At the end of May, US President Donald Trump announced the suspension of the US contribution to the World Health Organization (WHO), which he accused of complacency with China. In the midst of this crisis, how should WHO's action during the pandemic be viewed? Antoine Flahault MD, PhD, Director of the Institute of Global Health in Geneva, answered questions from Angèle Malâtre-Lansac, Institut Montaigne’s Associate Director in charge of Healthcare Policy.
WHO was the subject of much criticism during the pandemic. Is the discontent expressed by some States with regard to the role played by WHO justified, and how can this be explained?
I would like to begin by clarifying exactly what WHO is and what it is not. The World Health Organization is an intergovernmental UN agency, and not a supranational one. It also has fairly limited resources: its budget is equivalent to that of a large regional university hospital. In spite of these rather low means, WHO gathers world-renowned experts, and its publications and technical recommendations are very rarely called into question. However, its role is primarily normative: WHO has neither sanctioning nor inspection powers, unlike other agencies such as the International Labour Organization (ILO) or the World Trade Organization (WTO).
WHO's action during the pandemic took place within the framework of the International Health Regulations (IHR 2005), which aim to prevent serious risks to public health and to manage epidemic crises. Based on these regulations, Dr. Tedros Adhanom Ghebreyesus, Director-General of WHO, convened an IHR Emergency Committee on January 30. Taking the committee’s opinion into consideration, Dr. Tedros declared that the coronavirus epidemic constituted a Public Health Emergency of International Concern (PHEIC). In the days that followed, WHO issued non-binding temporary recommendations. Among other things, these recommendations advised against "unnecessarily interfering with travel and trade". By quickly enforcing restrictions on both travel and trade, most member countries openly violated these recommendations.
WHO’s critics are mainly the richest member countries, i.e. those that need WHO the least, as they have their own robust public health infrastructures and public health agencies. WHO is rightly criticized for not having played its role as a coordinator and leader in the face of the pandemic. However, this situation is also the result of a framework wherein member states do not give WHO any binding capacity. Its powers are almost non-existent due to its limited resources, as well as its operating and governance mode. WHO is very democratic, with 194 member countries, each having an equal voice, even though contributions are at the sole discretion of the states.