January, the WHO has been at the center of the global response, convening experts, disseminating research and urging countries to "test, test, test." The organization has been praised for some of its technical work, most notably quickly distributing a test to more than 70 laboratories worldwide - a test the United States chose not to use. The WHO also has shipped almost 2 million protective gear items to 74 countries, Tedros said, and plans to ship more.

It is not surprising to some who support the WHO's mission that Trump has chosen to focus exclusively on the organization's apparent failings during this pandemic. 

"I think it's a diversion from the fact that the U.S. did not respond as aggressively or as appropriately as we should have," said Jimmy Kolker, a former U.S. ambassador who served as assistant secretary for global affairs at the Department of Health and Human Services until 2017. 

"There are lots of reasons for that," he continued. "A minor one is that some of the information about what was happening in China was withheld longer than it should have been."

But even the organization's defenders, including current and former advisers, have questioned why the WHO kept lending credibility to China when it could have expressed more skepticism.

"That is what should have happened," said Lawrence Gostin, a professor of global health law at Georgetown University, who also provides technical assistance to the WHO. "That was WHO's responsibility."

A WHO spokesman put the onus on member states to provide truthful information. 

"WHO expects all its member states to report data in a timely and accurate manner," Tarik Jasarevic said. "We have from the very beginning urged all countries to share data in a timely fashion, and we continue to do so."

Public health advocates responded strongly after Trump's announcement and worried that the funding freeze could have a catastrophic impact. Democrats in the United States said that the president does not have the legal authority to withhold money already approved by Congress. The president's decision, said House Speaker Nancy Pelosi, D-Calif., is "dangerous, illegal and will be swiftly challenged."According to the State Department, the United States has committed to providing the WHO with $893 million during its current two-year funding period. (China has committed to $86 million during the same period.)

"Halting funding for the World Health Organization during a world health crisis is as dangerous as it sounds," Bill Gates, Microsoft co-founder and co-chairman of the Bill & Melinda Gates Foundation, tweeted Wednesday. "Their work is slowing the spread of COVID-19 and if that work is stopped no other organization can replace them. The world needs @WHO now more than ever." 

Even those who have been critical of the WHO urge the Trump administration to reconsider. 

German lawmaker Norbert Röttgen called the organization's treatment of China "concerning" but said those concerns should be addressed when the crisis is over. This is not the time to freeze funding, he said in a tweet. Doing so "will harm those countries most that are least equipped to help themselves."

And a freeze, warned Kristine Lee, an associate fellow at the Center for a New American Security, won't necessarily lead to results that Trump or his administration would welcome. Trump's retreat from the WHO, she said, "makes it easier for Beijing to step in."

- - -

The WHO's approach to emergency response was indelibly shaped by China's attempts to conceal the 2002 SARS outbreak.

In the wake of that crisis, updated rules empowered the organization to consider nonstate sources of information, such as details from nongovernmental groups on the ground, to assess threats. The goal: preventing coverups. It is not clear whether that has worked in the case of the coronavirus.

In late 2019, Chinese doctors in Wuhan started discussing a SARS-like ailment that was spreading through hospitals. They were detained for spreading rumors and shamed on state television.

China notified the WHO on Dec. 31 that there was a mysterious pneumonia in Wuhan. On Jan. 5, the organization issued a statement saying that China had reported 44 cases. Chinese investigators reported no evidence of human-to-human transmission, the WHO statement said, or spread among medical workers.

In a Jan. 14 tweet that Trump referenced last week, the WHO said Chinese authorities had still found "no clear evidence" of person-to-person transmission. There was no hint of skepticism or comment about the detention of doctors.

There were also signs that China was undercounting cases. From Jan. 11 to Jan. 17, for instance, Hubei province, then the epicenter of the outbreak, held a Communist Party conclave. Each day during that time, the Wuhan Health Commission said that there were no new infections or deaths. At midnight on Jan. 18, it resumed reporting cases - a gap that raised eyebrows among scientists and researchers.

