THERE ARE SEVERAL interpretations of the Trump administration’s latest attacks on the World Health Organisation (WHO): they are a diversionary tactic to deflect scrutiny of the United States’ response to the Covid-19 pandemic; they represent an expansion of this particular front in ‘the new Cold War’ between Washington and Beijing; or they are a central plank of the president’s re-election campaign for November. Whatever view you hold, there is no escaping that they were predictable.
The WHO and the Donald have previous.
In 2016, the WHO urged then-President-elect Donald Trump to expand ‘Obamacare’, the signature health insurance legislation of his predecessor President Barrack Obama, whose enabling legislation, the Affordable Care Act, Trump had promised on the campaign trail to repeal immediately he took office. This did not bode well for the relationship doing the Trump presidency.
His administration from its outset embarked on a decrease of US support for global healthcare assistance in line with the ‘America First’ agenda on which the president was elected and campaign promises to end what the president described as other countries taking advantage of the United States and ‘failing to pay their fair share’. Its first budget, the administration proposed a $4.6 billion cut in humanitarian assistance and global health spending. Some $2.2 billion was accounted for by the latter.
This signalled the United States intent to remove itself from a two-decade-long role as the leading funder for preparing for and responding to global infectious disease outbreaks and basic health care delivery to low-income countries. The cuts included reducing funding for national disease surveillance systems, training and infrastructure.
At the time, there were plenty of warnings that these would put at risk rapid and coordinated responses to infectious disease outbreaks that recognise no borders. Nonetheless, barely a year after taking office, the president made the National Security Council’s global health and biodefence team redundant. This had been established by the Obama administration, with pandemic preparedness part of its remit. In a streamlining of the NSC, in which the directorates for arms control and nonproliferation, weapons of mass destruction and terrorism, and global health and biodefense were combined, the administration cut the pandemic preparedness team. Its role was subsumed within the NSC and given a more national security cast.
Nor has the Trump administration been enamoured with the WHO’s director-general, Tedros Adhanom Ghebreyesus, who has been an enthusiastic endorser of the healthcare component of President Xi Jinping’s Belt and Road Initiative. In a 2017 speech, Dr Tedros described the Health Silk Road as ‘visionary‘. The WHO had just signed a memorandum of understanding on a strategic health partnership with China along the Belt and Road and in Africa, The MOU included additional Chinese funding of the WHO.
China’s contributions to the WHO have been steadily climbing, though they still fall far short of the $400 billion-500 billion a year the United States pays in assessed dues and voluntary donations — or had been; even before Trump suspended payments it was almost 70% in arrears for 2019 and hadn’t handed over a dime of this year. While the US is on the hook for around 27% of the WHO’s member-nation dues, its share of the WHO’s total budget falls below 20% once voluntary contributions are factored in.
China has again offered to up its contributions to the WHO by $2 billion over the next two years to fight the pandemic, including making China the hub of global supply chains for anti-epidemic equipment and products, and to share any vaccine that it develops. The offers are efforts to defuse international criticism of its early response to the outbreak, but put the WHO in a tight spot.
Dr Tedros could call the United States’s bluff, and risk Washington walking away from membership as Trump has threatened. However, this Bystander does not reckon Trump would carry through the threat because of the win it would give Xi in expanding China’s global influence. Beijing would then be in pole position as the WHO’s lead funder and patron. However, it would also give substance to Trump’s allegations that the WHO is in Beijing ‘pocket’. That will concern a significant number of the WHO’s other members, including some who would not see themselves as in the first rank of allies of the United States.
It would also cut the WHO off from the United States’ technical expertise in public health and medical research — not to mention future funding under a different US administration. Setting up a review of its handling of the pandemic (update: now agreed in principle), some cosmetic distancing from Beijing and possibly the premature departure of Dr Tedros before his term of office is due to expire in July 2022, seem more likely.
The WHO may also look at the state of the World Trade Organisation and be reminded that when elephants dance, it is the grass that gets trampled.