From fighting Ebola to trying to wipe out polio, U.S. pullout from WHO will have tangible impact: experts

From fighting Ebola to trying to wipe out polio, U.S. pullout from WHO will have tangible impact: experts
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Ebola is a truly horrible disease, but the 2018-19 outbreak of the virus in the Democratic Republic of Congo was particularly chaotic, as health workers tried to save lives amid an ongoing civil war.

There could have been even more disarray, says Dr. Srinivas Murthy, had the World Health Organization not marshaled the various medical aid groups as they came under violent attack.

“The WHO effectively coordinated so many different NGOs in a very complicated area,” said the University of British Columbia intensive-care specialist, who worked on a previous Ebola epidemic in West Africa. “While, yes, it took a long time to get the outbreak under control, they were able to basically be the point people.”

The organization played a similar role when diphtheria swept through Rohingya refugees in Bangladesh recently and leads a program that is close to eradicating polio, he said.

It is that kind of work, Murthy and other experts argue, that will be in jeopardy if President Donald Trump follows through on his pledge last week to pull the United States out of the agency. Murthy has held various consulting positions with the WHO.

The organization has been repeatedly criticized over the years for a number of shortcomings, but even critics say the loss of its largest funder would have tangible negative effects.

While the WHO has gained an over-sized profile in the developed world because of COVID-19, much of its work is in poorer countries, helping battle diseases like HIV, tuberculosis and malaria in places that lack their own public-health infrastructure.

The U.S. supplies about 15 per cent of the organization’s budget and hundreds of seconded scientists and health workers.

Unless someone else fills the funding hole, “the WHO really will be financially in big trouble,” says Yanzhong Huang, director of the Center for Global Health Studies at New Jersey’s Seton Hall University.

And while Trump’s decision was based chiefly on his belief that China holds too much sway at the Geneva-based agency, a U.S. pullout could open the door for Beijing to inject more cash — and win additional influence.

“In spite of the rhetoric, the biggest beneficiary of the president’s move will almost surely be China,” wrote Dr. Ashish Jha, director of the Harvard Global Health Institute and a sometime-critic of the WHO.

The agency is funded with both “assessments” from countries based on their GDP — accounting for about 20 per cent of its budget — and voluntary contributions.

Many of the latter actually come from non-governmental organizations, the Gates Foundation being the second biggest overall contributor after the United States. Rotary International is also a major donor.

A health worker in Democratic Republic of Congo registers temperatures of people in July 2019, during an Ebola outbreak. The World Health Organization played an important role in handling the outbreak. Pamela Tulizo/AFP via Getty Images/File

The U.S. provided $893 million in assessments and voluntary contributions for the 2018-2019 funding cycle – about 15 per cent cent of the $5.6-billion total, according to WHO statistics.

Canada was the 14th largest donor for that period, tipping in $100 million. China was 46th, contributing $85 million.

The bulk of the U.S. slice of the pie was in the form of voluntary grants earmarked for specific programs, like polio and TB.

Trump criticized the WHO for bending to pressure from China as that country initially covered up and then downplayed the COVID-19 outbreak. An Associated Press report Tuesday added a new wrinkle to the story, saying WHO officials grew increasingly frustrated with China behind the scenes as it delayed releasing data on the new coronavirus.

In announcing the pullout, the president said the U.S. would redirect its funding “to other worldwide and deserving urgent global public health needs.”

The biggest beneficiary of the president’s move will almost surely be China

The agency has been criticized in recent weeks for too readily accepting China’s initial claim that COVID-19 couldn’t be transmitted person to person; arguing persistently against travel restrictions to slow the virus’s spread; and failing to recognize Taiwan’s much-praised response to the crisis.

It drew fire over other issues, too, before COVID-19. Its handling of the 2009 H1N1 flu pandemic was, ironically, deemed overly alarmist, yet its response to the 2013-14 Ebola outbreak in West Africa was considered ineffective.

Huang also questions some spending priorities, though they are often dictated by how voluntary donors direct their money. Polio eradication took up 27 per cent of the 2018-19 program budget — almost $1 billion — as the number of cases shrunk to a couple of hundred.

But doctors, academics and global-health experts familiar with the WHO point to much good work that would be hurt by a U.S. withdrawal.

Despite flaws in its approach, they say, it has played a crucial role in the current pandemic by, for instance, coordinating COVID-19 vaccine development efforts and organizing clinical trials of possible treatments.

WHO Director-General Tedros Adhanom Ghebreyesus delivering a speech via video link at the opening of the World Health Assembly virtual meeting from the WHO headquarters in Geneva, amid the COVID-19 pandemic. World Health Organization / AFP

It was key in the vaccination programs that wiped out smallpox in 1979, while the similar polio campaign is considered a major achievement despite its expense. The WHO is the de-facto public-health agency for countries that don’t have their own, said Murthy.

“As soon as you start defunding that approach, you create a vacuum where those countries don’t have a capacity to respond to outbreaks as well,” he said.

Dr. Rob Fowler, a Toronto critical-care medicine specialist who, like Murthy, is heading the Canadian arm of a WHO trial of COVID-19 treatments, has seen its importance in the developing world first hand.

“I have donated years of my time to organizations like and including the WHO for absolutely no pay — set up and worked in Ebola treatment units in West and Central Africa with the WHO,” he said. “Because no one else was there.”

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