If the WHO was concerned about the figures, it did not say so. "WHO just routinely repeated as if it were its own information, as if it were verifying it," said Gostin, the Georgetown law professor.

"WHO is reliant on member states for data, but it could have noted gaps in the data or simply noted that they were not able to independently verify it," he continued. "By uncritically citing Chinese data, WHO officials lent credibility to information that was false." 

In the meantime, the virus kept spreading, unchecked. It was not until Jan. 20 that Chinese officials acknowledged that the virus was spreading person to person. By that time, Wuhan was in crisis, and confirmed cases were in multiple Chinese cities, Japan, Korea, Thailand and - later that day - the United States. 

In Geneva, an emergency panel convened to decide whether to declare a public health emergency of international concern, or PHEIC, a post-SARS term that signals a health crisis "that poses a public health risk to other countries through international spread."

On Jan. 23, while the panelists were gathered, Chinese officials began locking down Wuhan. Officials in Geneva wrestled with whether to declare a PHEIC, weighing Chinese pushback about economic damage and assurances that everything was fine. 

The committee was split but decided that it was not an emergency, surprising public health experts.

The panel waited until Jan. 30 - a full month after Chinese doctors issued a warning - to make the declaration. "The Chinese government is to be congratulated for the extraordinary measures it has taken," said Tedros, the WHO chief. "I left in absolutely no doubt about China's commitment to transparency."

- - -

In February and March, as evidence of a coverup intensified, the WHO continued to praised Beijing, baffling some experts. 

By late January, for instance, Chinese officials acknowledged that they should have acted sooner. But the WHO and Tedros assured the world that they were doing great. 

After meeting privately with Xi on Jan. 28 in Beijing, Tedros lauded the country's handling of the outbreak, according to the state-run Xinhua News Agency, and the effectiveness of "China's system."

Some say that the flattery was strategic to allow an international team of doctors, scientists and observers to enter the country. But when a WHO team finally made it to China in mid-February, Tedros and his team did not modulate their tone.

At a news conference after an international team visited, Bruce Aylward, the head of the mission, called China's work "stunning," "extraordinary" and "successful."

While there were certainly elements of China's response that were worthy of study, WHO watchers were surprised to hear Aylward praising measures, such as travel bans, that the organization opposed. 

They also wondered why Tedros waited until March 11 to say that covid-19, by then ravaging multiple continents, was a pandemic. In public remarks, the WHO's leadership sometimes stayed mum on basic matters of human rights. 

At one news conference, Tedros was asked about China, including thedeath of a Chinese doctor whoalerted colleagues about thevirus, only to be detained by police. He first deferred to a colleague, then took the chance to speak. "It is very difficult, given the facts," he said, "to say that China was hiding."

- - -

The organization's messaging has been a boon for conservative critics of multilateral organizations, including Trump.

Former national security adviser John Bolton tweeted Friday that the WHO has been "fully penetrated by the Chinese," echoing conservative claims that the agency and its leader have been co-opted. 

There is no evidence that Tedros is directly acting at Beijing's behest. Trump echoed the WHO's praise for China by applauding Beijing's transparency on Jan. 24, brushed off concerns about a coverup on Feb. 7 and on March 4 said China had the situation under control. 

What is striking is the extent to which the WHO's China messaging has overshadowed more successful elements of its response, eroding the agency's credibility just when it needed it most. 

Some critics have called for the agency to be scrapped. "What would you replace it with?" asked David Heymann, a professor of infectious-disease epidemiology at the London School of Hygiene and Tropical Medicine who also advises the WHO. "Would it ever be possible to have 194 countries agree to a new organization?"

Kelley Lee, a professor at Simon Fraser University in Canada who wrote a book about the WHO and co-established the WHO Collaborating Center on Global Change and Health, said the coronavirus pandemic shows the need for a well-funded, capable agency. A robust WHO is "going to be much cheaper than the trillions of dollars we're seeing splashed out now," she said.

"It's pay now or pay later."