LESS THAN PERFECT
In April, Trump sent a letter to the director-general of the WHO, Tedros Adhanom Ghebreyesus, demanding within 30 days “major substantive improvements” meant especially to establish the WHO’s independence from China. In announcing last week that he was terminating the United States’ relationship with the WHO, Trump attributed his decision to its failure to undertake the requested reforms—despite a resolution by the WHO’s governing body, the World Health Assembly, to conduct an independent evaluation of its COVID-19 response. Apart from the virtual impossibility of the president’s demands—that an organization comprising nearly every government in the world make substantial reforms within a month while responding to a global health crisis—the charges were frequently false and misleading. Trump asserted that the WHO knew of the novel coronavirus’s human-to-human transmission by December 31; it did not. And he claimed that the WHO was aware of the virus spreading in Wuhan in December based on reports in The Lancet medical journal; there were no such reports. This is not to say that all of Trump’s criticisms of the WHO’s actions and its relationship with China are misguided. The organization (and Trump) did praise Beijing for its transparency in late January, by which time the world was fully aware that China had suppressed information about the virus’s spread. And the United States, along with other countries, including Canada, is correct to call for Taiwan to be invited as an observer at the WHO; Taiwan has much to offer, including the tactics from its effective COVID-19 response, and it deserves a seat at the table. But critics must remember that, as an intergovernmental body, the WHO is inherently a political organization. The WHO is governed by governments, and with nearly 80 percent of its budget funded through voluntary contributions, it has limited room to maneuver. And although the WHO’s member states could and should cede more authority to the organization, they have not done so. The truth is that the WHO has no power to independently verify official government reports, nor can it conduct an investigation on a sovereign government’s soil without its permission. Indeed, early in the coronavirus outbreak, China blocked personnel from the WHO and the United States Centers for Disease Control and Prevention from going to Wuhan. WHO officials themselves were deeply frustrated at the lack of data that China was providing and debated how best to press for more information without losing access.
PAY UP
The United States’ departure from the WHO is not as simple as Trump assumes. Legally, the president cannot just withdraw unilaterally from the organization. After the United States helped draft the WHO’s constitution, it joined the organization in 1948 under a joint congressional resolution specifying that the United States could withdraw if it both provided one year’s notice and fully met the current year’s financial obligations. That resolution also authorized annual State Department appropriations for U.S. membership, thus invoking both Congress’s power to approve treaties and its power of the purse. So the law is clear: for at least a year, the United States cannot withdraw from the WHO and is still a member. By this time next year, Joe Biden may be president and could rescind the United States’ withdrawal notice. Nor does the law permit Trump to immediately suspend funding that Congress has already appropriated, including the remainder of the United States’ 2020 dues, roughly $60 million, since Congress’s 1948 resolution bars U.S. withdrawal from the WHO unless all assessed dues are paid in full. The United States also has a remaining balance from its 2019 assessment. Congressional silence on Trump’s decision to withdraw from the organization would not make the move constitutional. The United States joined the WHO through a joint resolution, so the president should need a similar joint resolution in order to approve withdrawal. Over the past 40 years, Congress has largely acquiesced in a president’s decision to leave bilateral agreements of lesser significance. But Congress may not be so compliant when considering withdrawal from vital multilateral organizations such as the WHO. Try as he might, Trump can’t skirt Capitol Hill—when a bilateral treaty withdrawal went to the Supreme Court in 1979, not a single justice took the position that a president, as a general rule, has the constitutional authority to unilaterally withdraw from treaties.
ESSENTIAL PUBLIC GOODS
Even with its flaws and limitations, the WHO is essential during a global health crisis. Responding to a pandemic requires global solutions. To disengage from the WHO now would erode the United States’ influence as a global health leader. Exiting the WHO, for example, may require leaving other WHO treaties such as the International Health Regulations—the very treaty Trump complained China was violating when it failed to report COVID-19 cases. And although the State Department previously identified the WHO as a key partner in its Global Health Strategy to strengthen disease detection and response, exiting the organization would deny the United States access to the WHO’s global system for sharing outbreak data and vaccines. Even more concerning, cutting off funding to the WHO will devastate the organization’s capacity to fight COVID-19 and other major health threats. The United States supplies about 15 percent of the WHO’s biennial budget, with U.S. contributions equaling $893 million in 2018-19. The United States also provides the largest portion of funding for the WHO’s emergencies program, which means withdrawal will cut critical funding for the COVID-19 response. Loss of funding for testing and contact tracing, as well as vaccine development, would expand the scale and duration of the pandemic, costing many more lives. It would also harm U.S. security because COVID-19 outbreaks in other parts of the world would eventually arrive in the United States during a second or third wave of cases. And without U.S. funding, the WHO will have less surveillance capacity to ensure that the next outbreak is quickly detected and contained, increasing the likelihood of another pandemic. U.S. withdrawal would also deal a blow to many of the WHO’s crucial global health initiatives, such as polio eradication, child nutrition, vaccine distribution, and projects to combat HIV/AIDS, malaria, and tuberculosis, efforts already disrupted by COVID-19. The pandemic risks doubling the number of malaria and HIV/AIDS deaths in sub-Saharan Africa, and it has already delayed measles immunization campaigns in 25 countries. And although efforts to eradicate polio over the last two decades have reduced global cases by 99.9 percent, a withdrawal of U.S. funding would derail these efforts, potentially allowing annual global cases of polio to jump from a few hundred to 200,000 within a single decade. The United States may attempt to maintain its role as a global health leader by rerouting WHO funding directly to countries or through global public-private partnerships, such as the Global Fund or Gavi Alliance. Yet this strategy would have a far more limited impact on global health outcomes. It would not be possible to stop an infectious disease outbreak, which can originate anywhere in the world, without the global coordination that is core to the WHO’s mandate. Even U.S.-led initiatives such as the President’s Emergency Plan for AIDS Relief, which has made the United States the world’s unquestioned leader in responding to HIV/AIDS since 2003, have relied on the WHO for its expertise in delivering health messages, ensuring quality medications, and setting standards for expanding the health workforce. There is only one World Health Organization, and every other nation will remain a member. A single country, acting alone, simply cannot tackle global health on its own, today or in the future.
This article was originally published on ForeignAffairs.com
